2026年6月 保髋进展 JCR Q3+Q4

INTRODUCTION: Subchondral insufficiency fracture (SIF) of the femoral head typically occurs in older adults with compromised bone quality and often progresses to rapidly destructive coxarthropathy. However, the etiology of SIF remains poorly understood. We examined associations among spinopelvic alignment, pelvic tilt, and microdamage accumulation in the femoral head in patients with SIF compared with osteoarthritis (OA) secondary to hip dysplasia and cadaveric controls.

MATERIALS AND METHODS: We analyzed eight SIF patients, ten OA patients, and nine cadaveric controls. All patients underwent total hip arthroplasty. Radiological evaluation included lumbar lordosis angle (LLA), sacral slope (SS), and pelvic tilt angles (PA) in standing and supine positions. Histomorphological assessment focused on a 5 × 5-mm cancellous bone area beneath the joint surface.

RESULTS: The SIF group exhibited significantly lower LLA and SS, as well as a greater difference between standing and supine PA compared with the OA group, indicating increased posterior pelvic tilt. Histomorphologic analysis revealed reduced trabecular bone volume and greater crack length in SIF compared with OA. Crack surface density was significantly higher in both SIF and OA groups than in controls.

CONCLUSION: SIF patients demonstrated greater posterior pelvic tilt and lower LLA compared with OA. Histologically, SIF showed lower trabecular bone volume and longer microcracks. These data suggest the nature of the microdamage, not just the amount of the microdamage, is important to skeletal fragility. Our findings underscore the importance of assessing both spinopelvic alignment and bone quality when evaluating patients at risk for SIF.

INTRODUCTION: Purpose Patients with cam-type femoroacetabular impingement (FAI) frequently present with concomitant borderline developmental dysplasia of the hip (BDDH), a critical instability risk factor. Capsular plication may contribute to improved stability through the screw-home mechanism. This study evaluates the clinical outcomes of arthroscopic T-capsulotomy combined with V-shaped capsular plication for managing cam-type FAI in BDDH-associated instability and confirms its short-term efficacy.

METHODS: This retrospective cohort study included 15 patients diagnosed with symptomatic cam-type FAI and concomitant BDDH (LCEA: 20°-25°) between July 2019 and July 2023. All patients underwent arthroscopic labral repair, femoroacetabular osteoplasty, and T-capsulotomy with V-shaped capsular plication. Clinical outcomes were assessed using the Visual Analog Scale (VAS) for pain, Modified Harris Hip Score (mHHS), Hip Outcome Score-Activities of Daily Living (HOS-ADL), and Hip Outcome Score Sport-Specific Subscale (HOS-SSS) preoperatively and postoperatively. Statistical analysis employed paired t-tests for intra-group comparisons.

RESULTS: All 15 patients completed follow-up with a minimum duration of 12 months (mean 18.2 months, range 12-24). No major complications occurred. Significant improvements were observed in all outcome measures at final follow-up: mHHS improved from 57.33 ± 5.34 to 86.07 ± 2.67 (P < 0.01); VAS decreased from 5.73 ± 0.57 to 1.07 ± 0.57 (P < 0.001); HOS-ADL improved from 50.09 ± 5.02 to 89.31 ± 2.43; HOS-SSS improved from 41.66 ± 5.08 to 85.92 ± 4.70 (both P < 0.01).

CONCLUSIONS: The described arthroscopic technique, adapting principles from pediatric DDH surgery, appears to be a promising approach for addressing cam-type FAI in BDDH patients with instability risk factors, demonstrating short-term clinical outcomes. But, further studies with larger cohorts and longer follow-up are warranted.

BACKGROUND/OBJECTIVE: Systemic lupus erythematosus (SLE) is a known risk factor for femoral head osteonecrosis (FHON), but its impact on FHON risk following hip trauma has not been well characterized. We evaluated whether adults with SLE have an increased risk of FHON after hip trauma compared with patients without SLE.

METHODS: We conducted a retrospective cohort study using de-identified electronic health record data from the TriNetX Research Network. Adults aged 18 to 65 years with an incident hip trauma diagnosis and no prior FHON were included. SLE was defined by the presence of an ICD-10 diagnosis code for SLE documented in the electronic health record. Patients with and without SLE were matched 1:1 using propensity scores incorporating demographics, baseline comorbidities, and systemic glucocorticoid exposure. The primary outcome was incident FHON within 5 years following hip trauma, with a secondary analysis evaluating FHON risk in matched cohorts without hip trauma. Kaplan-Meier and Cox proportional hazards analyses were performed.

RESULTS: Among adults with incident hip trauma, patients with SLE had a higher 5-year incidence of FHON than patients without SLE. In propensity score-matched time-to-event analyses, SLE was associated with an increased hazard of osteonecrosis (hazard ratio: 2.9; 95% CI: 2.0-4.3; log-rank p < 0.001). These findings were consistent with a similarly elevated baseline risk of FHON observed in patients with SLE in analyses without hip trauma.

CONCLUSIONS: SLE is associated with an increased FHON risk both with and without hip trauma. The modest absolute post-trauma risk difference supports symptom-guided vigilance rather than routine imaging after trauma.

PRACTICAL POINT: Persistent, progressive, or atypical hip symptoms after trauma in patients with SLE warrant clinical vigilance for osteonecrosis, but these findings do not support routine imaging of all patients with SLE after trauma.

PURPOSE: To assess correlation of pre-operative symptoms, labral damage and chondrolabral junction pathology on MRI with intra-operative findings in patients undergoing hip arthroscopy for femoroacetabular impingement (FAI).

METHODS: Consecutive patients with FAI treated surgically were included. Data were collected on patient demographics and preoperative clinical outcome measures. Three radiologists performed retrospective independent reviews of pre-operative MRIs in 96 hips. The presence of cartilage fraying, chondrolabral separation, labral tear pattern (intrasubstance, linear, complex), chondral flap, cartilage delamination, and ligamentum teres (LT) pathology (degeneration/partial or complete tear) were recorded on preoperative MRI and intraoperatively during arthroscopy. Inter-reader and inter-method agreement were measured using weighted-Cohen's or Fleiss'-kappa, or Kendall's coefficient. Associations between MRI and arthroscopic findings and preoperative modified-Harris-Hip-Score (mHHS) and Non-Arthritic-Hip-Score (NAHS) were assessed using Mann-Whitney-U or Kruskal-Wallis test.

RESULTS: All readers detected lower rates of chondrolabral separation, cartilage delamination, and chondral flap, and higher rates of LT tear on MRI compared to arthroscopy. Linear tears were the most common tear pattern detected by readers on MRI (29%-50%) and arthroscopy (71%). The inter-reader agreement was moderate for LT findings and fair for remaining MRI variables. Between MRI and arthroscopy, there was moderate agreement for labral fraying for one reader (k = 0.303, 95% CI[0.106-0.501], p = 0.004) and fair agreement for labral tear pattern for one reader (k = 0.187, 95% CI[0.037-0.337], p = 0.006). There was poor-to-no agreement between MRI and arthroscopy for the remaining MRI variables for all readers (p = 0.05). Preoperative mHHS and NAHS scores demonstrated no significant association with preoperative MR or intraoperative findings (p > 0.05).

CONCLUSION: MRI labral and chondrolabral findings in patients with FAI underestimated the intraoperative pathology identified during hip arthroscopy and were not associated with preoperative patient reported outcome measures.

LEVEL OF EVIDENCE: III (retrospective case series).

PURPOSE: The relationship between early postoperative pain and long-term outcomes after hip arthroscopy is unclear. This study examined whether 2-week postoperative pain scores are associated with 2-year patient-reported outcomes (PROs) after hip arthroscopy and compared outcomes between patients with and without early postoperative pain improvement.

METHODS: Patients undergoing hip arthroscopy for labral tear and/or femoroacetabular impingement syndrome were retrospectively identified from a prospectively enrolled registry. Patients completed baseline, 2-week, and 2-year surveys. Patient-reported outcomes measurement information system (PROMIS) pain interference (PI) assessed pain. Early improvement was defined as a change in PROMIS PI score relative to the minimal clinically important difference threshold of ± 3.1 points from baseline at 2 weeks postoperatively. Patient characteristics and PROs were compared between groups by early improvement status.

RESULTS: Of 136 patients, 95 (71%) completed 2-week follow-up, and 70 of 95 (74%) completed 2-year. Improved early PROMIS PI was associated with worse baseline PROMIS Physical Function (p < .001) and PROMIS PI (p < .001), and better 2-week PROs across nearly all outcomes. Worse 2-week PROMIS PI scores correlated with worse 2-year PROMIS PI (p = .02), Fatigue (p = .02), and Anxiety (p = .002). On multivariable analysis, improved 2-week PROMIS PI was independently associated with better 2-year PROMIS PI, Marx Activity Rating Scale, and greater improvement in PROMIS PI.

CONCLUSION: Early improvement in PROMIS PI after hip arthroscopy was independently associated with better 2-year pain and activity outcomes. Patients with improved early postoperative pain had worse baseline pain and function but better early postoperative PROs. 2-week PROMIS PI may serve as a useful prognostic indicator for 2-year PROs after hip arthroscopy.

BACKGROUND: Proximal femur growth requires a dynamic balance between the femoral head, neck, and greater trochanter. Severe Legg-Calvé-Perthes disease (LCPD) disrupts this balance, limiting femoral head and neck growth as the greater trochanter grows normally. This relative overgrowth of the greater trochanter (ROGT) can further impair already compromised hip function. Greater trochanter apophyseodesis (GTA) is a surgical procedure aimed at preventing ROGT and has varying effectiveness depending on disease severity. The purpose of this study was to evaluate the association between disease severity, as determined by the lateral pillar (LP) classification, and ROGT in patients undergoing GTA and to compare outcomes with controls.

METHODS: We retrospectively reviewed 139 patients with unilateral LCPD treated at a single institution between January 1998 and June 2025. Seventy-three patients underwent GTA while 66 served as controls. All patients were followed to skeletal maturity. Patients were stratified by LP classification (B, B/C, C) and age. Radiographic measurements included articulotrochanteric distance (ATD), center-trochanteric distance (CTD), trochanter-to-trochanter distance (TTD), femoral neck length, femoral neck width, and neck-shaft angle to measure proximal femoral morphology. ROGT was defined as an ATD or CTD below the 5th percentile of measurements in unaffected hips. Absolute trochanteric growth inhibition (ATGI) was calculated using TTD measurements to determine the inhibition obtained in each GTA.

RESULTS: The GTA had the same effect independent of LP class when measured by ATGI. GTA reduced ROGT frequency in LP B and LP C patients compared with controls. However, LP C patients maintained high rates of ROGT after undergoing GTA. LP C patients exhibited significantly shorter, wider femoral necks and smaller neck-shaft angles compared with LP B patients.

CONCLUSIONS: GTA effectively reduces ROGT across LP classifications, independent of age at surgery. However, high rates of ROGT persist in LP C patients despite experiencing similar levels of inhibition through GTA compared with LP B and B/C patients, with proximal femoral measurements suggesting that LP C patients may need additional interventions to overcome growth disturbances observed in severe cases of LCPD.

LEVELS OF EVIDENCE: Level III-retrospective comparative study.

BACKGROUND: In situ pinning (ISP) is the standard treatment for slipped capital femoral epiphysis (SCFE). While spontaneous remodeling of the femoral head following ISP is recognized, the factors influencing this remodeling, specifically the impact of sagittal screw placement, remain unclear. This study aimed to investigate whether screw placement is associated with changes in the Southwick angle 1 year postoperatively and to determine the optimal insertion position to facilitate remodeling.

METHODS: We retrospectively reviewed 59 hips in 47 patients treated with ISP using a single screw between 1983 and 2024 who had a minimum follow-up of 1 year. A metric defined as screw position (%) and the Southwick angle were measured on Lauenstein lateral radiographs immediately postoperatively and at 1 year. The relationship between Southwick angle improvement and variables including screw position (%), age, BMI percentile, type, onset, fixation method, and Southwick angle just after the surgery was analyzed using the Spearman rank correlation and multivariable linear regression analysis.

RESULTS: The mean Southwick angle improved significantly from 31.8 degrees immediately postoperatively to 25.1 degrees at 1 year (P<0.05). Spearman rank correlation showed a significant negative correlation (ρ=-0.43, P<0.01) between screw position (%) and angle improvement, indicating that anterior screw placement was associated with greater correction. Multivariable linear regression analysis identified the magnitude of the immediate postoperative Southwick angle and screw position (%) as significant independent predictors of remodeling (P<0.05). However, the effect of screw position on this improvement was also relatively small (regression coefficient=-0.31).

CONCLUSIONS: An anterior screw placement was identified as a significant predictor of Southwick angle improvement. However, given the limited clinical significance of the angular improvement, we fundamentally recommend central screw placement to ensure safety while avoiding posterior screw placement.

LEVELS OF EVIDENCE: Level III-retrospective case series.

Magnesium has been shown to reduce postoperative pain scores and opioid use in select orthopedic patient populations with a satisfactory safety profile. The objective of the MAGNA-PAO clinical trial is to observe and quantify the efficacy of magnesium as an adjuvant for postoperative analgesia following periacetabular osteotomy (PAO). Sixty-four patients will be randomly allocated to two groups: peri-operative pain protocol with or without adjuvant intra operative intravenous magnesium. The primary outcomes include visual analog score (VAS) pain scores over the first seven postoperative days and the amount of opioid medications used, expressed as morphine milligram equivalents (MME) and number of tablets, postoperatively. Secondary outcome measures include Patient Reported Outcomes Measurement Information System (PROMIS) and modified Harris Hip Score (mHHS) scores. This article will discuss the rationale, objective, and in-depth methodology of the MAGNA-PAO clinical trial. The results of the clinical trial could minimize postoperative pain and reduce the usage of post-operative narcotic medications.Clinical Trial Registration: The ClincialTrials.gov identifier is NCT05947760.

Capsular management in hip arthroscopy is an area of ongoing research, where ease of access to the hip joint is balanced with the preservation of capsular integrity and stability. Traditional techniques such as interportal and T capsulotomies allow broad exposure but may increase the risk of postoperative instability or microinstability if not repaired. Periportal capsulotomy aims to limit disruption of the iliofemoral ligament while still allowing sufficient access for safe and efficient treatment of hip pathology and typically does not necessitate closure. However, in patients who are at higher risk for postoperative instability such as those with borderline dysplasia or joint hypermobility, closure of the periportal capsulotomy may be warranted. We describe a technique for intracapsular closure of both the anterolateral and modified midanterior periportal capsulotomies in which closure of the anterolateral portal capsulotomy is facilitated by passage of the capsule closure suture at the beginning of the case while the hip is in traction. This approach minimizes the risk of postoperative instability without significant additional operative time.

BACKGROUND: Computed tomography scans (CTs) are routinely obtained before hip preservation surgery or to evaluate pelvic and/or hip fractures. Analyzing bone mineral density (BMD) using CT Hounsfield units (HU) before surgical intervention may improve surgical management and outcomes. This systematic review summarizes the current literature on reliability and placement of regions of interest (ROIs) within the hip, pelvis, and sacrum, and their correlation with local and systemic BMD.

METHODS: A systematic review in PubMed, Scopus, and Web of Science was performed. Twenty-four studies reported intraclass correlation coefficients of HU measurements and/or compared the HU value obtained from CT and t-score of DXA for predicting regional BMD within the hip, pelvis, and sacrum.

RESULTS: Twenty-four studies were included, enrolling 7,035 patients. The HU measurement was most frequently made at the femoral neck (n = 10). Femur and pelvis intrarater and interrater reliability was moderate to excellent. Moderate to strong correlations between femoral head and femoral neck CT HU and DXA, and poor to moderate correlations between the pelvis CT HU and DXA were found.

CONCLUSION: A variety of ROIs have been described around the pelvis and proximal femur all with reasonable reliability for the measurement of CT HU. The strongest correlations between CT HU and DXA were reported between HU of the femoral neck and DXA of the hip/femur suggesting this ROI may be used for opportunistic BMD screening using preoperative hip/pelvis CT scans.

LEVEL OF EVIDENCE: III.

BACKGROUND: The short-term efficacy of hip arthroscopy as a salvage procedure for acetabular dysplasia and concomitant femoroacetabular impingement syndrome (FAIS) in patients who are not candidates for periacetabular osteotomy remains unclear.

PURPOSES: We sought to compare 2-year patient-reported outcome measures (PROMs) after hip arthroscopy for FAIS (control group) versus FAIS with acetabular dysplasia (dysplasia group) in patients over 40 years of age and/or with mild osteoarthritis (OA). We also sought to measure the rate of subsequent total hip arthroplasty (THA) on the same operative hip.

METHODS: We retrospectively reviewed prospectively collected data from patients who underwent hip arthroscopy for FAIS by a single surgeon between January 2021 and December 2024. Fourteen patients in the dysplasia group (mean lateral center-edge angle <23°, range 12-32; anterior center edge angle 20°, range 8-25; age 41.5 ± 11.4 years) and 140 controls (mean age 36.0 ± 12.5 years) were included. We analyzed the European Quality of Life - 5 Dimensions-5 Levels, Mental Health Inventory-5, International Hip Outcome Tool-12 (iHOT-12), Physical Function Short Form of the Hip Disability and Osteoarthritis Outcome Score (HOOS-PS), University of California at Los Angeles (UCLA) Activity Scale, Adult Single Item Measure physical activity, Patient-Acceptable Symptoms State (PASS) single item, and subsequent THA on the same operative hip.

RESULTS: The dysplasia group demonstrated lower PASS rates, iHOT-12 scores, and HOOS-PS scores compared to controls. THA conversion was higher in the dysplasia group than in the control group (50% vs 5%). In multivariate analysis, dysplasia negatively predicted all outcomes. Intraoperatively identified high-grade cartilage defects predicted THA conversion, but none of the PROMs.

CONCLUSION: This retrospective case-control study suggests that hip arthroscopy alone for FAIS with acetabular dysplasia in patients over 40 years and/or with mild OA may increase the odds of clinical failure compared to arthroscopy for FAIS without dysplasia. High-grade cartilage defects identified intraoperatively were independent risk factors for conversion to THA regardless of dysplasia status.

LEVEL OF EVIDENCE: Level III: retrospective case-control study.

BACKGROUND: Radiographic assessment is central to the diagnosis of femoroacetabular impingement (FAI) syndrome. However, the relationship between specific bony morphology and symptom severity remains unclear.

PURPOSE: We sought to evaluate the relationship between FAI morphology, quantified through preoperative radiographic measures, and preoperative symptom burden in patients with FAI syndrome.

METHODS: We conducted a retrospective study of prospectively collected data that included a series of consecutive patients diagnosed with FAI syndrome who underwent hip arthroscopy by a single surgeon between January 2024 and October 2025. Inclusion criteria were (1) diagnosis of FAI syndrome and (2) availability of complete preoperative patient records, including X-ray images and preoperative patient-reported outcome measures. Exclusion criteria were (1) patients <14 or >60 years, (2) diagnosis that included FAI syndrome with concomitant intra-articular pathology, (3) hip surgery other than primary hip arthroscopy, (4) unavailable X-ray imaging, and (5) history of lower extremity osteotomy for abnormal rotational profile. Hip impingement measures were obtained on preoperative radiographs, including α angle, head-neck offset, anterior center-edge angle, and lateral center-edge angle, crossover sign, crossover ratio, and ischial spine sign. Preoperative symptom severity was assessed by the International Hip Outcome Tool-12 (iHOT-12). Multivariate models adjusted for demographics, mental health, physical activity, and corticosteroid injection history.

RESULTS: Among 285 patients (median age 34.9 years, 75.4% female), the median iHOT-12 score was 37.5. Proximal femur measures and acetabular coverage were not correlated with iHOT-12. The presence of crossover or ischial spine signs was associated with higher iHOT-12 on bivariate analysis and remained predictive of higher iHOT-12 after adjustment for demographics and injection status in multivariate modeling. All other radiographic measures were non-significant after further adjustment for mental health and activity level.

CONCLUSION: Radiographic measures of retroversion are associated with better preoperative symptoms in patients with FAI syndrome. Other radiographic measures of hip impingement showed no meaningful association with preoperative symptom severity. For patients with FAI syndrome, psychological and functional factors exerted a larger influence on symptom severity than did impingement severity as reflected on radiograph.

LEVEL OF EVIDENCE: Level IV: retrospective case series.

BACKGROUND: Adequate cam resection during hip arthroscopy for femoroacetabular impingement syndrome (FAIS) is necessary to restore femoral head-neck offset while avoiding under- or over-resection. The relationship between the extent of femoroplasty and postoperative patient-reported outcomes remains unclear.

PURPOSE: We sought to answer the following questions: What is the association between the extent of cam femoroplasty resection and postoperative improvements? and is a 5% resection threshold associated with improved outcomes?

METHODS: We conducted a retrospective review of patients with adequate acetabular coverage who underwent primary hip arthroscopy with femoroplasty between January 2015 and December 2022 at our institution and had preoperative and 1- and/or 2-year postoperative modified Harris hip score (mHHS) and/or International Hip Outcome Tool (iHOT) scores. We included 400 patients (409 hips; ages 14-50 years). Outcomes included score changes and achievement of minimum clinically important difference (MCID) and substantial clinical benefit (SCB). Postoperative Dunn lateral radiographs quantified femoroplasty by resection depth percentage (resection depth/femoral head diameter), proximal resection angle, and postoperative α angle. Hips were classified as under-resection, neutral (0%-5%), or over-resection (>5%), and differences in outcomes were compared between resection groups. Multivariable regression analyses controlled for demographic, radiographic, and surgical variables.

RESULTS: Mean resection depth was 4.8%; mean proximal resection angle was 72.6°. No differences were observed in score improvements or MCID/SCB rates between groups with under-resection versus over-resection at 1 or 2 years. Greater resection depth was associated with larger 1-year mHHS and iHOT improvements and independently predicted 1-year iHOT MCID and SCB. Higher proximal resection angle predicted 2-year iHOT MCID.

CONCLUSION: In this retrospective, single-institution cohort study, we found that in patients with FAIS, greater femoroplasty depth was associated with improved 1-year clinical outcomes.

LEVEL OF EVIDENCE: Level III, retrospective cohort study.

OBJECTIVES: Proximal femoral growth disturbance (PFGD), resulting from conditions such as Legg-Calvé-Perthes disease and developmental dysplasia of the hip, causes femoral head deformity and trochanteric overgrowth. This study evaluates the effectiveness of distal trochanteric transfer (DTT) in anatomical restoration using objective radiological parameters.

METHODS: Patients with unilateral PFGD who presented with pain, abductor muscle weakness, and Trendelenburg gait and subsequently underwent DTT were retrospectively included in this study. All patients had skeletal growth potential, confirmed by the presence of open growth plates. Patients who had standard anteroposterior pelvic radiographs and anteroposterior and lateral hip radiographs were included, as these imaging modalities were required to evaluate the articular trochanteric distance (ATD), central trochanteric distance (CTD), trochanteric offset (TO), and lever arm ratio (LAR).

RESULTS: The study cohort consisted of 13 patients (11 females, 2 males). The mean age at surgery was 10.54±2.11 years, and the mean follow-up period was 7.62±5.25 years. The intraclass correlation coefficient (ICC) was significant for 9 of the 12 total measurements, with three parameters demonstrating statistically non-significant values. Preoperatively, the pathological hips showed a significantly reduced mean ATD of -2.00±8.57 mm compared with the normal hips (17.38±5.58 mm; p=0.001). Postoperative ATD significantly improved to 15.62±6.36 mm (p=0.001). Similarly, the significantly reduced preoperative TO (18.69±6.84 mm) was restored to 24.85±7.03 mm postoperatively (p=0.008). Furthermore, the postoperative LAR (2.83±0.48) was significantly higher than both the preoperative value (2.21±0.46; p=0.012) and the normal hip value (p=0.001). No significant difference was observed for CTD.

CONCLUSION: DTT effectively achieves trochanteric distalization and lateralization, leading to restoration of the abductor muscle mechanism. Our analysis confirms that both ATD and TO are reliable radiographic parameters, as demonstrated by their strong ICC values, for evaluating immediate anatomical results. However, CTD is age-dependent, and both CTD and LAR are inherently influenced by the underlying femoral head anatomy. Future studies are needed to correlate these anatomical improvements with long-term clinical outcomes.

INTRODUCTION: Proximal femoral focal deficiency (PFFD) is a rare congenital skeletal abnormality with an incidence of 1 per 100,000 births. It is typically a unilateral abnormality but can present bilaterally in 15% of PFFD cases. It is characterized by the absence of the proximal femur and shortening of the affected limb henceforth. It is associated with other skeletal anomalies, and its radiographic appearance continues to progress with age. Treatment options vary widely from conservative approaches to surgical correction and stabilization. This report presents a case description and a review of diagnostic and management approaches.

CASE PRESENTATION: A 2-year-old girl presented with abnormal crawling, standing, and walking postures. On physical examination, the patient had unusual short bulky thighs with an apparent limb length discrepancy of 2.5 cm and the hips positioned in flexion, abduction, and external rotation, with bilateral knee flexion contractures. Radiographs showed focal deficiency of the proximal femurs bilaterally and shortening. MRI revealed bilateral severely dysplastic acetabula with dislocation of bilateral femurs and formation of pseudoacetabula. PFFD on the right is consistent with Aitken C (absent femoral head) and on the left with Aitken B (femoral head present but without an osseous connection between the head and shaft).

CONCLUSION: Bilateral PFFD is a rare entity that is associated with a myriad of difficulties. It is crucial to acknowledge the importance of imaging-based diagnosis and individualized management tailored to imaging findings, possibly even within the same patient with bilateral asymmetric PFFD. A multidisciplinary approach is needed to discuss the treatment options available, aiming to restore a functional limb of adequate length and maintain quality of life.