Aseptic Necrosis. Pathogenesis

An original view on the pathogenesis of aseptic (avascular) necrosis of the femoral head.

According to our view, the pathogenesis of aseptic (avascular) necrosis of the femoral head is based on mechanical damage to the ligamentum capitis femoris (LCF) or its dysfunction. Due to excessive stress on the LCF, it can rupture completely or partially, or tear off with or without a bone fragment. The most common mechanism of injury is forced adduction or rotation of the hip in the horizontal plane (pronation-supination). Damage can occur immediately or gradually, with prolonged existence of bioeffective stresses in the LCF. Partial damage to the LCF with elongation and dysfunction is not excluded at the initial stage. We consider the commonly held opinion about the vascular genesis of the disease to be incorrect.

Due to the violation of the integrity of the LCF, the hip joint in the single-support period of the step is not converted into a lever of the second kind. Accordingly, in all phases of walking, as well as in any vertical position, only the upper sector of the femoral head and acetabulum are loaded. The actual average daily stresses in them naturally increases. They, being higher than the level of optimal daily average stresses, cause the appearance of bioeffective stresses. The latter, in turn, induce biological adaptive processes (for more details, see the Law of Bioinduction).

One of the first manifestations is the formation of compact bone tissue in the subchondral zone of the femoral head (radiological symptom of "eggshell"). If, due to traumatic impact, along with damage to the LCF, an impression fracture of the upper pole of the femoral head does not occur, it develops gradually. The high intensity of internal forces in the upper sector of the femoral head leads to fractures of individual trabeculae in areas of stress concentration, which further weakens bone tissue and reduces the level of optimal average daily stresses.

Mechanical processes form a kind of bone-cartilaginous sequestrum at the upper pole of the femoral head. Along its periphery, bioeffective stresses induce adaptive processes, and granulation tissue appears, which is gradually transformed into fibrous tissue. Bone cysts develop in the femoral head, and the separated part of the bone undergoes lysis. Osteophytes appear at the edges of the femoral head and acetabulum due to metaplasia of fibrous tissue induced by bio-effective stresses. Thanks to osteophytes, the area of the contacting elements of the hip joint increases, which partly reduces the level of actual average daily stresses in them.

Restructuring of the acetabulum is also observed: the semilunar surface expands, the acetabular canal is eliminated, and the cartilaginous cover is worn out. Due to the death of part of the head of the femur and slow adaptive changes, it cannot fully adapt to the situation that has arisen. The inability to neutralize bio-effective stresses in the hip joint area leads to its further deterioration not only mechanically but also through biological processes.

The disruption of congruence and functioning of the hip joint leads to a change in the level of actual average daily stresses in all adjacent elements of the musculoskeletal system. Bioeffective stresses appear in them, leading to pathological changes. The energy intensity of locomotion increases, including due to an increase in the activity of the abductor group of muscles of the hip joint, which keep the pelvis in the single-support step period and in single-support vertical poses.

Keywords: ligamentum capitis femoris, ligamentum teres, ligament of head of femur, hip joint, biomechanics, aseptic necrosis, avascular necrosis, pathogenesis

In translating to English, the author is assisted by ChatGPT (version 3.5) and the Google Translate service.

If you notice an error, please let us know!

The first version of the text in:

Архипов-Балтийский СВ. Рассуждение о морфомеханике. Норма. В 2 т. Т. 2. Гл. 5-6. испр. и доп. изд. Калининград, 2004. (Archipov-Baltic SV. Reasoning about Morphomechanics. The norm – Kaliningrad, 2004. [Rus]) [aleph.rsl.ru]

BLOG CONTENT

ETIOLOGY AND PATHOGENESIS

Comments

1845HollsteinL

Fragments from the book Hollstein L. Compendium der Anatomie des Menschen (1865). The author discusses the anatomy of the ligamentum capitis femoris (LCF), and mentions its synonyms. The text is prepared for machine translation using a service built into the blog from Google or your web browser. Quote p. 144 Das Lig am. teres s. rotundum femoris (Fig. 50, 7.) hat eine dreieckige Gestalt, und ist mit seiner Basis in dem Fundus acetabuli, mit seiner rundlichen Spitze in der Fovea capitis ossis femoris befestigt. Es besteht aus einem Bündel Sehnenfasern, und erhält von der Synovialmembran einen scheidenformigen Ueberzug; bisweilen existirt letzterer allein, und manchmal felilt das Band ganz und gar. Fig. 50. Seitliche Ansicht der Bänder des Beckens und Hüftgelenks. Quote p. 145 Die weite Synovialmembran überzieht den Schenkelkopf, geht alsdann als Scheide des Ligam. teres zur Gelenkpfanne über, welche sie ebenfalls auskleidet, und schlägt sich hierauf über die ...

Vertebrates

VERTEBRATES According to the molecular clock, a specific method for dating phylogenetic events, vertebrates (Vertebrata) separated from arthropods (Arthropoda) 976±97 Ma (2004HedgesSB_ShoeJL). The latter began to dominate in species diversity with the Cambrian burst of radiation, which occurred 520 Ma (2010EdgecombeGD). This ratio in the fauna of the Earth is still preserved. Approximately 525 Ma, the phylum Chordates separated from the group of bilaterally symmetrical animals (1995ChenJY_ZhouGQ). In turn, the evolution of chordate organisms led to the formation of the first vertebrates at least 500 Ma, from which the jawed mouths 450-400 Ma descended, becoming the ancestors of the placoderms or "armored" fish (Placodermi) (1979 НаумовНП _ КарташевНН ). Sculptural reconstruction of the placoderm Coccosteus from the order Arthrodires, Middle Devonian, 393.3-382.7 Ma ; exposition of the Orlov Paleontological Museum (Moscow); photo by the author. The first cartilaginou...

1981OrtnerDJ_PutscharWGJ

Content [i] Annotation [ii] Original text [iii] Illustrations [iv] Source & links [v] Notes [vi] Authors & Affiliations [vii] Keywords [i] Annotation Fragment from the book: Ortner DJ, Putschar WGJ. Identification of Pathological Conditions in Human Skeletal Remains (1981). The authors describe signs of ligamentum capitis femoris (LCF) pathology in the remains of a Bronze Age individual, possibly resulting from recurrent hip subluxation. The text in Russian is available at the following link: 1981OrtnerDJ_PutscharWGJ . [ii] Original text Quote pp. 360-361 An adult male skeleton from tomb A100E at the Early Bronze Age [c. 3500–2000 BCE] cemetery of Bab edh-Dhra in Jordan has an abnormally shallow acetabulum of the right hip. This is the same skeleton that had a separate neural arch. The acetabulum is also much larger in diameter than the corresponding acetabulum of the left innominate (Figure 577). There is a moderate amount of arthritic lipping on the m...

1753AstrucJ

Content [i] Annotation [ii] Original text (in French) [iii] English translation [iv] Source & links [v] Notes [vi] Authors & Affiliations [vii] Keywords [i] Annotation Fragments from the book: Astruc J . Conjectures sur les memoires originaux dont il paroit que Moyse s'est servi pour composer le livre de la Genese (Conjectures on the Original Documents Which Moses Apparently Used in Compiling the Book of Genesis, 1753). In analyzing the book of Genesis, the author cites a French text mentioning a hip injury, damage to the ligamentum capitis femoris (LCF), and the consequences of an accident. An Russian translation is available at: 1753AstrucJ . [ii] Original text (in French) Quote p. 176 Genesis. Chap. XXXII A 25. Et quand cest hommeld vid qu’il ne le pouvoit vaincre, il toucha l'enrdroit de l'emboifiement de la hanche d'icelui: ainsi l'emboifiement de l'os de la hanche de Jacob fut entors quand l'homme luictoit avec lui. Quote p. 177...

1803LarreyDJ

Content [i] Annotation [ii] Original text [iii] English translation [iv] Source & links [v] Notes [vi] Authors & Affiliations [vii] Keywords [i] Annotation Fragment from the book: Larrey DJ. Relation historique et chirurgique de l'expedition de l'armée d'Orient, en Egypte et Syrie (Historical account and surgery of the expedition of the Army of the Orient, in Egypt and Syria, 1803). The author describes exarticulation in the hip joint and the technique of cutting the ligamentum capitis femoris (LCF), which he calls the "interarticular ligament". The text in Russian is available at the following link: 1803LarreyDJ . [ii] Original text (France ) Quote pp. 325-328 Les praticiens qui ont proposé l'extirpation de la cuisse ne sont point d'accord sur la manière de la faire; cependant presque tous, craignant l'hémorragie de l'artère crurale, commencent par la ligature de ce vaisseau, forment ensuite un lambeau aux dépens des muscles ...

1665LindenJA

Content [i] Annotation [ii] Original text (in Latin) [iii] English translation [iv] Source & links [v] Notes [vi] Authors & Affiliations [vii] Keywords [i] Annotation Fragment from the book: Linden JA . Magni Hippocratis Coi Opera Omnia Graece Et Latine Edita. Vol. I. (1665). This article presents an excerpt from the treatise «Mochlicus» (Instruments of Reductions) by Hippocrates of Cos (b. 460 BC), translated into Latin. The author describes for the first time the localization and area of distal attachment of the ligamentum capitis femoris (LCF) describit, mentionem in alio tractatu ponens. A translation of this article into Russian is available at the link: 1665LindenJA . The original source in Greek sees at the link: 1844LittreE , and in English at: 1886AdamsF . [ii] Original text (in Latin) Quote pp. 294-295 Vol. I. Ossium natura II. Ipsum aurem femur foras, & in anteriore parte incurvum est. Caput autem ejus appendix eft r...

1948EpsteinI

Content [i] Annotation [ii] Original text [iii] Illustration [iv] Source & links [v] Notes [vi] Authors & Affiliations [vii] Keywords [i] Annotation Fragments from the book: Epstein I. Babylonian Talmud. Seder Kodashim. Vol. 2. Hullin (1948). The editor comments on the words of Rabbi Samuel (Shmuel) in the tractate Hullin of the Babylonian Talmud, explaining the location of the ligamentum capitis femoris (LCF) in relation to the joint and its differences from the sciatic nerve. The original in Russian is available at: 1948EpsteinI . [ii] Original text Quote p. 500 Hullin. Chapter 7.89b MISHNAH. [THE PROHIBITION OF] THE SCIATIC NERVE(1) IS IN FORCE BOTH WITHIN THE HOLY LAND AND OUTSIDE IT, BOTH DURING THE EXISTENCE OF THE TEMPLE AND AFTER IT, IN RESPECT OP BOTH UNCONSECRATED AND CONSECRATED [ANIMALS]. IT APPLIES TO CATTLE AND TO WILD ANIMALS, TO THE RIGHT AND LEFT HIP, BUT IT DOES NOT APPLY TO BIRDS BECAUSE THEY HAVE NO SPOON-SHAPED HIP(2). IT ALSO APPLIES TO A F...

1742WesleyC

Works of art that mention ligamentum capitis femoris (LCF) are extremely rare. One such work is the poem «Wrestling Jacob» (Come, O Thou Traveler Unknown) by Charles Wesley. Wrestling Jacob 1. Come, O Thou Traveler unknown, Whom still I hold, but cannot see; My Company before is gone, And I am left alone with Thee. With Thee all night I mean to stay And wrestle till the Break of Day. 2. I need not tell Thee who I am, My Misery, or Sin, declare; Thyself hast call’d me by my Name, Look on Thy Hand and read it there. But who, I ask Thee, who art Thou? Tell me Thy Name, and tell me now! 3. In vain Thou strugglest to get free, I never will unloose my Hold; Art Thou the Man that died for me? The secret of Thy Love unfold; Wrestling I will not let Thee go, Till I Thy Name, Thy Nature know. 4. Wilt Thou not yet to me reveal Thy new, unutterable Name? Tell me, I still beseech Thee, tell, To know it Now resolv’d I am; Wrestling I...

2025ZhangY_MartinRL

We publish without changes an excellent article on the biomechanics of the ligamentum capitis femoris (LCF) by Zhang Y et al. «A finite element analysis model to support ligamentum teres function» (2025). This is an an Open Access article distributed under the terms of the Creative Commons Attribution License (CC BY 4.0, https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited. Journal of Hip Preservation Surgery A finite element analysis model to support ligamentum teres function Yongni Zhang , Jianing Wang , Linxia Gu , Hal David Martin , RobRoy L Martin Abstract The function of the ligamentum teres (LT) remains debated, particularly its role in limiting motion. The aim of this study was to use finite element analysis to assess LT stress during hip movements, which included external rotation with flexion. A 3D model of the hip joint, including the femoral hea...

THE DOCTRINE OF LCF

THE DOCTRINE OF ligamentum capitis femoris: An Instrument of Knowledge and Innovation. Definition: A set of theoretical provisions on all aspects of knowledge about the anatomical element ligamentum capitis femoris (LCF). 1. Structure of the Doctrine of LCF 2. Practical Application of the Doctrine of LCF : 2.1. Diagnostics 2.1. Prevention 2.3. Prognosis 2.4. Pathology 2.5. Veterinary 2.6. Professions 2.7. Products 2.8. Surgery 3. Theory of LCF Mechanics 4. The Base of the Doctrine of LCF 5. Stairway to the Past or History of the Doctrine of LCF 6. Ultimate Depth of Researches 7. Appendices 7.1. Acceptable Synonyms Structure of the Doctrine of ligamentum capitis femoris . E a R T ...

Search This Blog