Managing Severe Proximal Femoral Fibrous Dysplasia in a Young Adult Using Hemiarthroplasty in a Resource-Constrained Healthcare System: A Case Report.

Fibrous dysplasia of the proximal femur may lead to progressive deformity, pain, and pathological fractures, with shepherd's crook deformity representing one of its most severe manifestations. Although valgus osteotomy with intramedullary fixation is considered the preferred surgical treatment, extensive bone destruction and limited healthcare resources may preclude conventional reconstruction. We present a case of severe proximal femoral fibrous dysplasia successfully managed with bipolar cemented hemiarthroplasty in a resource-constrained healthcare setting. A 25-year-old man presented with progressive left hip pain, severe proximal femoral deformity, and impaired ambulation. Radiographic evaluation demonstrated lateral bowing of the proximal femur, while histopathological examination following core biopsy confirmed fibrous dysplasia. Internal fixation using an intramedullary nail was initially planned; however, intraoperative findings revealed extensive fibro-osseous replacement, severely compromised bone quality, and inadequate cortical support, making stable fixation technically impossible. Because more complex reconstructive procedures were not covered by the national health insurance system, a bipolar cemented hemiarthroplasty, augmented with plate fixation of the osteotomized fragments, was performed as a salvage procedure. The postoperative course was uneventful, with marked pain relief, improved gait, and satisfactory functional recovery at 10 months of follow-up (Oxford Hip Score 34/48). Conventional fixation for shepherd's crook deformity requires adequate residual cortical bone to achieve stable implant fixation. In cases with extensive cortical destruction and bone stock too thin to support reliable press-fit fixation, cemented hemiarthroplasty may represent a practical alternative. Preservation of the native acetabulum may also reduce postoperative instability while providing satisfactory functional outcomes. Bipolar cemented hemiarthroplasty may be an effective salvage option for selected patients with severe proximal femoral fibrous dysplasia when conventional fixation is technically unfeasible, particularly in resource-constrained healthcare systems.