Impeded Venous Drainage from the Bone Marrow of the Femoral Head: A Synthesis

Abstract

This paper is a synthesis of the results of research on intraosseous circulation in the proximal end of the femur in children (Perthes' disease) and adults (degenerative osteoarthri tis, the intraosseous engorgement- pain syndrome, nontraumatic femor al head necrosis). These disorders are all characterized by more or less ex tensive degenerative bone lesions and pain. Bone cell death is generally caused by anoxemia, and the com monly held assumption is that most of these disorders are due to failure of arterial supply to the bone marrow ("avascular necrosis"). Impaired capillary flow may also be due, how ever, to high resistance on the venous side of the capillary bed. This mech anism is best known from the patho logic mechanism of the venous lower extremity ulcer. The findings re ported in this synthesis point to the disturbance of venous drainage from the bone marrow of the femoral head as an important factor in the patho logic mechanism probably responsi ble for both the characteristic pain and degenerative skeletal changes.