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

Comments

4cent.Gothic Bible

About the Book of Genesis of the Gothic Bible (4th century). A Gothic term that may have been used to refer to the ligamentum capitis femoris (LCF) of an animal and a human. See our commentary at the link: 4cent.Gothic Bible [Rus]. Quote [ Got ] Genesis 32:33 (possible term; original source lost) Translation [Eng] Genesis 32:33 The original text and English translation are currently unavailable to our project. Suggested term: … gabinda ( gabundi) … The closest analogue is in the Epistle to the Colossians 2:19 — jah ni habands haubiþ, us þammei all leik þairh gawissins jah gabindos auknando jah þeihando wahseiþ du wahstau gudis. — καὶ οὐ κρατῶν τὴν κεφαλήν , ἐξ οὗ πᾶν τὸ σῶμα διὰ τῶν ἁφῶν καὶ συνδέσμων ἐπιχορηγούμενον καὶ συμβιβαζόμενον αὔξει τὴν αὔξησιν τοῦ θεοῦ . — And not holding the Head, from which all the body by joints and bands having nourishment ministered, and knit together, increaseth with the increase of God. (original source: wulfila.be ; Codex Ambrosianus? Milan, Bi

2018FreitasA_BandeiraVC

The authors reported a case of open hip dislocation and documented avulsion of the ligamentum capitis femoris (LCF) from the acetabulum. The injured LCF appeared as a large cord-like structure, attached to the femoral head ( Fig. 1 ). Perhaps Hippocrates of Kos saw such an LCF in open dislocation of the hip and described it in his treatise «Mochlicus» ( 1886AdamsF ). One year later, the patient's x-ray revealed a significant narrowing of the joint space in the upper part of the hip joint ( Fig. 9 ). In our opinion, this to be a consequence of hyaline cartilage wear due to overload in the absence of LCF. In an unaffected hip joint, the width of the radiological joint space at the upper section than in the lower section ( Ossification of the LCF ). When examined one year after the injury, the patient could stand on one leg. We noticed that his body was excessively deviated towards the supporting hip joint, and the opposite half of the pelvis was elevated ( Fig. 8 ). This is a me

1875BrauneW

We present a study dedicated to the experimental investigation of the function of the ligamentum capitis femoris (LCF). Wilhelm Braune established that the LCF prevents hip supination and adduction, especially during flexion. In the conclusion of the study, the author writes: "It also remains to determine in which body movements this ligament function plays a role, as it is currently unclear why the femur requires a special fixing device…". Apparently, Wilhelm Braune did not have time to find the answer, since his outstanding monograph on LCF does not say a word ( Braune W, Fischer O. Der Gang des Menschen (1895 books.google ) . Based on our own experiments on mechanical models and research, we believe that adduction and supination of the hip, along with flexion, are observed at the beginning of the single-support period of the step. At this moment, tension occurs in the LCF, allowing to reduce the load on the upper segment of the femoral head. The LCF is also stretched in

927-942Arabic Bible

Fragment of the Book of Bereshit translated into Arabic by Saadia Gaon ( 927-942 ) . The Arabic text contains mentioned to ligamentum capitis femoris (LCF) of an animal and a human. See our commentary at the link: 927-942ArabicBible [Rus]. Quote [ a ra] التكوين 32:32 (original source: 1653WaltonB, p. 145) See also modern editions: لذلك لا يأكل بنو اسرائيل عرق النّسا الذي على حقّ الفخذ الى هذا اليوم . لانه ضرب حقّ فخذ يعقوب على عرق النّسا (original source: arabicbible.com ) لِذَلِكَ لا يَاكُلُ بَنُو اسْرَائِيلَ عِرْقَ النَّسَا الَّذِي عَلَى حُقِّ الْفَخِْذِ الَى هَذَا الْيَوْمِ لانَّهُ ضَرَبَ حُقَّ فَخْذِ يَعْقُوبَ عَلَى عِرْقِ النَّسَا (original source: copticchurch.net ) Translation [Eng] Genesis 32:32 Translation of the text is currently unavailable for our project. The term for the LCF: النّسا ~ sciatica ( see also: 70-110Rufus Ephesius ; 180-238PolluxJ ) Saʻadia ben Joseph . Pentateuch ( 1600) , p. 1 ( original: digital.library.yu.edu ) External links Saʻadia

2016ArkhipovaAS Classification of Joints with Flexible Elements.

Classification of Joints with Flexible Elements The classification of joints with flexible elements was first proposed by A.S. Arkhipova in 2016 and presented at conferences in 2016-2017 ( 2017АрхиповаАС ). Joints with flexible elements are divided by the author into detachable and non-detachable, three-axis, two-axis, and single-axis. Each can contain in various combinations one or more external and internal flexible elements - analogs of joint ligaments, including the ligamentum capitis femoris (LCF). Conditional designations of joints with flexible elements using the example of a ball joint: Detachable ball joint with an internal flexible element Non-detachable ball joint with an internal flexible element Detachable ball joint with an external flexible element Non-detachable ball joint with an external flexible element Detachable ball joint with both internal and external flexible elements Non-detachable ball joint with both internal and external flexible elements Flexible e

1879MorrisH

Fragments of the book Morris H. The anatomy of the joints of man (1879) dedicated to ligamentum capitis femoris (LCF). The author discusses the anatomy of the LCF and describes his experiments to study its movement. Quote p p . 318-319 The acetabulum is partly articular, partly non-articular. The articular portion is of horseshoe shape, and extends inwards from the margin, more or less. It is altogether deficient at the cotyloid notch, which corresponds with the gap of the horseshoe. It is the widest at the iliac part, where it is over one inch from without inwards; then it very gradually gets narrower along the ischium, but widens out again at the ischial end of the cotyloid notch ; forwards from the pubo-iliac suture it narrows more rapidly, and does not extend quite up to the pubic end of the cotyloid notch. At its narrowest point in an adult bone it measures half an inch in width. When coated with cartilage, and fringed round with the cotyloid ligament, it fits very closel

DIAGNOSTICS AND EXAMINATION

DIAGNOSTICS AND EXAMINATION (Diagnostic, examination and testing methods... ) Catalog. LCF Pathology Tests Tests for the detection of pathology LCF. 2004VialleR_GlorionC The article discusses the examination technique for dislocation of the femur and describes the radiographic symptom of infringement of the damaged LCF. BLOG CONTENT

150-250Targum Jonathan

Fragments from the Targum Jonathan on Genesis. Tractate was written between about 150 - 250 in lend of Israel. The text is a combination of a translation and commentary on the book of Bereshit. The unknown compiler mentions ligamentum capitis femoris (LCF) in an animal and an episode of its damage in a human. See our commentary at the link: 150-250Targum Jonathan [Rus]. Quote 1. [Heb] Genesis. 32:33 (original source: sefaria.org ) Quote 2. [Heb] Genesis. 43:16 (original source: sefaria.org ) Translation Quote 1. [Eng] Genesis. 32:33 Therefore, the sons of Israel eat not the sinew which shrank, which is in the hollow of the thigh of cattle and of wild animals, until this day; because the Angel touched and laid hold of the hollow of the right thigh of Jakob, in the place of the sinew which shrank. (Transl. by J.W. Etheridge (186 2 ) ; original source: targum.info ) Quote 2. [Eng] Genesis. 43:16 And Joseph saw Benjamin with them: and he said to Menasheh whom he had made superintende

1679DiemerbroeckI

Fragments from the book Diemerbroeck I. Anatome corporis humani (1679). The author describes the pathology variants, function, topography and attachment of the ligamentum capitis femoris (LCF). The damage to the LCF in hip dislocation, symptoms and treatment are discussed. The text is similar to a paraphrase of Hegetor's work «On Causes» and Galen of Pergamon's commentary on Hippocrates' treatise «On Joints» ( 1745CocchiA ; 2020ArkhipovSV_ProlyginaIV ). Isbrand van Diemerbroeck uses many synonyms for LCF: nervus cartilaginosus, terete, teres, rotundum ligamentum, interius ligamentum. Quote p. 593. [Lat] CAPUT XIX. De Ossibus Femoris, & Cruris. Superius procesum crassum, versus coxendicis os prominentem, eique epiphyin rotundam & amplam impositam habet, sicque globosum femoris caput, valida cervice subnixum, constituit, quod cartilagine obductum in coxendicis acetabulum reconditur, in eoque duobus validis ligamentis detinetur: uno lato, crasso, & membranoso,

2014ArkhipovaAS

In 2014, at the International Olympics Space for school students, Alexandra Arkhipova presented a report on the feasibility of using joints with flexible elements in walking machines. The author was recognized as the overall winner (more details: cyclowiki.org ). The report suggested: «An important area of possible application of walking robots would be remote exploration of other planets». Ten years later, professionals from NASA began to put this idea into practice: Robot dog trains to walk on Moon in Oregon trials (more details: bbc.com ). Below we present the text of the first message about walking machines in space, the ball joint of which contains a flexible element - an analogue of the ligamentum capitis femoris (LCF). Mobile biomorphic platforms with analogues of natural locomotion algorithms Arkhipova A.S. For ten years of its mission, American wheeled Mars rover vehicle 'Opportunity' covered just 40 kilometers through the Red Planet, and its twin Spirit go

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