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]

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ETIOLOGY AND PATHOGENESIS

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4cent.Gothic Bible

About the Book of Genesis of the Gothic Bible (4th century). A Gothic term that may have been used to refer to the ligamentum capitis femoris (LCF) of an animal and a human. See our commentary at the link: 4cent.Gothic Bible [Rus]. Quote [ Got ] Genesis 32:33 (possible term; original source lost) Translation [Eng] Genesis 32:33 The original text and English translation are currently unavailable to our project. Suggested term: … gabinda ( gabundi) … The closest analogue is in the Epistle to the Colossians 2:19 — jah ni habands haubiþ, us þammei all leik þairh gawissins jah gabindos auknando jah þeihando wahseiþ du wahstau gudis. — καὶ οὐ κρατῶν τὴν κεφαλήν , ἐξ οὗ πᾶν τὸ σῶμα διὰ τῶν ἁφῶν καὶ συνδέσμων ἐπιχορηγούμενον καὶ συμβιβαζόμενον αὔξει τὴν αὔξησιν τοῦ θεοῦ . — And not holding the Head, from which all the body by joints and bands having nourishment ministered, and knit together, increaseth with the increase of God. (original source: wulfila.be ; Codex Ambrosianus? Milan, Bi

2018FreitasA_BandeiraVC

The authors reported a case of open hip dislocation and documented avulsion of the ligamentum capitis femoris (LCF) from the acetabulum. The injured LCF appeared as a large cord-like structure, attached to the femoral head ( Fig. 1 ). Perhaps Hippocrates of Kos saw such an LCF in open dislocation of the hip and described it in his treatise «Mochlicus» ( 1886AdamsF ). One year later, the patient's x-ray revealed a significant narrowing of the joint space in the upper part of the hip joint ( Fig. 9 ). In our opinion, this to be a consequence of hyaline cartilage wear due to overload in the absence of LCF. In an unaffected hip joint, the width of the radiological joint space at the upper section than in the lower section ( Ossification of the LCF ). When examined one year after the injury, the patient could stand on one leg. We noticed that his body was excessively deviated towards the supporting hip joint, and the opposite half of the pelvis was elevated ( Fig. 8 ). This is a me

1875BrauneW

We present a study dedicated to the experimental investigation of the function of the ligamentum capitis femoris (LCF). Wilhelm Braune established that the LCF prevents hip supination and adduction, especially during flexion. In the conclusion of the study, the author writes: "It also remains to determine in which body movements this ligament function plays a role, as it is currently unclear why the femur requires a special fixing device…". Apparently, Wilhelm Braune did not have time to find the answer, since his outstanding monograph on LCF does not say a word ( Braune W, Fischer O. Der Gang des Menschen (1895 books.google ) . Based on our own experiments on mechanical models and research, we believe that adduction and supination of the hip, along with flexion, are observed at the beginning of the single-support period of the step. At this moment, tension occurs in the LCF, allowing to reduce the load on the upper segment of the femoral head. The LCF is also stretched in

927-942Arabic Bible

Fragment of the Book of Bereshit translated into Arabic by Saadia Gaon ( 927-942 ) . The Arabic text contains mentioned to ligamentum capitis femoris (LCF) of an animal and a human. See our commentary at the link: 927-942ArabicBible [Rus]. Quote [ a ra] التكوين 32:32 (original source: 1653WaltonB, p. 145) See also modern editions: لذلك لا يأكل بنو اسرائيل عرق النّسا الذي على حقّ الفخذ الى هذا اليوم . لانه ضرب حقّ فخذ يعقوب على عرق النّسا (original source: arabicbible.com ) لِذَلِكَ لا يَاكُلُ بَنُو اسْرَائِيلَ عِرْقَ النَّسَا الَّذِي عَلَى حُقِّ الْفَخِْذِ الَى هَذَا الْيَوْمِ لانَّهُ ضَرَبَ حُقَّ فَخْذِ يَعْقُوبَ عَلَى عِرْقِ النَّسَا (original source: copticchurch.net ) Translation [Eng] Genesis 32:32 Translation of the text is currently unavailable for our project. The term for the LCF: النّسا ~ sciatica ( see also: 70-110Rufus Ephesius ; 180-238PolluxJ ) Saʻadia ben Joseph . Pentateuch ( 1600) , p. 1 ( original: digital.library.yu.edu ) External links Saʻadia

2016ArkhipovaAS Classification of Joints with Flexible Elements.

Classification of Joints with Flexible Elements The classification of joints with flexible elements was first proposed by A.S. Arkhipova in 2016 and presented at conferences in 2016-2017 ( 2017АрхиповаАС ). Joints with flexible elements are divided by the author into detachable and non-detachable, three-axis, two-axis, and single-axis. Each can contain in various combinations one or more external and internal flexible elements - analogs of joint ligaments, including the ligamentum capitis femoris (LCF). Conditional designations of joints with flexible elements using the example of a ball joint: Detachable ball joint with an internal flexible element Non-detachable ball joint with an internal flexible element Detachable ball joint with an external flexible element Non-detachable ball joint with an external flexible element Detachable ball joint with both internal and external flexible elements Non-detachable ball joint with both internal and external flexible elements Flexible e

1879MorrisH

Fragments of the book Morris H. The anatomy of the joints of man (1879) dedicated to ligamentum capitis femoris (LCF). The author discusses the anatomy of the LCF and describes his experiments to study its movement. Quote p p . 318-319 The acetabulum is partly articular, partly non-articular. The articular portion is of horseshoe shape, and extends inwards from the margin, more or less. It is altogether deficient at the cotyloid notch, which corresponds with the gap of the horseshoe. It is the widest at the iliac part, where it is over one inch from without inwards; then it very gradually gets narrower along the ischium, but widens out again at the ischial end of the cotyloid notch ; forwards from the pubo-iliac suture it narrows more rapidly, and does not extend quite up to the pubic end of the cotyloid notch. At its narrowest point in an adult bone it measures half an inch in width. When coated with cartilage, and fringed round with the cotyloid ligament, it fits very closel

DIAGNOSTICS AND EXAMINATION

DIAGNOSTICS AND EXAMINATION (Diagnostic, examination and testing methods... ) Catalog. LCF Pathology Tests Tests for the detection of pathology LCF. 2004VialleR_GlorionC The article discusses the examination technique for dislocation of the femur and describes the radiographic symptom of infringement of the damaged LCF. BLOG CONTENT

150-250Targum Jonathan

Fragments from the Targum Jonathan on Genesis. Tractate was written between about 150 - 250 in lend of Israel. The text is a combination of a translation and commentary on the book of Bereshit. The unknown compiler mentions ligamentum capitis femoris (LCF) in an animal and an episode of its damage in a human. See our commentary at the link: 150-250Targum Jonathan [Rus]. Quote 1. [Heb] Genesis. 32:33 (original source: sefaria.org ) Quote 2. [Heb] Genesis. 43:16 (original source: sefaria.org ) Translation Quote 1. [Eng] Genesis. 32:33 Therefore, the sons of Israel eat not the sinew which shrank, which is in the hollow of the thigh of cattle and of wild animals, until this day; because the Angel touched and laid hold of the hollow of the right thigh of Jakob, in the place of the sinew which shrank. (Transl. by J.W. Etheridge (186 2 ) ; original source: targum.info ) Quote 2. [Eng] Genesis. 43:16 And Joseph saw Benjamin with them: and he said to Menasheh whom he had made superintende

1679DiemerbroeckI

Fragments from the book Diemerbroeck I. Anatome corporis humani (1679). The author describes the pathology variants, function, topography and attachment of the ligamentum capitis femoris (LCF). The damage to the LCF in hip dislocation, symptoms and treatment are discussed. The text is similar to a paraphrase of Hegetor's work «On Causes» and Galen of Pergamon's commentary on Hippocrates' treatise «On Joints» ( 1745CocchiA ; 2020ArkhipovSV_ProlyginaIV ). Isbrand van Diemerbroeck uses many synonyms for LCF: nervus cartilaginosus, terete, teres, rotundum ligamentum, interius ligamentum. Quote p. 593. [Lat] CAPUT XIX. De Ossibus Femoris, & Cruris. Superius procesum crassum, versus coxendicis os prominentem, eique epiphyin rotundam & amplam impositam habet, sicque globosum femoris caput, valida cervice subnixum, constituit, quod cartilagine obductum in coxendicis acetabulum reconditur, in eoque duobus validis ligamentis detinetur: uno lato, crasso, & membranoso,

2014ArkhipovaAS

In 2014, at the International Olympics Space for school students, Alexandra Arkhipova presented a report on the feasibility of using joints with flexible elements in walking machines. The author was recognized as the overall winner (more details: cyclowiki.org ). The report suggested: «An important area of possible application of walking robots would be remote exploration of other planets». Ten years later, professionals from NASA began to put this idea into practice: Robot dog trains to walk on Moon in Oregon trials (more details: bbc.com ). Below we present the text of the first message about walking machines in space, the ball joint of which contains a flexible element - an analogue of the ligamentum capitis femoris (LCF). Mobile biomorphic platforms with analogues of natural locomotion algorithms Arkhipova A.S. For ten years of its mission, American wheeled Mars rover vehicle 'Opportunity' covered just 40 kilometers through the Red Planet, and its twin Spirit go

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