Perthes' disease of a severe type developing after satisfactory closed reduction of congenital dislocation of the hip. A report of three cases.

Some 2500 children with congenital dislocation of the hip were treated at the Orthopaedic Hospital of the Invalid Foundation over the period 1954 to 1974 and have been regularly followed up to the end of growth. One of us (Laurent 1953) had already observed that the vulnerability of the femoral head had often led to changes resembling Perthes’ disease. In 1957 preliminary traction and adductor tenotomy was adopted as an essential part of the treatment, and from that time the incidence and severity of necrosis of the femoral head decreased markedly. Recently, neonatal diagnosis and treatment led to a remarkable change, the number of cases of established dislocation falling to between two and four a year compared with the previous average of 120. In cases developing Perthes’ disease, varus osteotomy was performed whenever a tendency to subluxation was observed-a practice similar to that of other workers (Lloyd-Roberts, Catterall and Salamon 1976). Epiphysiodesis of the greater trochanter to prevent severe coxa vara was also performed in a few cases (Laurent 1959). Over the twenty years, a severe form of late-onset Perthes’ disease developed in three children who had been successfully treated for congenital dislocation of the same hip. As this occurrence had not to our knowledge been previously described, we found it appropriate to present these cases.