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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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...

The First Scientific Mention

European science has known the LCF for about 2500 years. It is the most important functional connection of the hip joint. The first person to describe the LCF was Hippocrates (c. 460-370 BCE). A written mention of the LCF is found in §1 of his treatise "On the Instrument of redactions". In our opinion, a book created in the library of the Asclepeion of the island of Kos. Hippocrates did not dissection of the human body, did not operate on the hip joint, did not have a CT scan and MRI. How he could discover the LCF? In our view, it is possible that Hippocrates treated a patient with an open hip dislocation. Track Music: Blue Dot Sessions , Vittoro (CC BY-NC 4.0 DEED / fragment) keywords: ligamentum capitis femoris, ligament of head of femur, ligamentum teres, hip dislocation . ...

University_of_Guelph(website)

Content [i] Annotation [ii] Original text [iii] Illustrations [iv] Source & links [v] Notes [vi] Authors & Affiliations [vii] Keywords [i] Annotation A quote from an article on the University of Guelph website. The publication mentions the animal's ligamentum capitis femoris (LCF) and states its function: fixing the femoral head in the acetabulum. The text in Russian is available at the following link: University_of_Guelph(website) . [ii] Original text Quote 1. Hindlimb skeleton. Femur [animals] The articular head of the femur is deeply rounded and it bears a round ligament that holds it into the acetabulum. [iii] Illustrations – [iv] Source & links STRUCTURE OF THE SKELETON. 2023. animalbiosciences.uoguelph.ca [v] Notes The work is cited in the following publications: [vi] Authors & Affiliations Unive...

BIOMECHANICS OF THE HIP JOINT WITHOUT LCF

Biomechanics of the hip joint without LCF Do you remember the comparison of the ligamentum teres with the spring element of a cart? ( 1874SavoryWS ). An analogy could arise after reading the book Bell J. The Principles of Surgery (1801) . Most orthopedists still think so. For more details see: https://roundligament.blogspot.com/2024/04/1836-1840partridger.html & 1836-1840PartridgeR (remembering the history of orthopedics) #ligamentum_teres #ligamentum_capitis_femoris #hip #biomechanics Publication in the facebook group 03/28/2025. ...

The First Open Reconstruction

The first open reconstruction of the ligamentum capitis femoris (LCF) was performed in 1926 by Ernest William Hey Groves (1872-1944) (1927Hey-GrovesEW). The surgery was proposed for the treatment of congenital hip dislocation in children. Later, in 1928, regarding this pathology, he noted: «Congential dislocation of the hip is a deformity which is mysterious in its origin, insidious in its course and relentless in its final crippling results» (quoted from 1983RatliffAH). In the early 20th century, a pioneer in orthopedic surgery realized that the LCF played a crucial role in the development of this pathology and developed a technique for its reconstruction. Illustration: Open reconstruction of the LCF in congenital hip dislocation. Copies of drawings from 1927Hey-GrovesEW with our additions; arrows indicate the reconstructed LCF. . ...

1747PlatnerJZ

Fragments of the book by J.Z. Platner « Institutiones Chirurgiae rationalis ...» (1747) with mention of ligamentum capitis femoris (LCF). The author describes the LCF as a durable structure that can be damaged by traumatic hip dislocations and also become pathologically altered: weakened, elongated, and disappear. The text is prepared for machine translation using a service built into the blog from Google or your web browser. In some cases, we have added links to quotations about LCF available on our resource, as well as to publications posted on the Internet. Quote p p . 432-433 §. 1192. Femur parte sua suprema habet magnum teretemque processum, qui oblique ad os coxæ procedit, quem cervicem appellant. Hæc cervix, intus rara & cavernosa, desinit in magnum & rotundissimum caput, cartilagine etiam mollitum, quod in sinum rotundum coxæ conjicitur. Sinus Anatomicis κοτύλη , vel acetabulum, vocatur, qui in junioribus ex tribus ossibus, quæ media cartilagine inter se co...

The Big Bang

The Big Bang The maximum age of the observable Universe, established by measuring the anisotropy of the cosmic microwave background, is 13.801±0.024 billion years. (2020AghanimN_RoudierG). The relic stages of the creation of the World are only approxim ately understood by theoretical physicists. The development of matter into molecules, as well as the start of time, is logically described by the Big Bang theory and the concept of the expansion of space (2012HawkingS). It is impossible to imagine the Universe before its expansion from some homogeneous space or an infinitesimal grain. The reason for this is the «inner cosmic oblivion» of the previous state (2007BojowaldM). In our opinion, before that there was a black, cold, motionless Peace. Accordingly, before the mark of 13.8 billion years ago, the search for evidence of ligamentum capitis femoris (LCF) is futile anywhere in the Universe. One second after the Big Bang, the Universe consisted of light and elementary particles hea...

280-352Rava

Sayings of Rava extracted from the tractates Chullin and Horayot (Babylonian Talmud). Babylonian Talmud was written between about 450 - 550 in present-day Iraq (formerly Babylonia). The rabbi identifies the location and distal attachment site of the ligamentum capitis femoris (LCF) and demonstrates knowledge of its function. See our commentary at the link: 280-352Rava [Rus]. Quote 1. [Heb] Chullin 54b3 (original source: sefaria.org ) Quote 2. [Heb] Chullin 91a12 (original source: sefaria.org ) Quote 3. [Heb] Horayot 12a:16 (original source: sefaria.org ) Translation Quote 1. [Eng] Chullin 54b3 The Gemara addresses the matter itself: Rav Mattana says: This head of the femur that was completely dislocated renders the animal a tereifa. And Rava said: The animal is kosher, but if its sinew holding the bone in place is cut, it is a tereifa. The Gemara concludes: And the halakha is: Even if the sinew is cut, the animal is still kosher...

1876SappeyMPC

Fragments from the book Sappey PC. Traité d'anatomie descriptive. T.1 (1876). The author summarized the basic information about ligamentum capitis femoris (LCF). The text is prepared for machine translation using a service built into the blog from Google or your web browser. In some cases, we have added links to quotations about LCF available on our resource, as well as to publications posted on the Internet. FIG. 225. Extrémité supérieure du fémur. FIG. 225. I, 1. Tête du fémur. - 2. Dépression à laquelle s'attache le ligament rond - 3. Ligne courbe séparant la partie supérieure de la tête fémorale da la partie correspondante du col. - 4. Ligne courbe qui sépare la partie inférieure de la tête de la partie inférieure du col. - 5. Angle obtus que forment ces deux lignes en s'unissant par leur extrémité antérieure. - 6. Bord supérieur du col. - 7. Son bord inférieur. - 8. Tuber cule du grand trochanter, destiné à recevoir l'insertion du faisceau supérieur du ligamen...

922-722bcElohist

Excerpt from the book of Bereishit (Genesis), the lost biblical source Elohist, written in Paleo-Hebrew script. A variant of the oldest description of damage to the ligamentum capitis femoris (LCF) and the cause of lameness in Hebrew, dating from 922-722 BCE. See our commentary at the link: 922-722bcElohist [Rus]. Quote [ Paleo-Hebrew ] Elohist. Bereshit 32:32-33 (original source: 5784 Moshe Ben Amram, p. 41; our correction) Translation [Eng] Elohist. Bereshit 32:32-33 and the sun riseth on him when he hath passed over Penuel, and he is halting on his thigh; therefore the sons of Israel do not eat the sinew which shrank, which is on the hollow of the thigh, unto this day, because He came against the hollow of Jacob's thigh, against the sinew which shrank. (our correction-reconstruction of the version 1898 YoungR ( p. 23, Bereishit 32:32-33); preserved the text of the age of 922-722 BC belonging to the lost biblical source "Elohist") Moshe Ben Amram. Pentateuch in P...

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