Lexicon on the Pathomechanics of the Native Hip Joint at Risk for Arthritis
15 affiliations
- 1Division of Orthopaedic Surgery, University of Ottawa, Ottawa, Ontario, Canada
- 2Hirslanden Clinic St. Anna, Luzern, Switzerland
- 3Paracelsus Medical University, Salzburg, Austria
- 4University College London Hospitals, London, United Kingdom
- 5Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, Michigan
- 6Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
- 7Department of Orthopaedics, University of Utah, Salt Lake City, Utah
- 8Institute for Biomechanics, ETH Zurich, Zurich, Switzerland
- 9Department of Mechanical Engineering, University of Bath, Bath, United Kingdom
- 10Department of Orthopaedic Surgery, Washington University School of Medicine in St. Louis, St. Louis, Missouri
- 11Schulthess Klinik, Zurich, Switzerland
- 12Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, California
- 13Clinique du Sport Bordeaux-Mérignac, Mérignac, France
- 14Department of Orthopaedic Surgery, Inselspital, University of Bern, Bern, Switzerland
- 15Department of Orthopaedic Surgery, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts
Abstract
Background:: Degenerative osteoarthritis (OA) of the hip often arises from structural abnormalities that alter load distribution, which leads to progressive chondrolabral damage. Although substantial advances have been made, the existing terminology in the field of hip preservation remains heterogeneous and inconsistently applied, limiting scientific communication and treatment standardization. The aim of this article is to link evidence from existing literature to develop a framework in the form of a structured lexicon, one that defines the morphological features and pathomechanical mechanisms that are relevant to the symptomatic, pre-arthritic hip.
Methods:: This descriptive framework was developed through the synthesis of current biomechanical, radiographic, and clinical evidence, combined with expert consensus from an international, multidisciplinary panel. Foundational concepts were derived from basic science research, including tribology, mechanobiology, and contact mechanics, to establish a unified terminology.
Results:: Three principal wear modes—instability, impingement, and mixed mechanisms—are proposed, corresponding to distinct pathological loading environments. Wear mechanisms include dysplasia with rim overload and stress-related cartilage failure, impingement with cam-induced shear or pincer rim conflict, and secondary inflammatory degeneration. Wear damage is classified by tissue involvement, encompassing labral degeneration, chondrolabral detachment, staged cartilage delamination, and subchondral bone changes (sclerosis, cystic change). By linking lesion topography to underlying mechanics, this framework has diagnostic and therapeutic relevance as well as encompasses radiographic measurements and clinical features of wear that are pertinent to hip instability and femoroacetabular impingement.
Conclusions:: This lexicon provides a coherent framework for pre-arthritic hip disease, establishing a shared terminology to guide basic-science research integration and the interpretation of current clinical practice in hip preservation.
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BibTeX
@article{beaule2026lexicon,
title = {{Lexicon on the Pathomechanics of the Native Hip Joint at Risk for Arthritis}},
author = {Paul E. Beaulé and Martin Beck and Moritz Wagner and Johan Witt and George Grammatopoulos and Ira Zaltz and Nobuhiko Sugano and Andrew E. Anderson and Stephen J. Ferguson and Richie Gill and John C. Clohisy and Michael Leunig and Christopher L. Peters and Marc Safran and Pierre Laboudie and Klaus Siebenrock and Michael Millis},
journal = {The Journal of Bone and Joint Surgery. American Volume},
year = {2026},
month = jul,
doi = {10.2106/jbjs.26.00112},
url = {https://doi.org/10.2106/jbjs.26.00112},
note = {CC BY-NC-ND 4.0},
}
RIS
TY - JOUR
TI - Lexicon on the Pathomechanics of the Native Hip Joint at Risk for Arthritis
AU - Paul E. Beaulé
AU - Martin Beck
AU - Moritz Wagner
AU - Johan Witt
AU - George Grammatopoulos
AU - Ira Zaltz
AU - Nobuhiko Sugano
AU - Andrew E. Anderson
AU - Stephen J. Ferguson
AU - Richie Gill
AU - John C. Clohisy
AU - Michael Leunig
AU - Christopher L. Peters
AU - Marc Safran
AU - Pierre Laboudie
AU - Klaus Siebenrock
AU - Michael Millis
PY - 2026
DA - 2026/07/27
JO - The Journal of Bone and Joint Surgery. American Volume
DO - 10.2106/jbjs.26.00112
UR - https://doi.org/10.2106/jbjs.26.00112
AB - Background:: Degenerative osteoarthritis (OA) of the hip often arises from structural abnormalities that alter load distribution, which leads to progressive chondrolabral damage. Although substantial advances have been made, the existing terminology in the field of hip preservation remains heterogeneous and inconsistently applied, limiting scientific communication and treatment standardization. The aim of this article is to link evidence from existing literature to develop a framework in the form of a structured lexicon, one that defines the morphological features and pathomechanical mechanisms that are relevant to the symptomatic, pre-arthritic hip. Methods:: This descriptive framework was developed through the synthesis of current biomechanical, radiographic, and clinical evidence, combined with expert consensus from an international, multidisciplinary panel. Foundational concepts were derived from basic science research, including tribology, mechanobiology, and contact mechanics, to establish a unified terminology. Results:: Three principal wear modes—instability, impingement, and mixed mechanisms—are proposed, corresponding to distinct pathological loading environments. Wear mechanisms include dysplasia with rim overload and stress-related cartilage failure, impingement with cam-induced shear or pincer rim conflict, and secondary inflammatory degeneration. Wear damage is classified by tissue involvement, encompassing labral degeneration, chondrolabral detachment, staged cartilage delamination, and subchondral bone changes (sclerosis, cystic change). By linking lesion topography to underlying mechanics, this framework has diagnostic and therapeutic relevance as well as encompasses radiographic measurements and clinical features of wear that are pertinent to hip instability and femoroacetabular impingement. Conclusions:: This lexicon provides a coherent framework for pre-arthritic hip disease, establishing a shared terminology to guide basic-science research integration and the interpretation of current clinical practice in hip preservation.
SN - 0021-9355
SN - 1535-1386
ER -