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.

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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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The First Scientific Mention

European science has known the LCF for about 2500 years. It is the most important functional connection of the hip joint. The first person to describe the LCF was Hippocrates (c. 460-370 BCE). A written mention of the LCF is found in §1 of his treatise "On the Instrument of redactions". In our opinion, a book created in the library of the Asclepeion of the island of Kos. Hippocrates did not dissection of the human body, did not operate on the hip joint, did not have a CT scan and MRI. How he could discover the LCF? In our view, it is possible that Hippocrates treated a patient with an open hip dislocation. Track Music: Blue Dot Sessions , Vittoro (CC BY-NC 4.0 DEED / fragment) keywords: ligamentum capitis femoris, ligament of head of femur, ligamentum teres, hip dislocation . ...

LCF in English Bibles

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Catalog. Classifications of LCF Pathology

The classifications are intended to systematize of ligamentum capitis femoris pathology and assist in the development of general approaches to its description, registration, analysis and treatment. Keywords ligamentum capitis femoris, ligamentum teres, ligament of head of femur, hip joint, histology, pathological anatomy, pathology, trauma INTRODUCTION In Russia, the initial attempts to classify pathology of the ligamentum capitis femoris (LCF) were made by morphologists. The development of arthroscopic surgery has made it possible to identify various, previously undescribed types of LCF pathology, which prompted the development of various modern classifications based on intraoperative observations. Analysis of literature data and our own morphological observations allowed us to propose a General Classification of the Ligamentum Teres Pathology, which has the form of a collection of classifiers, as well as a Classification of Functions of the Ligamentum Teres. The ...

University_of_Guelph(website)

Content [i] Annotation [ii] Original text [iii] Illustrations [iv] Source & links [v] Notes [vi] Authors & Affiliations [vii] Keywords [i] Annotation A quote from an article on the University of Guelph website. The publication mentions the animal's ligamentum capitis femoris (LCF) and states its function: fixing the femoral head in the acetabulum. The text in Russian is available at the following link: University_of_Guelph(website) . [ii] Original text Quote 1. Hindlimb skeleton. Femur [animals] The articular head of the femur is deeply rounded and it bears a round ligament that holds it into the acetabulum. [iii] Illustrations – [iv] Source & links STRUCTURE OF THE SKELETON. 2023. animalbiosciences.uoguelph.ca [v] Notes The work is cited in the following publications: [vi] Authors & Affiliations Unive...

BIOMECHANICS OF THE HIP JOINT WITHOUT LCF

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The Shortest Comments on Genesis, Chap. XXXII-XXXIII

The chosen fragment records ancient views on the symptoms, mechanism, and differential diagnosis of ligamentum capitis femoris (LCF) injury. The author describes the emotional status, work capacity of the patient, circumstances, time, and place of the injury, as a physician in the modern medical record (Genesis 32:8-33:20). Further in the text, apparently, a pathoanatomical investigation is mentioned, confirming the antemortem diagnosis, place of dissection (Genesis 50:2-3), as well as the location of the burial of embalmed remains (Genesis 50:13). Our comments on chapters 32-33 are presented in the table. The quotes are based on the translation of the Book of Bereshit (Genesis) from Hebrew by Isaac Leeser (1922). The shortest comments Quotes from the original source Emotional status and the name of injured person. 32:8 Then Jacob was greatly afraid, and he felt distress...

Tweet of December 19, 2025

Edwin Smith Papyrus vis-à-vis Book of Genesis A correspondence was found between the level of medical knowledge in the Edwin Smith Papyrus and the Book of Genesis; they were written during the same historical period. see: https://kruglayasvyazka.blogspot.com/2025/11/lcf-1.html Tweet of December 19, 2025 #Edwin_Smith_Papyrus #Genesis #Book_of_Genesis #Ancient_Egypt BLOG CONTENT TWITTER OR X

The Birth of the Earth

The Birth of the Earth The solar system arose 4.5682-4.567 billion years ago (2013HazenRM). It has been found with an accuracy of 1% that the substance of the "Earth-Moon-meteorite" complex is 4.55-4.51 billion years old (2001DalrympleGB). The outlined segment is the immediate beginning of the arrangement of our Home in the Universe. One of the most important conditions for the emergence of life is liquid water (2002ChybaCF_PhillipsCB). Analysis of lithosphere particles aged 4406 (+14/-17) million years showed that they crystallized under conditions of increased water pressure (2012O'NeilJ_FrancisD). Accordingly, moisture was present no later than 160 million years after the "establishment" of the planet. The explanation for this is the proven presence of water in the accretion disk of the newborn Sun, which the Earth could have received in a volume equivalent to one to three oceans (2005DrakeMJ). According to a conservative estimate, half of the Earth's w...

THE OLDEST LCF

The very first four-legged animal, the lobe-finned fish Tiktaalik roseae, lived about 375 million years ago. Based on indirect evidence (paired notches of the acetabulum), we believe that in the hip joint it had two ligaments of the head of femur, in Latin called ligamentum capitis femoris (LCF). A similar anatomy of the hip joint is preserved in the salamander. Illustration Tiktaalik roseae is the first animal to have a LCF A) 3D model of the right pelvic bone of the fish Tiktaalik roseae (fragment of a screenshot: media.hhmi.org ), where we depicted the dissected anterior LCF (lig.cap.fem.ant.) and posterior LCF (lig.cap.fem.post.), that are attached to the corresponding notches of the acetabulum ( inc.ac.ant. & inc.ac.post.). Below the pelvis is a photograph of our model of the Tiktaalik roseae femur with fragments of two LCFs (a fossil femur of Tiktaalik roseae has not yet been discovered). B) View of a salamander femur with a proximal fragment of the ilia...

The First Open Reconstruction

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