An original
view on the pathogenesis of osteoarthritis of the hip joint.
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
.
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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]
ETIOLOGY AND PATHOGENESIS
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