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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1740KulmusJA

Fragments from the book Kulmus JA. Tables anatomiques (1734). The author briefly writes about the anatomy, properties and attachment of the ligamentum capitis femoris (LCF). There are known translations of the treatise into Latin ( 1732KulmusJA ) and French ( 1734KulmusJA ). Quote p. 51 [Deu] Translation [Eng] с . In the upper part of the head there is a recess in which the round ligament is attached. Quote p. 54 [Deu] Translation [Eng] 2.) The round ligament is short but very strong; it arises at the bottom of the acetabulum and joins the fossa at the top of the femoral condyle. External links Kulmus JA. Anatomische Tabellen: Nebst dazu gehörigen Anmerckungen und Kupffern, Daraus des gantzen Menschlichen Cörpers Beschaffenheit und Nutzen deutlich zu ersehen; Welche Den Anfängern der Anatomie zu bequemer Anleitung verfasset hat… Nuremberg, Frankfort, Leipzig: J.A. von Creutz, MDCCXXXX [1740]. [ archive.org ] Authors & Affiliations Johann Adam Kulmus (...

ILIOTIBIAL TRACT & LCF

ILIOTIBIAL TRACT & LCF There is an opinion that the iliotibial tract, like the ligamentum capitis femoris (LCF), provides pressing of the acetabulum to the lower surface of the femoral head. I think that this is not true. The tract is located above and lateral to the center of rotation of the hip joint. Its force vector, like the force vector of the abductor group of muscles, presses the acetabulum to the upper part of the femoral head, which increases the load on it. The ligamentum capitis femoris acts in the opposite direction. Below is a diagram for a single-support position. #ligamentum_teres #hip #biomechanics #ligamentum_capitis_femoris Publication in the facebook group 04/12/2025. ...

Human Children. Retelling of Chapter 13

Short retelling of chapter 13 of the essay: Arkhipov S.V. Human Children: The Origins of Biblical Legends from a Physician's Perspective. Joensuu: Author's Edition, 2025. [In Russian] Chapter 13. PROPHETIC DREAMS After his wanderings and battles, Abraham settles in “Mamre’s oaks in Hebron.” Following these events, he experiences a divine “word in a vision” and a dream promising him lands “from Egypt’s river to the great river, Euphrates.” His family relocates to a desert along the Shur road, near the well “Beer-Lahai-Roi,” between Kadesh and Bered. In another divine appearance, Abraham is commanded to circumcise all males’ foreskins, rename Sarai as Sarah, and is told he’ll father a child at 100, despite Sarah’s barrenness at 89. That day, Abraham circumcises his son Ishmael, household males, and, at 99, himself. In Mamre’s oaks, during “daytime heat,” a mirage foretells fatherhood. The dream shifts, showing Sodom and Gomorrah’s destruction and Lot’s miraculous rescue. ...

1548HirschvogelA

Hirschvogel A, etching Jacob Wrestling with the Angel (1548). Depicting the circumstances and mechanism of the ligamentum capitis femoris (LCF) injury based on the description in the Book of Genesis: 25 And Ja cob was left alone; and there wrestled a man with him until the breaking of the day. 26 And when he saw that he could not pre vail against him, he struck against the hollow of his thigh ; and the hollow of Jacob's thigh was put out of joint, as he was wrestling with him. … 33 Therefore do the children of Israel not eat the sinew which shrank, which is upon the hollow of the thigh, unto this day; because he struck against the hollow of Jacob's thigh on the sinew that shrank. ( 1922LeeserI , Genesis (Bereshit) 32:25-26,33) More about the plot in our work: Ninth month, eleventh day ( 2024АрхиповСВ. Девятый месяц, одиннадцатый день ). Augustin Hirschvogel – Jacob Wrestling with the Angel (1548). Photo by Jojojoe; original in nga.g...

1914JonesFW_MorrisH

We are publishing a chapter from the fifth edition of «Morris's Human Anatomy» (1914). A significant portion of it is dedicated to the ligamentum capitis femoris (LCF). The original text has been edited by Wood Jones. Particularly notable are the illustrations depicting the LCF. Some of them are improved drawings by the first author ( 1879MorrisH ). Quote pp. 276-284 1. THE HIP-JOINT Class. — Diarthrosis. Subdivision. — Enarthrodia. The hip is the most typical example of a ball-and-socket joint in the body, the round head of the femur being received into the cup-shaped cavity of the acetabulum. Both articular surfaces are coated with cartilage, that covering the head of the femur being thicker above where it has to bear the weight of the body, and thinning out to a mere edge below; the pit for the ligamentum teres is the only part uncoated, but the cartilage is somewhat heaped up around its margin. Covering the acetabulum, the cartilage is horseshoe-shaped, a...

LCF in 2026 (August)

LCF in 2026 (August ) (Quotes from articles and books published in August 2026 mentioning the ligamentum capitis femoris) Maldonado, D. R., Schab, A. R., & Domb, B. G. (2026). Improvement in Patient‐Reported Outcomes, High Rate of Return to Sport, and Secondary Surgery Rate Ranging From 0% to 9.8% After Hip Arthroscopy in Dancers and Athletes in Flexibility Sports: A Systematic Review. Arthroscopy, Sports Medicine, and Rehabilitation , e70020. [i] arthroscopyjournals.onlinelibrary.wiley.com Klingele, K., & Strub, D. (2026). Author Response: Considerations and Challenges in Open Reduction With Ligamentum Teres Reconstruction for Pediatric Developmental Dysplasia of the Hip. Journal of Pediatric Orthopaedics . [ii] ovid.com Quesada‐Jimenez, R., Rana, K., Strok, M. J., Kahana‐Rojkind, A. H., Burt, A. K., Sugarman, E. P., & Domb, B. G. (2026). Dual Labral and Ligamentum Ter...

1849QuainJ

Fragments from the book by Jones Quain (fifth edition): Elements of anatomy Vol. 1 (1849), the first edition was published in 1828. The author writes about the anatomy of the ligamentum capitis femoris (LCF) and mentions synonyms. Quote p. 278 THE HIP-JOINT. This is a true ball-and-socket joint, in which the globular head of the femur is received into the acetabulum or cotyloid cavity. The articulating surfaces are covered by cartilage in the greater part of their extent. It is deficient, however, at the bottom of the cavity, and also a little beneath the central point of the head of the femur; the latter marking the insertion of the round ligament, the former a shallow fossa for the lodgment of the structure which has been called the synovial gland. The connecting means in this articulation are three ligaments, viz. a capsular, cotyloid, and interarticular ligament, together with a synovial membrane. Fig. 147. Ligaments of the pelvis and hip-joint. The view is t...

LCF in 2025 (July)

LCF in 2025 ( July ) (Quotes from articles and books published in July 2025 mentioning the ligamentum capitis femoris.) Tekcan, D., Bilgin, G., & Güven, Ş. Evaluation of Risk Factors for Developmental Dysplasia of the Hip. HAYDARPAŞA NUMUNE MEDICAL JOURNAL , 65 (2), 99-103. [i] jag.journalagent.com Domb, B. G., & Sabetian, P. W. (2025). Greater Trochanteric Pain Syndrome: Gluteal Tendinopathy, Partial Tear, Complete Tear, Iliotibial Band Syndrome, and Bursitis. In Orthopaedic Sports Medicine (pp. 1-17). Springer, Cham. [ii] link.springer.com Kuhns, B. D., Becker, N., Patel, D., Shah, P. P., & Domb, B. G. (2025). Significant Heterogeneity in Existing Literature Limits Both Indication and Outcome Comparability Between Studies Involving Periacetabular Osteotomy For Acetabular Dysplasia With or Without Arthroscopy Despite Improvement for Both: A Systematic Review. Arthroscopy . [iii] ...

150-200Pseudo-Galen

Fragment from the treatise Pseudo-Galen Introduction, or the Physician ( Εἰσαγωγὴ ἢ Ἰτρός ; Introductio, seu Medicus; ca. 150-200 [our opinion]). The author notes the connecting function of the ligamentum capitis femoris (LCF) and also specifies the proximal and distal attachment sites. See our commentary at the link: 150-200Pseudo-Galen [Rus]. Quote [Grc] Εἰσαγωγὴ ἢ Ἰτρός . K εφ . ιβ . [ Περί όστεολογἰας .] μηρου δέ έν μεν οστούν . συμβάλλει δε επικεκαμμένη μετρίως τη κεφαλή αυτού εις βαθείαν κοτύλην του ισχίου και νεύρῳ απήρτηται εκφυομένω εκ μέσης της κοτύλης και εμφυομένω εις μέσην την κεφαλήν του μηρού . (original source: 1827KühnCG, pp. 723-724) [Lat Introductio, seu Medicus. Cap. XII. [De osteologia] Femoris os unum est, cujus caput leniter reflexum in coxae profundum sinum conjicitur. Quam commissuram nervus, qui e medio sinu prodit et in medium femoris caput inseritur, continet. (original source: 1827KühnCG, pp. 723-724) Translation [Eng] Introduction, or the Phy...

Human Children. Retelling of Chapter 7

Short retelling of chapter 7 of the essay: Arkhipov S.V. Human Children: The Origins of Biblical Legends from a Physician's Perspective. Joensuu: Author's Edition, 2025. [In Russian] Chapter 7. ABEL AND CAIN A pivotal moment in the saga of early humanity was the departure from the "Garden of Eden" to cultivate fields, with a focus on growing grains, as "bread" is mentioned earlier in Genesis. The text does not specify where Adam and Eve settled after leaving Eden, but we can infer it was a warm region with ample water for crops and livestock. This is evidenced by their sons’ occupations: Cain as a "tiller of the ground" and Abel as a "keeper of sheep." Over time, Cain and his family moved "east of Eden" to the land of "Nod," where he founded a "city"—a settlement with permanent dwellings. His descendants developed sophisticated skills: some mastered music, playing the stringed "lyre" and the ...

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