The Hip Joint

The Hip Joint

The hip joint is formed by the articulation of the head of the femur into the acetabulum of the hip. ball-and-socket joint. Synovial joint

Bones
Ilium Ischium Pubis Femur

The acetabulum is formed by the pubis, ischium and ilium bones

Joint Capsule
Strong fibrous sleeve specialized thickening, called ligaments, add stability Anteriorly
proximally to the bone surrounding the acetabulum. Distally to the trochanteric line

Posteriorly
to the margins of the acetabulum and surrounding bone neck of the femur- not to the trochanteric crest

Ligaments
Iliofemoral ligament- strongest ligament in the human body. It attaches to the illium between the two heads of the rectus femoris muscle. It is Y shaped. One goes to the base of the greater trochanter and the other to the base of the lesser trochanter. Seeks to resist excessive extension of the hip joint. Ischiofemoral ligament- attaches from the ischial part of the acetabular rim to the femur. Posterior joint capsule is reinforced by this ligament. Pubofemoral ligament- attaches to the base of the lesser trochanter and the superior ramus of the pubis, just above the obturator foramen. It is inferior to the iliofemoral ligament and reinforces the inferior part of the hip joint capsule. It also blends with the medial parts of the iliofemoral ligament

Ligaments (cont.)
The round ligament of the head of the femur is attached to the transverse acetabular ligament and extends to the fovea centralis on the head of the femur A fibrocartilaginous ring called the acetabular labrum deepens the acetabulum and clasps the head of the femur which makes the joint more stable

Muscles
External rotators: piriformis, quadratus femoris, Obturator internus and externus, gemellus superior and inferior, Flexors: iliopsoas, rectus femoris Adductors: adductor magnus, adductor longus and brevis, pectineus, gracilis Internal rotators: gluteus medius, gluteus minimus, tensor fascia latae Extensors: semitendinosus and semimembranosus, biceps femoris, gluteus maximus Abductors: gluteus medius, gluteus minimus

Nerves
Femoral Obturator Sciatic Nerve to quadratus femoris Direct branches of sacral plexus

Blood Supply
Medial Circumflex Lateral Circumflex Obturator Inferior gluteal

Movements
The hip joint is the most mobile joint in the lower limb. It is capable of flexion and extension, abduction and adduction, medial and lateral rotation and all of these in a circular motion- circumduction

second largest range of movement (second only to the shoulder) supports the weight of the body, arms and head.

Movements
Flexion- mainly due to contraction of the iliopsoas muscle, with help from the sartorius, rectus femoris, and pectineus Extension- chiefly by the guteus maximus muscles with help by the hamstrings Adduction- by the adductor longus, brevis, magnus and the gracilis Abduction- by the gluteus medius and gluteus minimus Lateral rotation- by the gluteus maximus, quadratus femoris, piriformis, obturator internus and externus, gemelli Medial rotation- by the anterior part of the glueteus minimus and medius and tensor fasciae latae muscles

What causes Hip pain?

(refer to your Hip handout)

Arthritis Throchanteric Bursitis Tendonitis Osteonecrosis Lumbar pain- referred symptoms Snapping hip syndrome Muscles strains Hip fracture Childhood hip problems
Developmental dysplasia Legg-calve-perthes disease

Treatments
Rest Ice and heat application Stretching Physical Therapy Anti-inflammatory Meds Hip Replacement

Treatments (cont.)
Hip Replacement
First performed in 1960 More than 193,000 total hip replacements each year Benifical if:
Hip pain limits ADLs like walking or bending Hip pain continues while resting, either day or night Stiffness in hop limits mobility Little relief from medications No relief after physical therapy or use of gait aid such as a cane

Treatments (cont.)
Hip Replacement
Surgery
Admission into hospital General anesthesia or spinal anesthesia Usually takes a few hours Process- removal of damaged cartilage and bone, they then position new metal, plastic, or ceramic joint surfaces to restore alignment and function. A ball and socket component is used. Surgical cement may be used to fill the gap between prosthesis and remaining bone to secure the new joint In younger- more active patients, non-cemented prosthesis so the bone can grow into the prosthesis.

Dissection
With Cadaver in Supine position, find the Rectus Femoris muscle (1) and the Sartorius muscle (2)

Reflect the Rectus Femoris and Sartorius muscles to expose the Pectineus and Iliopsoas muscles.

Reflect the Iliopsoas and Pectineus muscles to expose the hip joint capsule.

Identify the following: pubofemoral ligament (2) which is partially seen inferiorly and the ischiofemoral ligament (1) which is viewed posteriorly.

Open the Capsule along in the same direction of the capsular ligaments to expose the head of the femur. The arrow points to where the hip capsule has been opened.

Then evulse the head of the femur to view the internal structure of the joint including the round ligament of the femur.

http://www.meddean.luc.edu/lumen/meded/grossanatomy/dissector/labs/le/joint/main.html

Final Note
Refer to the handout that was given to us last Monday in class regarding hip injuries and diseases. We found this very helpful as well!