Abnormalities of Vascular Structure and Function in Children With Perthes Disease

Abstract

Perthes disease is a childhood precipitant to osteoarthritis of the hip, for which the etiology and mechanism are unknown. There is mounting evidence to suggest a vascular insult is responsible for disease, and it is suggested that this may have long-term implications for the vascular health of affected individuals. This study sought to use ultrasound measures to investigate vascular structure and function in children affected by Perthes disease. This case control study encompassed 149 cases and 146 controls, frequency matched for age and gender. Endothelial function was measured by using the technique of flow-mediated dilation of the brachial artery, and alterations in arterial flow were recorded in response to an ischemic stimulus. There was a significant structural alteration in the vasculature among individuals with Perthes disease (resting brachial artery diameter (cases 2.97 mm versus controls 3.11 mm; P = .01), which remained even after adjusting for height. In addition, there was a notable reduction in blood velocity (cases 33.84 cm/s versus controls 37.83 cm/s; P = .01) and blood flow (cases 149.82 mL/min versus controls 184.67 mL/min; P = .001), which was independent of baseline arterial size. There was no evidence to suggest that flow-mediated dilation of the brachial artery was impaired among affected individuals (P = .71). Children with Perthes disease exhibit small artery caliber and reduced function, which is independent of body composition. These data imply that that Perthes disease may reflect a wider vascular phenomenon that could have long-term implications for the vascular health of affected individuals.