Presentation
Patient from an underserved area came to hospital complaining of knee joint pain, in a wheelchair and only able to walk with assistance.
Patient Data

Bilateral upward and lateral migration of both femoral heads with pseudoarthrosis with iliac bones. Both femoral heads are flattened and extensively deformed from longstanding untreated developmental hip dysplasia since childhood.
Bilateral moderate sclerosis of sacroiliac joints is noted.
Case Discussion
Bilateral developmental hip dysplasia (DDH) represents 20% of DDH cases 1. Early diagnosis of the disease in developing countries is uncommon, especially in underserved areas. Neglected DDH will result in osteonecrosis of femoral and acetabular bones by repeated pressure stress unless treated in early childhood.