Histopathologic alterations of retinacular vessels and osteonecrosis

To probe into the pathogenesis of osteonecrosis of the femoral head, the authors obtained 37 asymptomatic human femoral heads at autopsy; of these, 13 were cases of high dosage corticosteroid therapy (steroid group) and 24 were cases without steroid therapy (nonsteroid group). The steroid group included two asymptomatic cases of osteonecrosis incidentally recognized. These femoral heads then were studied histologically and morphometrically using 2-mm stepwise tissue sections of the whole femoral head and serial sections to examine the histopathologic alterations of superior retinacular arteries and veins in detail. There was no significant difference in the luminal stenotic rate of the superior retinacular arteries between the steroid and nonsteroid groups. However, the draining veins morphometrically were more stenotic or obliterated in the steroid group than were those in the nonsteroid group. In fact, the number of stenotic veins was significantly greater in the steroid group. These findings indicate that the stenotic changes of the draining veins may participate in the development and progression of steroid induced osteonecrosis of the femoral head.