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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NEWS 2026

New publications of our resource in 2026 The initial phase of collecting data on LCF, accumulated prior to the 20th century, is largely complete. Next, we plan to analyze and synthesize thematic information, adding data from the 20th and 21st centuries. The work will focus primarily on: prevention, diagnosis, arthroscopy, plastic surgery, and endoprosthetics. January 05, 2026 2018YoussefAO The article describes a method for transposition of the proximal attachment of the LCF in congenital hip dislocation. 2007WengerD_OkaetR The authors demonstrated in the experiment that the strength of the LCF is sufficient to ensure early stability during hip joint reconstruction in children. January 04, 2026 2008 BacheCE _TorodeIP The article describes a method for transposition of the proximal attachment of the LCF in congenital hip dislocation . 2021PaezC_WengerDR The ar ticle analyzes the results of open reconstruction of LCF in dysplasia. 2008DoddsMK...

1970MichaelsG_MatlesAL

Content [i] Annotation [ii] Original text [iii] References [iv] Source & links [v] Notes [vi] Authors & Affiliations [vii] Keywords [i] Annotation Abstract of the article: Michaels G, Matles AL. The role of the ligamentum teres in congenital dislocation of the hip (1970). The authors proposed an analogy for the role of the ligamentum capitis femoris (LCF) as a “ball and chain control” and noted that it can spontaneously reduce congenital hip dislocation. The text in Russian is available at the following link: 1970MichaelsG_MatlesAL . [ii] Original text Quote p. 199 Many papers in the literature have implicated the ligamentum teres as a hindrance to the late open reduction of a congenitally dislocated hip. Occasionally the ligamentum teres has been reported to be absent. However, in most cases it is hypertrophied and elongated. Our present knowledge confirms the fact that congenital dislocation of t...

IMPROVING POSTOPERATIVE COMFORT...

Improving Postoperative Comfort and Increasing the Reliability of Hip Prostheses by Supplementing with Artificial Ligaments: Proof of Concept and Prototype Demonstration S.V. Arkhipov, Independent Researcher, Joensuu, Finland CONTENT [i] Abstract [ii] Introduction [iii] Materials and Methods [iv] Results and Discussion [v] Static Tests [vi] Dynamic Tests [vii] Prototype Fabrication and Testing [viii] Conclusion [ix] References [x] Application [i] Abstract The principle of operation of an experimental total hip endoprosthesis augmented with ligament analogs has been demonstrated in single-leg vertical stances and at the mid-stance phase of the single-support period of gait. The experiments were conducted on a specially designed mechatronic testing rig. The concept of the important role of the ligamentous apparatus is further illustrated by a set of demonstrative mechanical models. The...

2008WengerDR_MiyanjiF

Article: Wenger DR et al. Ligamentum teres maintenance and transfer as a stabilizer in open reduction for pediatric hip dislocation: surgical technique and early clinical results (2008). The article describes a method of open reconstruction of the ligamentum capitis femoris (LCF) for hip dysplasia. The text in Russian is available at the following link: 2008WengerDR_MiyanjiF . Ligamentum teres maintenance and transfer as a stabilizer in open reduction for pediatric hip dislocation: surgical technique and early clinical results Wenger DR, Mubarak SJ, Henderson PC, Miyanji F CONTENT [i] Abstract [ii] Introduction [iii] Materials and Methods [iv] Surgical technique & Results [v] Discussion & Conclusion [vi] References [vii] Application [i] Abstract Purpose The ligamentum teres has primarily been considered as an obstruction to reduction in children with developmental dislocation of the hip (DDH). In the ea...

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1724FabriciusJA

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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 ...

The author is looking for a laboratory to continue his research

The author is looking for a laboratory to continue his research. Areas for cooperation: - pathogenesis and prevention of coxarthrosis - arthroscopy of the hip joint - hip arthroplasty - reconstruction of the hip joint ligaments - biomechanics of postures and locomotion - classification of ligament pathology - remote diagnostics of hip joint ligament pathology Email: archipovsv@gmail.com Briefly about Sergey Arkhipov Bibliography Experimental material Blog [Rus] Blog [Eng] ResearchGate ORCID Twitter / Х Academia.edu BLOG CONTENT NEWS AND ANNOUNCEMENTS

LCF in English Bibles

The primary source for translating the Bible into English is the Hebrew literary monument Torah. In its first part, the Book of Bereshit (32:33 ) , there is a mention of ligamentum capitis femoris (LCF), which in Hebrew is called « גיד » (gheed, gid) (1923, 2004PreussJ; 2019ArkhipovSV_SkvortsovDV; 2020ArkhipovSV_ProlyginaIV). Probably one of the earliest written translations of the Bible into Old English was made by Ælfric of Eynsham, who worked approximately between 955–1010 CE (1050Aelfric’s). In Aelfric's Anglo-Saxon Paraphrase, the Hebrew concept of « גיד » [gheed], that is, LCF, is mentioned twice in the 25th and 32nd verses of the XXXII Chapter of the Book of Genesis and is called «sine» ( Figure 1, 2 ). In Middle English, translators Nicholas of Hereford and John Wycliffe named LCF as «synwe», and in John Purvey's Bible edition - «senewe» (1850ForshallJ_MaddenF). In Bibles in Early Modern English, LCF is designated as «senow» and «senowe» (1530TyndaleW; 1535CoverdaleM; 1...

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