Microvascular obstruction in avascular necrosis. Immunohistochemistry of 14 femoral heads.

14 femoral heads with late stage avascular necrosis of different etiologies were histologically examined, with special attention to vascular structures. Decalcified slices were stained with hematoxylin-eosin, safranin-O, van Gieson stain, and Martius Scarlet Blue. Immunohistochemical techniques with antibodies against Factor VIII, and Ulex Europeus Lectin were used to visualize the endothelium of the blood vessels. 5 distinct zones of the necrotic femoral head could be identified. The necrotic zone contained areas with richly vascularized connective tissue. In the transitional zone, several areas with intravascular aggregations of newly formed and older fibrin clots were noticed, mainly on the venous side of the vascular system. Other small vessels were collapsed, with a few endothelial cells clumped together in the center of a concentric fibrous tissue. We suggest that obstruction to the venous outflow due to intravascular thrombosis as well as to perivascular fibrosis is important in the pathogenesis of non-traumatic avascular necrosis of the femoral head.