HIP JOINT

HIP JOINTHIP JOINTIt is one of the largest joints It is one of the largest joints

in the bodyin the body..It is the connection between It is the connection between

the lower limb and the pelvic the lower limb and the pelvic girdlegirdle..

TYPETYPEIt is a most perfect example It is a most perfect example

of of Ball and SocketBall and Socket joint joint..

ARTICULAR SURFACESARTICULAR SURFACES

Hemispherical Hemispherical headhead of of the the femurfemur and the cup and the cup shaped shaped AcetabulumAcetabulum..

The cavity of the The cavity of the acetabulum is deepened acetabulum is deepened by a by a fibro-fibro-cartilagenous cartilagenous lip lip attached to its margins attached to its margins ((Labrum Labrum AcetabulareAcetabulare))..

CAPSULECAPSULE

It is It is attachedattached to to : : ((aa ) )MediallyMedially toto

The hip boneThe hip bone : :11..Labrum acetabulareLabrum acetabulare..

22 . .Transverse Transverse acetabular ligamentacetabular ligament..

CAPSULECAPSULE

((bb ) )Laterally toLaterally toThe femurThe femur: : 11.. In frontIn front: :

Along theAlong the 11 . .Intertrochanteric lineIntertrochanteric line . .

22..The bases of the The bases of the greater and lesser greater and lesser trochanterstrochanters..

CAPSULECAPSULE

22 . .BehindBehind: : Halfway along the Halfway along the

posterior aspect of posterior aspect of the neckthe neck..

NECK OF FEMUR & CAPSULENECK OF FEMUR & CAPSULE

AnteriorlyAnteriorly: : The neck of the femur is The neck of the femur is

completelycompletely inside the inside the capsule of the jointcapsule of the joint

PosteriorlyPosteriorly: : PartPart of the neck lies of the neck lies

inside inside the capsule and the the capsule and the other part is other part is outside outside itit..

RETINACULARETINACULAThey are Bands of fibers They are Bands of fibers

from the from the capsulecapsule that are that are reflected to the neck of the reflected to the neck of the femurfemur..

They are very adherent to They are very adherent to the bone and run to the the bone and run to the margin of the headmargin of the head..

FunctionFunction: : They carry blood vessels to They carry blood vessels to

supply the head of the supply the head of the femurfemur..

EXTRINSIC LIGAMENTSEXTRINSIC LIGAMENTS

((11)) ILio-femoralILio-femoral: : It is a very strong inverted It is a very strong inverted

YY –shaped ligament which –shaped ligament which supports the front of the supports the front of the capsulecapsule..

Its base is attached to the Its base is attached to the Anteriorf inferior Iliac spine Anteriorf inferior Iliac spine and the two limbs of the Y and the two limbs of the Y to the intertrochanteric lineto the intertrochanteric line..

It resists hyper It resists hyper extensionextension strains on the hip joint strains on the hip joint during standingduring standing..

EXTRINSIC LIGAM ENTSEXTRINSIC LIGAM ENTS((22)) Pubo-femoralPubo-femoral

It is a triangular ligament It is a triangular ligament which supports the which supports the inferomedialinferomedial part of the part of the capsulecapsule..

It arises from the superior It arises from the superior pubic ramus and blends with pubic ramus and blends with the lower and anterior parts the lower and anterior parts of the capsule (lower part of of the capsule (lower part of intertrochanteric line)intertrochanteric line)..

It limits It limits extensionextension and and abductionabduction..

EXTRINSIC LIGAMENTSEXTRINSIC LIGAMENTS

((33 ) )Ischio-femoralIschio-femoral ::It is spiral shaped. It is It is spiral shaped. It is

attached to the body of attached to the body of the ischium below the the ischium below the acetabulum and to the acetabulum and to the greater trochantergreater trochanter..

It supports the It supports the posteriorposterior and and upper upper parts of the capsuleparts of the capsule..

It limits It limits extensionextension..

INTRINSIC LIGAMENTSINTRINSIC LIGAMENTS

((11 ) )Transverse Transverse Acetabular ligamentAcetabular ligament

It bridges over the It bridges over the acetabular notch acetabular notch inferiorly and inferiorly and transforms it into the transforms it into the acetabular foramenacetabular foramen..

INTRINSIC LIGAMENTSINTRINSIC LIGAMENTS((22)) ligament of the head of ligament of the head of

the femurthe femur: : It lies inside the hip joint and It lies inside the hip joint and

therefore it is ensheathed therefore it is ensheathed with a tube of synovial with a tube of synovial membranemembrane..

It is a weak ligament. It is It is a weak ligament. It is attached between the pit of attached between the pit of the head of the femur and the the head of the femur and the transverse acetabular transverse acetabular ligament and the margins of ligament and the margins of the acetabuluar notchthe acetabuluar notch..

ligament of the head of the ligament of the head of the femurfemur

Its function is to carry Its function is to carry blood supply to the head blood supply to the head of the femurof the femur..

It has no function with It has no function with keeping the stability of keeping the stability of the jointthe joint..

SYNOVIAL MEMBRANESYNOVIAL MEMBRANEIt lines the capsule and It lines the capsule and

is reflected to cover is reflected to cover the intra capsular part the intra capsular part of the neck of the of the neck of the femurfemur..

It covers all the It covers all the structures inside the structures inside the joint (ligament of the joint (ligament of the head of the femur and head of the femur and the pad of fat) the pad of fat) ExceptExcept the articular surfacesthe articular surfaces..

SYNOVIAL MEMBRANESYNOVIAL MEMBRANE

It bulges anteriorly It bulges anteriorly between the ilio-femoral between the ilio-femoral and pubo- femoral and pubo- femoral ligaments to form the ligaments to form the psoas bursapsoas bursa..

RELATIONSRELATIONSThe hip joint is directly related The hip joint is directly related

to many musclesto many muscles..((11 ) )Anterior (In Front)Anterior (In Front)

From medial to lateral, they From medial to lateral, they areare: :

Pectineus, iliopsoas and rectus Pectineus, iliopsoas and rectus femoris (straight head)femoris (straight head)..

The iliopsoas and pectineus The iliopsoas and pectineus separateseparate the femoral nerve the femoral nerve and vessels from the anterior and vessels from the anterior aspect of the jointaspect of the joint..

RELATIONRELATION

((22 ) )LateralLateral ::Tensor fascia latae Tensor fascia latae

Gluteus medius and Gluteus medius and MinimusMinimus..

((33)) Superior (above)Superior (above) Piriformis and gluteus Piriformis and gluteus

minimusminimus..((44)) Inferio (below )Inferio (below )

Obturator externusObturator externus..

RELATIONSRELATIONS((55)) Posterior (behind)Posterior (behind)From above downwardsFrom above downwards

::obturator internus (+ obturator internus (+

two gemelli) and the two gemelli) and the quadratus femorisquadratus femoris . .

They They separateseparate the the joint from the joint from the Sciatic Sciatic nervenerve..

STABILITY OF THE JOINTSTABILITY OF THE JOINT

The hip joint is one of the The hip joint is one of the most stablemost stable joints of the joints of the body becausebody because: :

((11)) The The head of the femurhead of the femur fits very accurately in the fits very accurately in the acetabulum due to the acetabulum due to the followingfollowing

A.A. The acetabulum is very The acetabulum is very deep and its depth is deep and its depth is increased by the labrum increased by the labrum acetabulareacetabulare..

STABILITY OF THE JOINTSTABILITY OF THE JOINTB.B. The labrum acetabulare The labrum acetabulare

forms a firm grip on the head forms a firm grip on the head of the femurof the femur..

C.C. The atmospheric pressure The atmospheric pressure resists separation between resists separation between the head of the femur and the head of the femur and the acetabulumthe acetabulum..

((22)) The three strong The three strong extrinsic ligamentsextrinsic ligaments..

((33)) The surrounding strong The surrounding strong musclesmuscles..

MOVEMENTSMOVEMENTS

((11)) FlexionFlexion : Iliopsoas: Iliopsoas..SartoriusSartorius . .

Tensor fascia latae. Tensor fascia latae. Rectus femoris. Rectus femoris. PectineusPectineus . .

Adductor Longus. Adductor Longus. Adductor BrevisAdductor Brevis..

Adductor Magnus. Adductor Magnus. GracilisGracilis..

MOVEMENTSMOVEMENTS((22)) ExtensionExtension : :

Hamstrings Hamstrings (Semitendinosus, (Semitendinosus, Semimembranosus, Semimembranosus, Long headLong head of Biceps of Biceps Femoris)Femoris) . .

Adductor MagnusAdductor Magnus . .Gluteus MaximusGluteus Maximus..

The extensor musclesThe extensor muscles are more powerful than are more powerful than the flexorsthe flexors..

MOVEMENTSMOVEMENTS

((33)) Adduction Adduction :: Adductor LongusAdductor Longus..

Adductor Brevis. Adductor Brevis. Adductor Magnus. Adductor Magnus. GracilisGracilis . .

Pectineus Pectineus Obturator Obturator ExternusExternus..

MOVEMENTSMOVEMENTS

((44)) Abduction :Abduction : Gluteus Medius. Gluteus Medius. Gluteus Minimus. Gluteus Minimus. Tensor Fascia LataeTensor Fascia Latae..

((55)) Medial rotationMedial rotation : :Gluteus MediusGluteus Medius . .

Gluteus MinimusGluteus Minimus . .Tensor Fascia LataeTensor Fascia Latae..

MOVEMENTSMOVEMENTS((66)) Lateral rotationLateral rotation::

Obturator ExternusObturator Externus..Obturator InternusObturator Internus . .

GemelliGemelli..PiriformisPiriformis . .

Quadratus FemorisQuadratus Femoris . .Gluteus MaximusGluteus Maximus..

The lateral rotators are more The lateral rotators are more powerful than the medial powerful than the medial rotatorsrotators..

LIMITATION OF MOVEMENTSLIMITATION OF MOVEMENTS

11 . .ExtensionExtension: : The The ilio femoralilio femoral, ,

pubofemoralpubofemoral and and ischiofemoralischiofemoral ligamentsligaments..

22 . .FlexionFlexion: : Tension of the Tension of the

hamstringhamstring group of group of musclesmuscles..


((33)) AbductionAbduction:: The The pubo femoralpubo femoral

ligamentligament..((44)) AdductionAdduction: :

The two limbs The two limbs come in contact come in contact with each otherwith each other..


((55)) Medial Medial rotationrotation ::

The The ischio-ischio-femoral femoral ligamentligament..

((66)) LateralLateral rotationrotation ::

The The pubo-femoral pubo-femoral ligamentligament..

BLOOD SUPPLYBLOOD SUPPLYThe main arterial supply The main arterial supply

is from branches of the is from branches of the circumflex femoralcircumflex femoral arteries ( arteries ( especially the especially the medialmedial))..

BLOOD SUPPLYBLOOD SUPPLY

The blood supply The blood supply passes to the joint passes to the joint throughthrough: :

((11 ) )Retinacular Retinacular fibersfibers..

((22 ) )Ligament of the Ligament of the head of the femurhead of the femur..

BLOOD SUPPLYBLOOD SUPPLYDamage of the retinacular Damage of the retinacular

fibers as in fibers as in fracture neckfracture neck of the femur can results in of the femur can results in A vascular necrosisA vascular necrosis of of the head of the femurthe head of the femur..

Fracture neck of the femur Fracture neck of the femur is common after age of is common after age of (60) years especially in (60) years especially in women because of women because of OsteoprosisOsteoprosis..

NERVE SUPPLYNERVE SUPPLY

FemoralFemoral . .SciaticSciatic . .

ObturatorObturator . .Nerve to Quadratus Nerve to Quadratus

FemorisFemoris..

REFERRED PAINREFERRED PAIN

OsteoarthritisOsteoarthritis is the is the most common cause most common cause of pain and stifness in of pain and stifness in the hip joint of adultsthe hip joint of adults..

The pain is referred The pain is referred to the knee through to the knee through the the obturatorobturator nerve nerve which supplies both which supplies both jointsjoints . .

CONGENITAL DISLOCATIONCONGENITAL DISLOCATIONMore common in girls More common in girls

and associated with and associated with inabilityinability to abduct to abduct the thighthe thigh..

The upper lip of the The upper lip of the acetabulum fails to acetabulum fails to develop adequatelydevelop adequately..

The head of the femur The head of the femur rides up out of the rides up out of the acetabulum onto the acetabulum onto the gluteal surface of the gluteal surface of the

ileumileum..

TRAUMATIC DISLOCATIONTRAUMATIC DISLOCATIONIt is common in motor It is common in motor

vehicle accidents when vehicle accidents when the thigh is flexed and the thigh is flexed and adductedadducted . .

The dislocated head is The dislocated head is displaced displaced posteriorlyposteriorly to lie on the posterior to lie on the posterior surface of the ileumsurface of the ileum..

In In posterior posterior dislocation dislocation the the sciatic nervesciatic nerve is is liable to be injuredliable to be injured..

TRENDELENBURG’S SIGNTRENDELENBURG’S SIGN

Positive signPositive sign: : Tilting of the pelvis Tilting of the pelvis

downwards on the downwards on the unsupported side unsupported side (with the foot is (with the foot is raised above the raised above the ground)ground)..

TRENDELENBURG’S SIGNTRENDELENBURG’S SIGNThe stability needsThe stability needs: :

((11 ) )Normally functioning Normally functioning glutei medius and glutei medius and minimusminimus..

((22 ) )The head of the femur The head of the femur is located in the is located in the acetabulumacetabulum..

((33 ) )The neck of the femur The neck of the femur is intact and has a normal is intact and has a normal angle with the shaftangle with the shaft..

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HIP JOINT