2. HIP JOINT
…..the largest joint in the body
Dr. Zeenat Zaidi

3. ARTICULATION Hemispherical head of Femur
Cup-shaped acetabulum of the hip bone
Articular surfaces covered with hyaline cartilage

4. Head of Femur Globular, more than a hemisphere
Directed upward, medially, and a little forward
Surface is smooth, covered with hyaline cartilage, except over an ovoid depression, the fovea capitis femoris, which is situated a little below and behind the center of the head
The fovea gives attachment to the ligament of the head of femur

5. ACETABULUM Horse-shoe shaped articular surface
Deepened by fibro-cartilaginous rim called acetabular labrum
Deficient inferiorly as the acetabular notch that is filled up by transverse acetabular ligament
Nonarticular part, acetabular fossa, lodges pad of fat

6. TYPE
Synovial
A perfect example of a ‘Ball and Socket’ joint

7. CAPSULE Encloses the joint Attachment: Medially: Acetabular labrum
Laterally:
Anteriorly: to the intertrochanteric line. Some fibers reflect upward along the neck, form ‘retinacula’ (carry blood vessels for head & neck of femur)
Posteriorly halfway along the posterior aspect of neck

8. LIGAMENTS Iliofemoral Pubofemoral Ischiofemoral Transverse acetabular
Ligament of head of femur

9. Prevents over-extension during standing
Iliofemoral Ligament
Strong, Y-shaped
Attachment:
Base to anterior inferior iliac spine
Two limbs to upper & lower ends of intertrochanteric line
Prevents over-extension during standing

10. Limits extension & abduction
Pubofemoral Ligament
Triangular in shape
Attachment:
Base to superior ramus of pubis
Apex to lower part of inter-trochanteric line
Limits extension & abduction

11. Ischiofemoral Ligament
Spiral in shape
Attachment:
Medially to the body of the ischium near acetabulum
Laterally to the greater trochanter
Limits extension

12. Transverse Acetabular Ligament
Formed by acetabular labrum
Bridges acetabular notch, converting it into tunnel through which vessels and nerves enter the joint

13. Ligament of Head of Femur
Flat & triangular
Attachment:
Apex to the pit (fovea) on the head of femur
Base to transverse ligament & the margin of acetabulum
Intracapsular, ensheathed by synovial membrane
Carries articular branch of obturator artery to the joint

14. SYNOVIAL MEMBRANE Lines the capsule
Attached to margins of articular surfaces
Covers intracapsular part of the neck of femur
Ensheaths ligament of head of femur
Covers pad of fat in acetabular fossa

15. Protrudes anteriorly through gap between pubofemoral & iliofemoral ligaments and forms psoas bursa

16. RELATIONS Anterior Inferior Iliopsoas Pectineus Rectus femoris
Obturator externus

17. Posterior Superior Sciatic nerve Gluteus minimus Obturator internus
Piriformis
Superior & inferior Gemelli
Quadratus femoris

18. BLOOD SUPPLY
Head & intra-capsular part of neck receives its blood supply from trochanteric anastomosis, mainly from branches of medial circumflex artery
A branch from obturator artery in the ligament of head of femur is importanat in young child

19. NERVE SUPPLY Apply Hilton’s law Femoral Obturator Sciatic
Nerve to quadratus femoris
The nerve supplying a joint also supplies both the:
Muscles that move the joint &
Skin covering the articular insertion (area of action) of those muscles
These nerves also supply knee joint & therefore pain arising in the hip joint may be referred to the knee

20. STRENGTH & STABILITY Depends largely on the: Shape of the bones
Ligaments

21. MOVEMENTS Wide range (less than shoulder joint)
Some movements sacrificed in order to provide strength & stability
Movements are:
Flexion/Extension
Abduction/Adduction
Lateral/Medial rotation
Circumduction

22. FLEXION
Flexors:
Iliopsoas
Rectus femoris
Sartorius
Adductor muscles
Limitation: with the knee flexed: Anterior surface of thigh coming in contact with the anterior abdominal wall
with the knee extended: Tension of hamstring group of muscles

23. EXTENSION Extensors: Gluteus maximus Hamstring muscles
Limitation: Tension of iliofemoral, pubofemoral & ischiofemoral ligaments

24. ABDUCTION Abductors: Gluteus medius & minimus Piriformis Sartorius
Tensor fascia lata
Limitation: Tension of pubofemoral ligament

25. ADDUCTION
Adductors:
Adductors (longus, brevis & adductor part of magnus)
Pectineus
Gracilis
Limitation: Contact with the opposite limb & by tension in ligament of head of femur

26. LATERAL ROTATION
Lateral Rotators:
Piriformis
Obturator internus & externus
Gemilli
Quadratus femoris
Gluteus maximus
Limitation: tension in iliofemoral & pubofemoral ligaments

27. MEDIAL ROTATION Medial Rotators:
Anterior fibers of gluteus medius & minimus
Tensor fascia lata.
Limitation: tension of ischiofemoral ligament.

28. CLINICAL ANATOMY

29. Referred Pain From the Hip Joint
The pain originating in the hip joint to be referred to the front and medial side of the thigh (femoral nerve)
The hip joint disease may give rise to pain in the knee joint (posterior division of the obturator nerve supplies both the hip and knee joints)

30. Congenital Dislocation
Affects 1-2 babies in every 1000
Associated with a shallow acetabulum and an altered angle of the femoral head
May be bilateral
Females affected more than males
May be caused by mechanical factors i.e. malformed uterus
The affected limb is shorter than the normal limb

31. Capsule is loose
Upper lip of acetabulum is not developed properly (hypoplasia).
Head of femur moves up out of acetabulum and lies against the gluteal surface of ilium.
Characteristic clinical sign is the inability to abduct the hip

32. Traumatic Dislocation
Rare, because of the strength of joint
Occurs when joint is flexed & abducted.
This can occur in a car crash where the knee is pushed backwards, often breaking off the posterior rim of the acetabulum

33. The head of femur is displaced posteriorly and rests on the gluteal surface of ilium (posterior dislocation).
Sciatic nerve is prone to get injured.
Lower limb is flexed, adducted & medially rotated and is shorter than the normal limb
Positive Trendelenburg’s sign
‘Dipping’ (unilateral dislocation) or ‘waddling’ (bilateral dislocation) gait

34. Osteoarthritis Most common disease of hip joint in the adults
Results in:
Pain
Stiffness (due to pain and reflex spasm of muscles)
Deformity i.e. flexion, adduction & external rotation (due to muscle spasm & later on muscle contractures)

35. Arthritis of the Hip Joint
A patient with an inflamed hip joint will place the femur in the position that gives minimum discomfort (the position in which the joint cavity has the greatest capacity to contain the increased amount of synovial fluid secreted).
The hip joint is partially flexed, abducted, and externally rotated
Tenderness over the head of the femur (on the anterior aspect of the thigh just inferior to the inguinal ligament and just lateral to the pulsating femoral artery) usually indicates the presence of arthritis of the hip joint.

36. Thank You & Good Luck