Hip Osteoarthritis. Pathogenesis

An original view on the pathogenesis of osteoarthritis of the hip joint.

Coxarthrosis is a disease that can develop either independently or against the background of other pathological conditions: congenital hip dislocation, Perthes' disease, aseptic necrosis of the femoral head, and some others. From our point of view, the basis of its pathogenesis, as a rule, is the pathology of ligamentum capitis femoris (LCF). This may involve its complete or partial damage, changes in size, mechanical properties, and the localization of attachment areas.

The pathogenesis of coxarthrosis is a clear illustration of the Law of Bioinduction that we have established. LCF dysfunction results in disruption of normal hip mechanics. In the single-support period of the step and the single-support orthostatic position, it begins to function not as a lever of the second kind, but as a lever of the first kind. Accordingly, only the upper sectors of the femoral head and acetabulum are constantly loaded; the values of the actual average daily stresses in them significantly increase. The bioeffective stresses that arise in this case induce a complex of biological processes.

In the upper sector of the hip joint, the cartilage wears out and becomes thinner. Decentration of the femoral head and its cranial subluxation gradually develop. Microfractures of trabeculae are observed in the bone tissue. The majority of ongoing biological processes aim to neutralize bio-effective stresses. Osteophytes form on the periphery of the articular surfaces, which increases the area of their contact, and at the same time deformation of the articular ends of the bones occurs. The first and second reduce the intensity of internal forces in the bone elements. As the acetabular canal has lost its functional role, the acetabular fossa is eliminated, and the facies lunata expands.

In the subchondral layer of the femoral head, a layer of compact bone tissue appears and gradually thickens, reducing local stresses in the underlying spongy substance. There is a reorientation of the trabecular systems of the proximal end of the femur. The first system of bone trabeculae is strengthened, the second system is eliminated. Bone cysts appear and enlarge as one of the ways to eliminate stresses concentrations inside the bone at the ends of microcracks. The presence of bioeffective stresses is also reflected in soft tissues: fibrosis is observed in tendons, joint capsules and muscles, and in the areas of their attachment there are foci of heterotopic ossification.

There is a shortening of the femoral neck and an increase in the femoral neck-diaphyseal angle. The size and shape of the entire proximal femur changes, and the depth of the acetabulum increases. To a large extent, the listed phenomena are compensatory processes. In some cases, they change the actual average daily stresses, and in others, the optimal average daily stresses; the meaning of both is to level out the existing bioeffective stresses.

The mechanics of a hip joint affected by arthrosis is the mechanics of a hip joint that is devoid of LCF. In this case, the kinematics of locomotion changes significantly and their energy intensity increases. Bioeffective stresses appear not only in the hip joint area, but also in all adjacent elements of the musculoskeletal system, which leads to their pathological changes. With a reduced adaptive potential of tissues and significant violations of the mechanics of the lower limb girdle, bioeffective stresses remain uncompensated. This gradually leads to complete destruction of the hip joint, as well as gross changes in the anatomical elements of adjacent kinematic chains.

Keywords: ligamentum capitis femoris, ligamentum teres, ligament of head of femur, abductor muscle group, hip joint, biomechanics, osteoarthritis, 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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LCF in 2026 (May)

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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 ...

LCF in 2026 (June)

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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...

Vertebrates

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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...

1900BetheE

Fragments of t he book Pollux J. Onomasticum (166-76) edited by E. Bethe (1900). In Greek the author calls ligamentum capitis femoris (LCF) «ἰσχίον», and the concept of «ligament» is designated by the term «νεῦρον / ν εῦρα ». The term «ἰσχίον» was used by Rufus of Ephesus ( 2020ArkhipovSV_ProlyginaIV ). The fragment of the Onomasticum dealing with the LCF was quoted by Giovanni Filippo Ingrassia ( 1603IngrassiaeIP ) . See our commentary at the link: 1900 BetheE [Rus]. Quote 1. Βιβλίου Β. 186-187 [Grc] καιλεῖται δὲ καὶ τὸ νεῦρον τὸ σ υνέχον τὴν κοτύλην πρὸ σ τὸν μηρὸν ἰ σ χίον. ὁμώνυμον δ’ ἐ σ τιν αύτῷ καὶ τὸ ἄρθρον. καὶ τὸ μὲν [τῇ] κοτύλῃ [ σ υνηρμο σ μένον] ὀ σ τοῦν σ τρογγύλον μηροῦ κεφαλὴ, μηρὸ σ δὲ τὸ ἁπ ὸ το ύ το υ μὲχρ ι γονάτων μὲρο σ , … (original source: 1900BetheE , pp. 140-141 ) Quote 2. Βιβλίου Β. 234 [Grc] Νεῦρα δ’ ἐστι σύνδεσμος ὀστῶν εἴκων τε καὶ τεινόμενος, ἀφ ̓ ὧν κ...

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...

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...

1842GreenhillGA

A Latin translation of Theophilus Protospatharios's treatise On the Construction of the Human Being [Θεοφιλος ο Πρωτοσπαθάριος. Περὶ τῆς τοῦ ανθρώπου κατασκευῆς] (ca. 976-1115?). The author writes about the normal anatomy of the ligamentum capitis femoris (LCF) and its connective function. For our commentary, see the link: 1842GreenhillGA [Rus]. See also 1581CrassoPI , 1724FabriciusJA , 2020ArkhipovSV_ProlyginaIV . Quote. [Grc] Περὶ τῆς τοῦ ανθρώπου κατασκευῆς . Βιβλιον Ε . 13. (original source: 1842GreenhillGA, p. 204) [Lat] De corporis humani fabrica. Liber quintus. Cap. XIII. Dei erga homines amor [et sapientia] ex heminae fundo teretem nervum promisit, cartilaginosum vinculum femoris capiti insertum, adstringensque ne facile elabatur; inde ex heminae oris aliae copulae oriuntur, totum femoris caput in orbem constringentes, non teretes et solae, (qualis quae ex fundo porrigitur,) sed latae, valenterque heminae oras ad comrai...

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