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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A Novel Technique for Proximal Fixation

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1851HyrtlJ

The author expresses a classic view on the functions of the ligamentum capitis femoris (LCF): a conductor of blood vessels and a limiter of adduction of the femur. J. Hyrtl believed that it was impossible to completely dislocate the hip without tearing the LCF. Hyrtl J. Lehrbuch der Anatomie des Menschen, mit Rücksicht auf physiologische Begründung und praktische Anwendung. Wien: W. Braumüller, 1851. [fragment] Quote p. 265 In der Höhle des Gelenks liegt das runde Band des Schenkelkopfes (Lig. teres), welches an der Incisura acetabuli entspringt, und bei richtiger Neigung des Beckens, senkrecht zur Grube des Schenkelkopfes aufsteigt. Es beschränkt dieses Band die Zuziehung des Schenkels, und schreibt zugleich den durch die Incisura acetabuli eindringenden Blutgefässen den Weg vor, den sie zum Oberschenkelkopfe zu nehmen haben. Da das Band, wenn es in die Höhle des Gelenkes vorragen würde, durch Reibung viel zu leiden hätte, so...

1902RilkeRM

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1823CooperA

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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] ...

1730CheseldenW

Fragments from the book Cheselden W. The Anatomy of the Human Body (1730). The author draws attention to the role of ligamentum capitis femoris (LCF) in counteracting hip dislocation and maintaining the femoral head in the joint. The work notes that the LCF is “powerful” and “short” - “about two inches” i.e. approximately 5 cm! This error will be corrected in a subsequent treatise ( 1733CheseldenW ) . Quote pp. 43 - 44 Chap. VII. Of the Ligaments At the upper part of the articulation of the Os Femoris and Os Innominatum, is a strong ligament of great consequence; it contributing very much to preserve that joint from being luxated by the weight of the body. And from the lower edge of the Acetabulum of the Os Innominatum, runs a ligament to the middle of the head of the Os Femoris, about two inches long (which the Motion in this joint requires) called Teres, or Rotundum, whose use is to prevent the Os Femoris from being luxated upwards, but down wards it will le...

LCF in 2026 (May)

LCF in 2026 (May ) (Quotes from articles and books published in May 2026 mentioning the ligamentum capitis femoris) Kim, P. S., Kang, C., Lee, J. K., & Hwang, J. M. (2026). Hip arthroscopy to treat symptomatic paralabral cysts: a retrospective analysis of clinical outcomes. Arthroscopy and Orthopedic Sports Medicine , 13 (1), 27-34. [i] e-aosm.org Ko, H. Y. (2026). Vascular Anatomy of the Extremities and Lungs. In Practical Functional Anatomy for Spinal Cord Injury Rehabilitation: A Guide for Physiatrists and Rehabilitation Specialists (pp. 191-223). Singapore: Springer Nature Singapore. [ii] link.springer.com Aiba, H., Yamaguchi, M., Kimura, H., & Murakami, H. (2026). Advances in limb-salvage surgery and reconstruction for pediatric bone and soft tissue tumors. Frontiers in Pediatrics , 14 , 1817788. [iii] pmc.ncbi.nlm.nih.gov Bajwa, A., Villar, R., ...

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Short retelling of chapter 14 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 14. ESAU AND JACOB At 40, Isaac marries Rebekah, his cousin’s daughter. Their marriage is long childless until Rebekah conceives twins, detected prenatally, possibly by her large belly or palpation. Genesis states that at 60, Isaac fathers the twins, born naturally after 20 years of marriage. The first, Esau, emerges “red, all hairy like a cloak,” followed by Jacob, unremarkable but grasping Esau’s heel. Over time, their differences deepen: Esau, a skilled hunter, roams fields; Jacob, gentle, stays in tents. Famine forces the family from “Beer-Lahai-Roi” in the Negev to “Gerar’s Philistine king,” then to “Gerar’s valley,” and finally to Beersheba. At 40, Jacob, urged by Rebekah, deceives blind Isaac to steal Esau’s inheritance, sparking enmity. Rebekah advises Jacob to flee to rela...

1877MorrisH

An excerpt from the article by Morris H. Dislocations of the Thigh: their mode of occurrence as indicated by experiments, and the Anatomy of the Hip-joint (1877, pp. 161-170). The author noted that the ligamentum capitis femoris (LCF) is stretched during flexion, adduction, and external rotation. It was found that the LCF is always damaged in hip dislocations, is more often torn from the femur, and is rarely ruptured. Discussion of article see article 1877BrookeC . DISLOCATIONS OF THE THIGH: THEIR MODE OF OCCURRENCE AS INDICATED BY EXPERIMENTS AND THE ANATOMY OF THE HIP-JOINT. BY HENRY MORRIS, M.A., M.B., F.R.C.S., ASSISTANT SURGEON TO, AND LECTURER ON ANATOY1 AT, THE MIDDLESEX HOSPITAL. Received January 9th-Read February 13th, 1877. RECENTLY, whilst making various dissections of the hip-joint, the usually accepted doctrine that dorsal and ischiatic dislocations of the femur occur when the thigh is in a position of adduction appeared to me as very improbable, on anatomi...

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