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.

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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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21cent.bcBaqetIII

Groups of wrestlers on the walls of tomb BH15, belonging to Baqet III – a contemporary of Pharaoh Mentuhotep II (frescoes, Beni Hasan, Egypt). These images depict wrestling scenes and the circumstances under which injuries to the hip joint — including the ligamentum capitis femoris (LCF) — might occur. The frescoes appear to have served as the basis for the description of wrestling found in the Book of Genesis: 25 And Ja cob 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: Nint...

MEDICAL RECORD. Title and contents

Book manuscript: Arkhipov S.V. Medical Record: The Contribution of a Middle Bronze Age Egyptian Physician to the Book of Genesis. Kyrö : Author’s Edition, 2026. – 312 pp. – 2 tables. – Bibliographical references: 856 entries. Google Books ID: GGKEY:5GXG1LS275N , play.google.com , books.google.com Title, Abstract and Contents CONTENT [i] Abstract [ii] Dedication [iii] Book Covers and Title [iv] Table of Contents [v] Application [i] ABSTRACT Before you is the final medical record compiled by the author over a professional career as an orthopaedic surgeon. This work outlines information regarding a patient who sustained a hip joint injury in the Middle Bronze Age. The source material is extracted from the Book of Genesis and cross-referenced with facts from history, archaeology, natural science, and medicine past and present. Along the way, it is demonstrated that the protograph was composed in Ancient Egypt during the Second Intermediate P...

MEDICAL RECORD. Chapter 2

Book manuscript: Arkhipov S.V. Medical Record: The Contribution of a Middle Bronze Age Egyptian Physician to the Book of Genesis. Kyrö: Author’s Edition, 2026. – 312 pp. – 2 tables. – Bibliographical references: 856 entries. play.google.com , books.google.com Introduction Chapter 2 Chronology of the Medical Record CONTENT [i] Text [ii] Navigation [iii] Application [i] Text When reading the Book of Genesis , we learn that the first recorded patient with an injury to the ligament of the head of femur was a man named Ya'akov (Gen. 32:25, 33). In adapted usage, the name is rendered as Jacob. According to the narrative, he was born near the well of Beer-Lahai-Roi, between Kadesh and Bered in the Negev Desert, which is in the south of the "Canaanite" land (Gen. 16:14, 23:19, 24:62). As is clear from the text, the "Canaanite land" is the western part of the current State of Israel, excluding the vicinity of the Jordan River (Gen. 13:11–12). Jacob's father ...

MEDICAL RECORD. Chapter 1

Book manuscript: Arkhipov S.V. Medical Record: The Contribution of a Middle Bronze Age Egyptian Physician to the Book of Genesis. Kyrö: Author’s Edition, 2026. – 312 pp. – 2 tables. – Bibliographical references: 856 entries. play.google.com , books.google.com Introduction Chapter 1 Preamble to the Medical Record CONTENT [i] Text [ii] Navigation [iii] Application [i] Text A unique feature of the Book of Genesis is the abundance of information regarding human physiology and ancient medicine. A striking example is the detailed description in the 32nd chapter of a hip joint injury and its consequences. This knowledge, seamlessly woven into the narrative, is as old as the literary monument itself. How long ago it was composed remains not definitively known, but according to the currently dominant view, it dates back to the late 6th or 5th century BCE (2017OliverS). With the intention of clarifying the aforementioned question and for dating the natural-scientific facts con...

MEDICAL RECORD. Notes

Book manuscript: Arkhipov S.V. Medical Record: The Contribution of a Middle Bronze Age Egyptian Physician to the Book of Genesis. Kyrö: Author’s Edition, 2026. – 312 pp. – 2 tables. – Bibliographical references: 856 entries. play.google.com , books.google.com NB! Notes CONTENT [i] Notes [ii] About the Book and Author [iii] Navigation [ iv] Application [i] Notes · Kyrö is an idyllic settlement situated in the upper reaches of the Finnish Aurochs River (the Tarvasjoki). · The bibliographic referencing system has been adapted by the author. In-text citations emphasize the publication date and the senior author, who typically acts as the principal investigator of the research team. The end-of-text references are based on the international APA (American Psychological Association) citation style and are tailored to reduce character count. This approach curtails typesetting costs, limits publication space requirements, and decreases paper and toner consumption during pri...

20cent.bcAmenemhet

Groups of wrestlers on the walls of tomb BH2, belonging to Amenemhat (Ameni)—a contemporary of Pharaoh Senusret I (frescoes, Beni Hasan, Egypt). These images depict wrestling scenes and the circumstances under which injuries to the hip joint—including the ligamentum capitis femoris (LCF)—might occur. The frescoes appear to have served as the basis for the description of wrestling found in the Book of Genesis : 25 And Ja cob 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...

MEDICAL RECORD. Chapter 9

Book manuscript: Arkhipov S.V. Medical Record: The Contribution of a Middle Bronze Age Egyptian Physician to the Book o f Genesis. Kyrö: Author’s Edition, 2026. – 312 pp. – 2 tables. – Bibliographical references: 856 entries. play.google.com , books.google.com Life History Chapter 9 Epidemiological and Sanitary-Hygienic HISTORY CONTENT [i] Epidemiological History [ii] Sanitary-Hygienic History [iii] Navigation [ iv] Application [i] Epidemiological History In general, Jacob's epidemiological history should be characterized as "unremarkable". No mass infection or deaths are described in his immediate environment. Our attention was drawn only to the account of the consecutive deaths of two young men. First, Jacob's grandson Er, the firstborn son of Judah, died (Gen. 38:6–7). Shortly thereafter, the younger brother of the deceased, Onan, passed away (Gen. 38:8, 10). No symptoms of disease are indicated for the deceased, nor is there any information r...

1893GriffithFL

Griffith F.L. (1893): A group of wrestlers on the wall of the tomb of Baqet III (fresco, late 20th century BCE, Egypt). A depiction of the circumstances surrounding a hip joint injury—possibly involving the ligamentum capitis femoris (LCF) – which served as the basis for the description of a wrestling match in the Book of Genesis: 25 And Ja cob 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 ( 2024АрхиповСВ ) and Medical Record (2026Ar...

MEDICAL RECORD. Chapter 16

Book manuscript: Arkhipov S.V. Medical Record: The Contribution of a Middle Bronze Age Egyptian Physician to the Book of Genesis. Kyrö: Author’s Edition, 2026. – 312 pp. – 2 tables. – Bibliographical references: 856 entries. play.google.com , books.google.com History of Present Illness Chapter 16 Textual and Conceptual Borrowings CONTENT [i] Borrowings in the Description of Circumstances [ii] Clarification of the Circumstances of Injury [iii] Medicine in the Description of Circumstances [ iv] Human Joint Ligaments [v] Navigation [vi] Application [i] Borrowings in the Description of Circumstances According to modern legal practice, borrowing ideas, concepts, or facts is not considered plagiarism. Today, legislation protects only a specific form of expression rather than thoughts themselves. However, paraphrasing someone else's ideas in one's own words without attributing the author is recognized as an ethical violation in the academic or scientific community. The Boo...

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. October 29 , 2026 22cent.bcBaqetI . Fresco. A depiction of the circumstances surrounding a hip joint injury. October 28 , 2026 17cent.Akrotiri . Fresco. A depiction of the circumstances surrounding a hip joint injury. 20cent.bcAmenemhet . Fresco. A depiction of the circumstances surrounding a hip joint injury. 20cent.bcKhety . Fresco. A depiction of the circumstances surrounding a hip joint injury. 21cent.bcBaqetIII . Fresco. A depiction of the circumstances surrounding a hip joint injury. October 26 , 2026 Tweet of October 26, 2026 . Book announcement 1893GriffithFL Fresco. A depi...

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