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.

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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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NEWS 2026

New publications of our resource in 2026 The initial phase of collecting data on LCF, accumulated prior to the 20th century, is largely complete. Next, we plan to analyze and synthesize thematic information, adding data from the 20th and 21st centuries. The work will focus primarily on: prevention, diagnosis, arthroscopy, plastic surgery, and endoprosthetics. January 05, 2026 2018YoussefAO The article describes a method for transposition of the proximal attachment of the LCF in congenital hip dislocation. 2007WengerD_OkaetR The authors demonstrated in the experiment that the strength of the LCF is sufficient to ensure early stability during hip joint reconstruction in children. January 04, 2026 2008 BacheCE _TorodeIP The article describes a method for transposition of the proximal attachment of the LCF in congenital hip dislocation . 2021PaezC_WengerDR The ar ticle analyzes the results of open reconstruction of LCF in dysplasia. 2008DoddsMK...

IMPROVING POSTOPERATIVE COMFORT...

Improving Postoperative Comfort and Increasing the Reliability of Hip Prostheses by Supplementing with Artificial Ligaments: Proof of Concept and Prototype Demonstration S.V. Arkhipov, Independent Researcher, Joensuu, Finland CONTENT [i] Abstract [ii] Introduction [iii] Materials and Methods [iv] Results and Discussion [v] Static Tests [vi] Dynamic Tests [vii] Prototype Fabrication and Testing [viii] Conclusion [ix] References [x] Application [i] Abstract The principle of operation of an experimental total hip endoprosthesis augmented with ligament analogs has been demonstrated in single-leg vertical stances and at the mid-stance phase of the single-support period of gait. The experiments were conducted on a specially designed mechatronic testing rig. The concept of the important role of the ligamentous apparatus is further illustrated by a set of demonstrative mechanical models. The...

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...

2008DoddsMK_McCormackD

Content [i] Annotation [ii] Original text [iii] References [iv] Source & links [v] Notes [vi] Authors & Affiliations [vii] Keywords [i] Annotation Abstract of the article: Dodds MK et al . Transarticular stabilization of the immature femoral head: assessment of a novel surgical approach to the dislocating pediatric hip in a porcine model (2008). The article describes an experiment of reconstruction of ligamentum capitis femoris (LCF) in pigs with the formation of a femoral tunnel. The text in Russian is available at the following link: 2008DoddsMK_McCormackD . [ii] Original text Abstract Background: Acetabular dysplasia and hip instability are common in neuromuscular diseases such as spina bifida and cerebral palsy due to deranged muscle function around the hip. Occasionally in developmental dysplasia of the hip, persistent instability may be difficult to manage by standard treatments. It i...

LCF in 2025 (December)

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...

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...

1724FabriciusJA

Fragments from the book Fabricius JA. Bibliothecae Graecae volume duodecimum (1724). The author quotes the Byzantine physician Theophilus Protospatharius, who supposedly lived between the 7th and 10th centuries. Selected passages provide views on the normal anatomy of the ligamentum capitis femoris (LCF) and its inherent connective function. [Grc] θεοφιλος ο Πρωτοσπαθάριος . Περὶ τῆς τοῦ ανθρώπου κατασκευῆς . Βιβλιον Ε . XIII, [p. 892] (see fig.) [Lat] Theophilus Protospatharius. De corporis humani fabrica, Liber quintus, Cap. XIII [p. 892] 1) Dei erga homines amor ex heminae fundo teretem nervum promisit, cartilaginosum vinculum femoris capiti insertum adstringensque, ne facile elabatur:» 2) inde ex heminae oris aliae copulae oriuntur, totum femoris caput in orbem constringentes, non teretes & solae, qualis quae ex fundo porrigitur, sed latae, valenter que heminae oras ad commissurae praesidium ambientes. Translation [Eng] 1) For the sake ...

2011HosalkarHS_WengerDR

Content [i] Annotation [ii] Original text [iii] References [iv] Source & links [v] Notes [vi] Authors & Affiliations [vii] Keywords [i] Annotation Abstract of the article: Hosalkar HS et al . Isocentric reattachment of ligamentum teres: a porcine study (2011). The article describes a method of isocentric fixation of the proximal end of the ligamentum capitis femoris (LCF) during plastic surgery in an experiment on pigs. The text in Russian is available at the following link: 2011HosalkarHS_WengerDR . [ii] Original text Abstract Background: Recent reports reveal interest in the mechanical importance of ligamentum teres (LT) in hip dislocation. In the previously established procedure of anteroinferior acetabular LT reattachment in developmental dysplasia of the hip, the LT functions as a check-rein, showing promising results. However, this position of reattachment could potentially limit motion. Th...

2023AbibeRB_SaundersWB

Article: Abibe RB et al. Ligamentum teres reconstruction using autogenous semitendinosus tendon with toggle technique in rabbits (2023). The article describes experimental reconstruction of ligamentum capitis femoris (LCF) in rabbits. The text in Russian is available at the following link: 2023AbibeRB_SaundersWB . Ligamentum teres reconstruction using autogenous semitendinosus tendon with toggle technique in rabbits Abibe RB, Rahal SC, Reis Mesquita LD, Doiche D, da Silva JP, Mamprim MJ, Pinho RH, Battazza A, Alves CEF, Saunders WB CONTENT [i] Abstract [ii] Introduction [iii] Materials and Methods [iv] Results [v] Discussion & Conclusion [vi] References [vii] Application [i] Abstract Background Ligamentum teres (LT) has traditionally been considered a vestigial or redundant structure in humans; however, based on new studies and the evolution of hip arthroscopy, the LT injury has been viewed as a source of hi...

2007WengerD_OkaetR

Content [i] Annotation [ii] Original text [iii] References [iv] Source & links [v] Notes [vi] Authors & Affiliations [vii] Keywords [i] Annotation Abstract of the article: Wenger D et al . The mechanical properties of the ligamentum teres: a pilot study to assess its potential for improving stability in children’s hip surgery (2007). The authors demonstrated in the experiment that the strength of the ligamentum capitis femoris (LCF) is sufficient to ensure early stability during hip joint reconstruction in children. The text in Russian is available at the following link: 2007WengerD_OkaetR . [ii] Original text Abstract The anatomic and histological characteristics of the ligamentum teres and its vascular contributions to the femoral head have been well described. The function of the ligamentum teres remains poorly understood. Although excision is the current standard in treating complete developme...

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