Case Report: Total hip arthroplasty via the direct anterior approach using a cementless revision stem without corrective osteotomy for fibrous dysplasia.

BACKGROUND

Fibrous dysplasia (FD) of the proximal femur frequently leads to secondary hip osteoarthritis and shepherd's crook deformity. Total hip arthroplasty (THA) in this setting typically requires corrective osteotomy and bone grafting. A simplified, osteotomy-free strategy has not been well characterised.

CASE PRESENTATION: A 50-year-old woman with monostotic FD and moderate shepherd's crook deformity (neck-shaft angle 110°) underwent primary THA via the direct anterior approach using a fully hydroxyapatite-coated cementless revision stem, without corrective osteotomy or bone grafting. Intraoperative blood loss was 200 mL. Full weight-bearing was achieved on postoperative day one. At six months, the Harris Hip Score improved from 64 preoperatively to 90, and radiographs confirmed stable implant fixation.

CONCLUSIONS

In selected patients with monostotic FD, neck-shaft angle ≥110°, and adequate distal bone stock, this simplified approach permits immediate weight-bearing and excellent early function. These are strictly preliminary results from a single case, and the long-term safety and durability of this strategy remain unproven.