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

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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]

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ETIOLOGY AND PATHOGENESIS

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THE GIFTS OF THE MAGI FOR ORTHOPEDIC SURGEONS

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11th-15th Century

11th-15th Century Catalog of archived publications of the specified period 11th century 976-1115Theophilus Protospatharius The author writes about the normal anatomy of the LCF and its connective function. 1012-1024Avicenna The author writes about the localization and variant of the pathology LCF, leading to hip dislocation. 1039-1065Giorgi Mtatsmindeli The translator mentions the LCF damage, and notes its presence in animals. 12 th century 1120-1140Judah Halevi The author mentions LCF (גיד) of mammals. 1176-1178(a)Rambam The author mentions the pathology of LCF (גיד) in humans and points out the presence of this structure in animals. 1176-1178(b)Rambam The author writes about the localization of LCF (גיד) ) and distinguishes it from a tendon, blood vessel or nerve. 1185-1235David Kimchi The author writes about the localization, purpose, and injury of the LCF (גיד), and also talks abo...

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LCF in 2025 ( December) (Quotes from articles and books published in December 2025 mentioning the ligamentum capitis femoris) Sarassa, C., Aristizabal, S., Mejía, R., García, J. J., Quintero, D., & Herrera, A. M. (2025). Intraosseous Tunneling and Ligamentum Teres Ligamentodesis “Teretization” to Enhance Stability in Congenital Hip Dislocation Surgery: Surgical Technique and Mid-Term Outcomes. Journal of Pediatric Orthopaedics , 10-1097. [i] journals.lww.com Kampouridis, P., Svorligkou, G., Spassov, N., & Böhme, M. (2025). Postcranial anatomy of the Late Miocene Eurasian hornless rhinocerotid Chilotherium. PLoS One , 20 (12), e0336590. [ii] journals.plos.org Burdette, T. N., Hsiou, C. L., McDonough, S. P., Pell, S., Ayers, J., Divers, T. J., & Delvescovo, B. Sidewinder syndrome associated with complete rupture of the ligamentum capitis ossis femoris in a horse. Eq...

Catalog. Classifications of LCF Pathology

The classifications are intended to systematize of ligamentum capitis femoris pathology and assist in the development of general approaches to its description, registration, analysis and treatment. Keywords ligamentum capitis femoris, ligamentum teres, ligament of head of femur, hip joint, histology, pathological anatomy, pathology, trauma INTRODUCTION In Russia, the initial attempts to classify pathology of the ligamentum capitis femoris (LCF) were made by morphologists. The development of arthroscopic surgery has made it possible to identify various, previously undescribed types of LCF pathology, which prompted the development of various modern classifications based on intraoperative observations. Analysis of literature data and our own morphological observations allowed us to propose a General Classification of the Ligamentum Teres Pathology, which has the form of a collection of classifiers, as well as a Classification of Functions of the Ligamentum Teres. The ...

2008WengerDR_MiyanjiF

Article: Wenger DR et al. Ligamentum teres maintenance and transfer as a stabilizer in open reduction for pediatric hip dislocation: surgical technique and early clinical results (2008). The article describes a method of open reconstruction of the ligamentum capitis femoris (LCF) for hip dysplasia. The text in Russian is available at the following link: 2008WengerDR_MiyanjiF . Ligamentum teres maintenance and transfer as a stabilizer in open reduction for pediatric hip dislocation: surgical technique and early clinical results Wenger DR, Mubarak SJ, Henderson PC, Miyanji F CONTENT [i] Abstract [ii] Introduction [iii] Materials and Methods [iv] Surgical technique & Results [v] Discussion & Conclusion [vi] References [vii] Application [i] Abstract Purpose The ligamentum teres has primarily been considered as an obstruction to reduction in children with developmental dislocation of the hip (DDH). In the ea...

1834MitchellE_KnoxR

Description and drawings of the proximal attachment and blood supply of the ligamentum capitis femoris (LCF) from book Mitchell E, Knox R. Engravings of the ligaments (1834 ). PLATE VI PLATE VI. … 49. The round ligament of the hip-joint, which arises from the sinus in the bottom of the acetabulum and descends into the head of the femur. 50. A portion of it which is thinner and membranous. 51. Portion of a ligament which arises from the outer surface of the ischiatic cavity and surrounds its neck as far as the notch of the acetabulum; there however it makes its way into the acetabulum, passing under the arch of the cotyloid ligament. 52. Branch of the obturator artery. 53. Two twigs which penetrate into the cotyloid cavity along with the ligament 51, to mingle with the round ligament. PLATE VII PLATE VII. Fig. 1. … 19, 19. Remarkable glands, which are concealed in the sinus of the acetabulum. 20. Origin of the exterior ligament which arises fr...

1970MichaelsG_MatlesAL

Content [i] Annotation [ii] Original text [iii] References [iv] Source & links [v] Notes [vi] Authors & Affiliations [vii] Keywords [i] Annotation Abstract of the article: Michaels G, Matles AL. The role of the ligamentum teres in congenital dislocation of the hip (1970). The authors proposed an analogy for the role of the ligamentum capitis femoris (LCF) as a “ball and chain control” and noted that it can spontaneously reduce congenital hip dislocation. The text in Russian is available at the following link: 1970MichaelsG_MatlesAL . [ii] Original text Quote p. 199 Many papers in the literature have implicated the ligamentum teres as a hindrance to the late open reduction of a congenitally dislocated hip. Occasionally the ligamentum teres has been reported to be absent. However, in most cases it is hypertrophied and elongated. Our present knowledge confirms the fact that congenital dislocation of t...

1893DenisM

Denis M., Jacob wrestling with the angel (1893). Depicting the circumstances and mechanism of the ligamentum capitis femoris (LCF) injury based on the description in the Book of Genesis: 25 And Jacob 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 ( 2024 АрхиповСВ. Девятый месяц, одиннадцатый день ). Maurice Denis – Jacob Wrestling with the Angel (ca. 1893); original in the wikimedia.org...

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