Disturbed patterns of venous drainage of the femoral neck in Perthes' disease.

The pathology of Perthes’ disease is an avascular necrosis of the proximal femoral epiphysis (Jons#{228}ter 1953, Trueta 1957). The cause is still unknown. Several investigators regard the disease as a disturbance of the arterial circulation which results either from changes in the arterial walls or from stagnation caused by thrombi (Hipp 1962, Nishio 1972). More interest has recently been focused on venous congestion. Raised intra-articular pressure due to synovitis can lead to disturbances in the venous flow (Tachdjian and Grana 1968, Jacobs 1971). The venous stasis in turn may be responsible for partial or total occlusion of the arterial system (Soto-Hall, Johnson and Johnson 1964; Farine and Engel 1972). Arteriography has been used in investigating the etiology of Perthes’ disease. Hipp (1962) found partial obstruction of the nutrient arteries of the epiphysis. Shiba (1965) concluded from arteriographic and venographic examinations that the reason for the circulatory disturbances lies in changes in the synovial membrane. In the present investigation the venous circulation of the femoral neck was studied by intra-osseous venography in order to discover any abnormality that might contribute to the solution of the pathogenesis of the disease.