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

LCF in 2025 (December)

LCF in 2025 ( December) (Quotes from articles and books published in December 2025 mentioning the ligamentum capitis femoris) Sarassa, C., Aristizabal, S., Mejía, R., García, J. J., Quintero, D., & Herrera, A. M. (2025). Intraosseous Tunneling and Ligamentum Teres Ligamentodesis “Teretization” to Enhance Stability in Congenital Hip Dislocation Surgery: Surgical Technique and Mid-Term Outcomes. Journal of Pediatric Orthopaedics , 10-1097. [i] journals.lww.com Kampouridis, P., Svorligkou, G., Spassov, N., & Böhme, M. (2025). Postcranial anatomy of the Late Miocene Eurasian hornless rhinocerotid Chilotherium. PLoS One , 20 (12), e0336590. [ii] journals.plos.org Burdette, T. N., Hsiou, C. L., McDonough, S. P., Pell, S., Ayers, J., Divers, T. J., & Delvescovo, B. Sidewinder syndrome associated with complete rupture of the ligamentum capitis ossis femoris in a horse. Eq...

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...

2008DoddsMK_McCormackD

Content [i] Annotation [ii] Original text [iii] References [iv] Source & links [v] Notes [vi] Authors & Affiliations [vii] Keywords [i] Annotation Abstract of the article: Dodds MK et al . Transarticular stabilization of the immature femoral head: assessment of a novel surgical approach to the dislocating pediatric hip in a porcine model (2008). The article describes an experiment of reconstruction of ligamentum capitis femoris (LCF) in pigs with the formation of a femoral tunnel. The text in Russian is available at the following link: 2008DoddsMK_McCormackD . [ii] Original text Abstract Background: Acetabular dysplasia and hip instability are common in neuromuscular diseases such as spina bifida and cerebral palsy due to deranged muscle function around the hip. Occasionally in developmental dysplasia of the hip, persistent instability may be difficult to manage by standard treatments. It i...

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. January 04, 2026 2008 BacheCE _TorodeIP The article describes a method for transposition of the proximal attachment of the L CF in congenital hip dislocation . 2021PaezC_WengerDR The article analyzes the results of open reconstruction of LCF in dysplasia. 2008DoddsMK_McCormackD The article describes an experiment of reconstruction of LCF in pigs with the formation of a femoral tunnel. 2011HosalkarHS_WengerDR The article describes a method of is...

1724FabriciusJA

Fragments from the book Fabricius JA. Bibliothecae Graecae volume duodecimum (1724). The author quotes the Byzantine physician Theophilus Protospatharius, who supposedly lived between the 7th and 10th centuries. Selected passages provide views on the normal anatomy of the ligamentum capitis femoris (LCF) and its inherent connective function. [Grc] θεοφιλος ο Πρωτοσπαθάριος . Περὶ τῆς τοῦ ανθρώπου κατασκευῆς . Βιβλιον Ε . XIII, [p. 892] (see fig.) [Lat] Theophilus Protospatharius. De corporis humani fabrica, Liber quintus, Cap. XIII [p. 892] 1) Dei erga homines amor ex heminae fundo teretem nervum promisit, cartilaginosum vinculum femoris capiti insertum adstringensque, ne facile elabatur:» 2) inde ex heminae oris aliae copulae oriuntur, totum femoris caput in orbem constringentes, non teretes & solae, qualis quae ex fundo porrigitur, sed latae, valenter que heminae oras ad commissurae praesidium ambientes. Translation [Eng] 1) For the sake ...

1883SuttonJB

According to the author, the ligamentum capitis femoris (LCF) is a tendon of the pectineus muscle, separated from it in consequence of skeletal modifications. THE LIGAMENTUM TERES By J. B. SUTTON, Demonstrator of Anatomy, Middlesex Hospital. (PLATE VIII.) The round ligament of the coxo-femoral articulation has long been an anatomical puzzle, consequently many diverse notions exist concerning it. Some anatomists ascribe to this hollow band of fibrous tissue very important functions in the mechanism of the hip-joint; others deprive it of all glory, simply assigning to it the menial duty of conveying blood-vessels to the head of the femur. Certain authors content themselves with a brief description of its attachments; others give elaborate and detailed accounts, extending over several pages, of its anatomy and supposed function. My object in the present communication is to show that this singular ligament is nothing more than the tendon of the pectineus muscle, sepa...

2012FrederickP_KelmanDC

Invention (Patent): Frederick P, Belew K, Jasper L, Gatewood J, Gibson L, Masonis J, Cooper M, Kelman DC. Methods and apparatus for FAI surgeries. US20120283840A1 (2012). US20120283840A1 US Inventors: Phillip Frederick, Kevin Belew, Lauren Jasper, James Gatewood, Luke Gibson, John Masonis, Michael Cooper, David C. Kelman Current Assignee: Smith and Nephew Inc Worldwide applications 2010 KR JP RU BR CA US CN EP CN WO AU 2014 US 2016 AU 2017 AU Application US13/202,612 events: 2010-02-25 Заявка подана Smith and Nephew Inc 2010-02-25 Приоритет US13/202,612 2012-11-08 Публикация US20120283840A1 2014-12-02 Заявка удовлетворена 2014-12-02 Публикация US8900320B2 Статус: Активный 2031-06-08 Измененный срок действия Methods and apparatus for FAI surgeries Phillip Frederick, Kevin Belew, Lauren Jasper, James Gatewood, Luke Gibson, John Masonis, Michael Cooper, David C. Kelman Abstract A partial rim implant for an acetabulum in a pelvic bone comprise...

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...

163-192Galen

Fragment from the treatise Galen. On anatomical procedures (Περὶ Ἀνατομικῶν Ἐγχειρήσεων, ca. 163-192). The author writes about the high resiliency and hardness of ligamentum capitis femoris (LCF), and also notes its connective function. See our commentary at the link: 163-192Galen [Rus], and 2020ArkhipovSV_ProlyginaIV . Quote [Grc] Περὶ Ἀνατομικῶν Ἐγχειρήσεων. Βιβλιον B. K εφ . ι ʹ . Αλλά χρή σε, καθάπερ επί της χειρός επεσκέψω τους συνδέσμους των οστών, ούτω και νυν επισκέψασθαι πασών των γεγυμνωμένων διαρθρώσεων, πρώτης μεν της κατ' ισχίον, εχούσης ένα μεν εν κύκλω σύνδεσμον, απάντων των άρθρων κοινόν, (ουδέν γάρ έστιν, ότω μή περιβέβληται τοιούτος σύνδεσμος,) έτερον δε τον διά του βάθους εν τη διαρθρώσει κατακεκρυμμένον, ος συνάπτει την κεφαλήν του μηρού τη κατ' ισχίον κοιλότητι, πάνυ σκληρός ών, ώς ήδη δύνασθαι λέγεσθαι νεύρον χονδρώδες. (original source: 1821KühnCG, pp. 328-329) [Lat] De Anatomicis Administrationibus. Liber II. Cap. X. Verum considerare te convenit, ut i...

2023AbibeRB_SaundersWB

Article: Abibe RB et al. Ligamentum teres reconstruction using autogenous semitendinosus tendon with toggle technique in rabbits (2023). The article describes experimental reconstruction of ligamentum capitis femoris (LCF) in rabbits. The text in Russian is available at the following link: 2023AbibeRB_SaundersWB . Ligamentum teres reconstruction using autogenous semitendinosus tendon with toggle technique in rabbits Abibe RB, Rahal SC, Reis Mesquita LD, Doiche D, da Silva JP, Mamprim MJ, Pinho RH, Battazza A, Alves CEF, Saunders WB CONTENT [i] Abstract [ii] Introduction [iii] Materials and Methods [iv] Results [v] Discussion & Conclusion [vi] References [vii] Application [i] Abstract Background Ligamentum teres (LT) has traditionally been considered a vestigial or redundant structure in humans; however, based on new studies and the evolution of hip arthroscopy, the LT injury has been viewed as a source of hi...

Search This Blog