Perthes disease. Pathogenesis

An original view on the pathogenesis of Perthes' disease (femoral head osteochondropathy, Legg-Calvé-Perthes disease).

By the onset of Perthes disease, the hip joint is generally formed, and the femoral head and acetabulum represent bone structures. From our perspective, the initiating factor is trauma, specifically, damage to the ligamentum capitis femoris (LCF). This can be its rupture (most commonly), detachment from its attachment point, or irreversible plastic elongation. In other words, the amount of mechanical energy acting on the LCF, at a certain moment, exceeds the amount that it can absorb. Another option is possible when individual LCF fibers are damaged. Bioeffective stresses arise and increase in it, inducing biological processes that transform the LCF (for more details, see the Law of Bioinduction). As a result, it is either permanently damaged or significantly lengthened.

Due to damage or uncompensated lengthening of the LCF, the statics and dynamics of the hip joint are disrupted. In the single-support phase of gait and in the single-support posture, it no longer functions as a second-class lever, but as a first-class lever. In the upper sector of the femoral head and acetabulum, the value of the actual average daily stresses increases, which turns out to be greater than optimal stresses. Bioeffective stresses emerge. The volume of the femoral head is smaller than the volume of the pelvic bone, therefore the magnitude of the effective stresses, and therefore the average daily stresses in it is greater. Accordingly, bioeffective stresses are higher in the head of the femur and biological processes are more active.

Due to mechanical phenomena and biological processes in the upper sector of the femoral head, an area of compression of the spongy substance is formed with its subsequent restructuring. Partially the bone tissue atrophies, its mass in the upper sector decreases. The presence of bioeffective stresses induces adaptive processes in the femoral head. The granulation tissue that appears at the site of damage through the processes of metaplasia is gradually transformed into fibrous and then into bone tissue. With a satisfactory course of adaptive processes in the head of the femur, not only qualitative, but also quantitative changes are observed. The trabecular systems are rearranged, the shape of the femoral head changes, which increases in size.

Changes in the head of the femur neutralize bioeffective stresses in it. This is achieved by eliminating zones of stress concentration, increasing the contact area of the femoral head and acetabulum, strengthening their upper sectors due to subchondral sclerosis, thickening and increasing the number of trabeculae. As these changes develop, the optimal average daily stresses for the newly formed femoral head are equalized with the actual stresses, and the bioeffective stresses are leveled. After this, the ongoing adaptive processes induced by bioeffective stresses fade away. The hip joint acquires a different structure from the norm, and the kinematics of locomotion also changes.

Keywords: ligamentum capitis femoris, ligamentum teres, ligament of head of femur, hip joint, biomechanics, osteochondropathy, Perthes' disease, 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]

BLOG CONTENT

ETIOLOGY AND PATHOGENESIS

Comments

THE GIFTS OF THE MAGI FOR ORTHOPEDIC SURGEONS

Translation of the article: Архипов СВ. Новая техника проксимального крепления при реконструкции ligamentum capitis femoris: Дары волхвов ортопедическим хирургам. The text in Russian is available at the following link: 2026АрхиповСВ . A Novel Technique for Proximal Fixation of Ligamentum Capitis Femoris Reconstruction: The Gifts of the Magi for Orthopedic Surgeons S.V. Arkhipov, Independent Researcher, Joensuu, Finland CONTENT [i] Abstract [ii] Introduction [iii] Materials and Methods [iv] Technique [v] Discussion [vi] Conclusion [vii] Appendix [viii] References [ix] Structured Abstract [x] Additional material [i] Abstract An experimental technique for reconstruction of the ligamentum capitis femoris (ligamentum teres femoris) is described. The proposed method involves creating two portions of the ligament analog: a pubic portion and an ischial portion. Fixation of thes...

2025SarassaC_HerreraAM

Content [i] Annotation [ii] Original text [iii] References [iv] Source & links [v] Notes [vi] Authors & Affiliations [vii] Keywords [i] Annotation Abstract of the article : Sarassa C. et al . I ntraosseous Tunneling and Ligamentum Teres Ligamentodesis “Teretization” to Enhance S tability in Congenital Hip Dislocation Surgery: Surgical Technique and Mid-Term Outcomes (2025). The article describes a technique for fixing the femoral head using the ligamentum capitis femoris (LCF) in congenital hip dislocation. The text in Russian is available at the following link: 2025SarassaC_HerreraAM . [ii] Original text Abstract Background Developmental dysplasia of the hip (DDH) with complete dislocation (grade ≥III) in older patients often requires open reduction. However, achieving long-term stability remains challenging. This study introduces and evaluates a novel surgical technique, intraosseous tunneling ...

Who, When, and Where Wrote the Book of Genesis?

Who, When, and Where Wrote the Book of Genesis? A Medical Hypothesis By Sergey V. Arkhipov, MD, PhD & Lyudmila N. Arkhipova, BSN CONTENT [i] Abstract [ii] Introduction [iii] Egyptian physician [iv] Asian diviner [v] Conclusion [vi] References [vii] Application [i] Abstract The Book of Genesis is an example of an ancient literary text that contains important medical insights. We propose that it was written in northern Egypt in the late 17th century BCE, approximately ten years after the Minoan eruption. The protograph likely emerged from the collaboration between an Asiatic seer, who rose to the rank of an Egyptian official, and an Egyptian physician-encyclopedist. By refining its dating and authorship, this hypothesis positions Genesis as a credible source of medical and historical data, thereby enhancing its value for interdisciplinary research. [ii] Introduction According to Rabbinic Judais...

Online Journal «ABOUT ROUND LIGAMENT OF FEMUR», January 2026

The journal is dedicated to the ligamentum capitis femoris (LCF) and related topics About the Journal »»» . The online journal « About Round Ligament of Femur » was created based on the scientific blog of the same name. The resource is the English-language part of the project: ONLINE JOURNAL: Ligamentum capitis femoris . Updates: As new materials are prepared. Mission : Popularization and preservation of knowledge about LCF, as well as promoting its practical application. Main goal: Improvement of diagnosis, treatment, and prevention of injuries and diseases of the hip joint. Publisher: Arkhipov S.V., independent researc...

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 31, 2026 Online Journal «ABOUT ROUND LIGAMENT OF FEMUR», January 2026 January 22, 2026 Full access to the PDF version of the book: Human Children January 16, 2026 The necessary is needed by no one (facebook) January 15, 2026 Tweet of January 15, 2026 A Novel Technique for Proximal Fixation (facebook) January 14, 2026 2026 ArkhipovSV. THE GIFTS OF THE MAGI FOR ORTHOPEDIC SURGEONS ( A Novel Technique for Proximal Fixation of Ligamentum Capitis Femoris Reconstruction ). January 05, 2026 2018YoussefAO The article describes a me thod for transposition of the proximal ...

Online Journal «ABOUT ROUND LIGAMENT OF FEMUR», December 2025

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...

BIOMECHANICS AND MORPHOMECHANICS

BIOMECHANICS AND MORPHOMECHANICS (On the rela tionship between the mechanics and morphology of the hip joint... ) 1586PiccolominiA One of the first discussions of the biomechanics of the LCF with a description of its shape, mechanical properties and attachment. 1728 WaltherAF The selected excerpt discusses the anatomy, mechanical properties and function of the LCF. 1836WeberW_WeberE Fragments from the book that laid the foundation of biomechanics of the hip joint considering th e LCF. 1836-1840PartridgeR The author compared the LCF, in its function to a leathern straps by which the body of a carriage is suspended on springs . 1856MeyerGH The author of the modern theory of bio mechanics of the hip joint discusses the significant role of the LCF during walking and maintaining an upright posture. 1857TurnerW The fragment of the «Human Anatomy and Physiology» narrates the involvement of the LCF in distri...

2025EnglertG_KlingeleK

Content [i] Annotation [ii] Original text [iii] References [iv] Source & links [v] Notes [vi] Authors & Affiliations [vii] Keywords [i] Annotation Abstract of the article: Englert G et al. Open Reduction With Ligamentum Teres Reconstruction—Preliminary Results of a Novel Technique for the Management of Pediatric Developmental Dysplasia of Hip). The article describes the ligamentum capitis femoris (LCF) reconstruction through the femoral tunnel for hip dysplasia. The text in Russian is available at the following link: 2025EnglertG_KlingeleK. [ii] Original text Abstract Background: The primary goal in the management of developmental dysplasia of the hip (DDH) is to obtain and maintain a stable, concentrically reduced hip via closed or open techniques while limiting iatrogenic risk. Recent studies suggest a 7% risk of recurrent instability following open reduction (OR) of idiopathic DDH an...

Search This Blog