Angiography in Perthes' disease.

Angiography may play an important role in the understanding of the cause and treatment of Perthes' disease. Angiograms were performed in 30 patients, including 26 aortographies and six selective angiographies. The major angiographic alterations were: general decrease of blood flow in the affected hip, lack of a patent medial circumflex artery, an atrophic medial circumflex artery or obstruction of its branches, distended vessels in subluxations of the hip joint, and almost complete absence of the obturator artery. These anatomic differences between normal and pathologic hips suggest a deficient blood supply in the affected side and an ischemic epiphysis. Surgical treatment is indicated in cases in which distention of the circumflex vessels is noted and the condition progresses to massive necrosis. There were no differences in circulation of the hip between men and women afflicted with Perthes' disease.