Purpose of study: To test the hypothesis that previous hip involvement leads to earlier presentation and a better outcome for the contra-lateral hip in bilateral Legg-Calve-Perthes’ disease (LCPD).

Method: Case notes and radiographs of 250 patients with LCPD treated by a single surgeon between 1984 and 2003 were retrospectively reviewed. Thirty three patients (4 girls: 29 boys) with a minimum 1 year follow-up were identified with bilateral involvement from a prospectively collected database. Patients were grouped according to age at presentation (Group A-< 6 years; Group B- 6–8 years; Group C-> 8 years). All radiographs were reviewed and consensus was obtained on the presenting Waldenstrom stages. The severity of disease was rated by Catterall and lateral pillar classifications. The outcome was determined by the Stulberg classification. The right hip was the first affected in 25 of the 33 hips.

Results: These are summarized below.

Conclusions: The present report, with 33 patients, is the second largest series of patients with bilateral LCPD to our knowledge. The second hip involvement was milder than the first, but the improvement in outcome was statistically insignificant.

We have documented the long term radiological outcome of developmental dysplasia of the hips (DDH) complicated by avascular necrosis (AVN). We have also assessed whether a policy of prolonged post-reduction containment has improved the results. Radiographs of patients with a minimum of 10 years followup wer assessed, and AVN diagnosed accordingly to Crerand and O’Brien’s criteria. Outcome grading was assessed by Severin’s criteria, and head sphericity using Mose’s rings.

We identified 35 hips (35 patients) who had developed AVN. Twenty hips had a medial pattern of deformity, and 15 had a valgus pattern. Fifteen hips were Severin grade III, 13 were grade IV, and 3 were grade V. Twenty four patients had more than 6 mm discrepancy in the head of sphericity. Six patients were reviewed clinically: 4 of 5 patients who were < 24 years old have hip symptoms, and the other patient (age 41) has osteoarthritis.

These results confirm that AVN is a serious complication with a poor longterm outcome, and that our prolonged containment treatment does not produce better results than those published on patients with shorter containment periods.