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.
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References
1.
Arnoldi CC: Physiologie und Pathophysiologie des venösen Rückstromes aus der unteren Extremität . In: Varizen, Ulcus cruris und Thrombose. 4th ed., ed. by Sigg K.Berlin: Springer-Verlag, 1976, pp 6-17.
2.
Arnoldi CC, Linderholm H.: On the pathogenesis of the venous leg ulcer. Acta Chir Scand134:427-440, 1968.
3.
Arnoldi CC, Linderholm H.: Intraosseous pressure of the calcaneus and venous pressure in the calf of healthy human subjects in the erect position. Acta Chir Scand132:646-662, 1966.
4.
Arnoldi CC, Linderholm H.: Intracalcanean pressure in patients with different forms of dysfunction of the venous pump of the calf. Acta Chir Scand137:21-27, 1971.
5.
Arnoldi CC, Linderholm H., Vinnerberg A.: Skeletal and soft tissue changes in the lower leg in patients with intracalcanean hypertension. Acta Chir Scand138:25-37, 1972.
6.
Lemperg RK, Arnoldi CC: The significance of intraosseous pressure in normal and diseased states with special reference to the intraosseous engorgement-pain syndrome. Clin Orthop136:142-156, 1978.
7.
Ficat RP: Idiopathic bone necrosis of the femoral head. J Bone Joint Surg67B:3-9, 1985.
8.
Liu S-L.: Studies on the mechanism of femoral head necrosis in Legg-Perthes' disease. Thesis. Sun Yat-Sen University of Medical Sciences . Guangzhou. People's Republic of China, 1986.
9.
Suramo I., Puranen J., Heikkinen ES, et al: Disturbed pattern of venous drainage of the femoral neck in Perthes' disease. J Bone Joint Surg56-B:448-453, 1974.
10.
Iwasaki K., Suzuki R., Okazaki T., et al: The haemodynamics of Perthes' disease. InternatOrthopaedics6:141-148, 1982.
11.
Arnoldi CC, Linderholm H., Müssbichler H.: Venous engorgement and intraosseous hypertension in osteoarthritis of the hip. J Bone Joint Surg54B:409-421, 1972.
12.
Ficat RP, Arlet J.: Ischemia and necrosis of bone. Edited and adapted by Hungerford DS . Baltimore: Williams & Wilkins , 1980.
13.
Arnoldi CC, Reimann I.: The pathomechanism of human coxarthrosis. Acta Orthop Scand181 (Suppl), 1979.
14.
Green NE, Griffin PP: Intra-osseous venous pressure in Legg-Perthes' disease. J Bone Joint Surg64-A:666-671, 1982.
15.
Christensen S.: Osteoarthrosis. Changes of bone, cartilage and synovial membrane in relation to bone scintigraphy. Thesis. Acta Orthop Scand (Suppl 214), Copenhagen: Munksgaard, 1985.
16.
Greiff J., Lang S., Højlund-Carlson PF, et al: Early detection by 99mTc-Sn-Pyrophosphate scintigraphy of femoral head necrosis following medial femoral neck fractures. Acta Orthop Scand51:119-125, 1980.
17.
Arnoldi CC, Linderholm H.: Fracture of the femoral neck. I. Vascular disturbances in different types of fractures assessed by measurements of intraosseous pressures. Clin Orthop84:116-122, 1972.
18.
Kofoed H., Svalastoga E., Grønlund J., et al: Continuous measurement of subchondral pO2 and pCO 2 by mass spectrometry. IRCS Med Sci11:583-584, 1983.
19.
Edwall G.: Stable and reproducible antimony-antimony-oxyde electrodes. Thesis. Stockholm, Sweden, 1976.
20.
Kofoed H., Lindenberg S.: Continuous in vivo measurement of pH in subchondral bone. IRCS Med Sci12:1050-1051, 1984 .
21.
Kiaer T., Petersen NN, Kristensen KD, et al: Intraosseous pessure and pO2 in relation to histological findings in non-traumatic necrosis of the femoral head treated with core decompression . (in press, 1988).
22.
Arnoldi CC, Reimann I., Christensen SB, et al: The effect of increased intraarticular pressure on juxtaarticular bone marrow pressure. IRCS Med Sci7:471, 1979.
23.
Arnoldi CC, Reimann I., Mortensen S., et al: The effect of joint position on juxtaarticular bone marrow pressure . Acta Orthop Scand51:893-897, 1980.
24.
Heigaard N., Arnoldi CC: Osteotomy of the patella in the patello-femoral pain syndrome. Internat Orthop8:189-194, 1984.
25.
Harrison Mhm , Schajowics F., Trueta J., et al: Osteoarthritis of the hip: A study of the nature and evolution of the disease. J Bone Joint Surg35B:598-626, 1953.
26.
Rösingh GE, James J.: Early phases of avascular necrosis of the femoral head in rabbits . J Bone Joint Surg51B:165-174, 1969.
27.
Henard DC, Calandruccio RA: Experimental production of roentgenographic and histological changes in the capital femoral epiphysis following abduction, extension and internal rotation of the hip. Surg Forum22:442-444, 1971.
28.
Arnoldi CC, Lemperg RK, Linderholm H., et al: Immediate effect of osteotomy on the intramedullary pressure of the femoral head and neck in patients with degenerative osteoarthritis . Acta Orthop Scand42:357-365, 1971.
29.
Liu S-L.: Personal communication, 1987.
30.
Heikkinen ES , Puranen J., Suramo I.: The effect of intertrochanteric osteotomy on the venous drainage of the femoral neck in Perthes' disease. Acta Orthop Scand47:89-95, 1976.
31.
Phillips RS , Bulmer JH, Davies W.: Venous drainage in osteoarthritis of the hip. J Bone Joint Surg49B-301-309, 1967.
