Kurdistan Region-Iraq

Ministry of Higher Education & Scientific Research

Erbil Polytechnique University
Medical Technical Institute / Erbil
Department of Radiology

Hip Joint
RADIOLOGY STUDENT SUMMER TRAINING REPORT
PREPARED BY
Abdula Burhan
Muhammad Jamal
Gailan Asuad

Supervised By
Dr . Aza Ismail

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CONTENTS
Subject Title Page Number
Introduction…………………………………………………. 3
Anatomy of the Hip Joint……………………………… 3
Position of the Hip Joint………………………………. 5
Indication……………………………………………………… 5
Technique........................................................ 5
AP Image……………………………………… 5
Lateral Image………………………………………………….. 6
The names of some hip joint fractures…………….. 9
References……………………………………………………….. 10

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 Introduction
The hip region is located lateral and anterior to the gluteal
region, inferior to the iliac crest, and overlying the greater
trochanter of the femur, or "thigh bone". In adults, three of the
bones of the pelvis have fused into the hip
bone or acetabulum which forms part of the hip region.

Anatomy of the Hip Joint

The hip joint is a ball and socket synovial joint, formed by
an articulation between the pelvic acetabulum and the head of
the femur. It forms a connection from the lower limb to the pelvic
girdle, and thus is designed for stability and

weight-bearing – rather than a large range of movement.

In this article, we shall look at the anatomy of the hip joint – its
articulating surfaces, ligaments and neurovascular supply.

Articulating Surfaces
The hip joint consists of an articulation between the head of
femur and acetabulum of the pelvis.

The acetabulum is a cup-like depression located on the inferolateral

aspect of the pelvis. Its cavity is deepened by the presence of a
fibrocartilaginous collar – the acetabular labrum. The head of femur is
hemispherical, and fits completely into the concavity of the
acetabulum.

Both the acetabulum and head of femur are covered

in articular cartilage, which is thicker at the places of weight bearing.

The capsule of the hip joint attaches to the edge of the acetabulum
proximally. Distally, it attaches to the intertrochanteric line anteriorly
and the femoral neck posteriorly.

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 The left and right hip bones (innominate bones, pelvic bones)
are two irregularly shaped bones that form part of the pelvic
girdle – the bony structure that attaches the axial skeleton to the
lower limbs.

The hip bones have three main articulations:

 Sacroiliac joint – articulation with the sacrum.

 Pubic symphysis – articulation between the left and right hip
bones.
 Hip joint – articulation with the head of femur.

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 Position of the Hip Joint
AP and Lateral

Indication
The hip X-ray is used primarily to demonstrate/exclude a
fracture. Hip X-rays are also frequently opted for as initial test in
chronic hip symptoms, e.g. osteoarthritis.

Technique
The hip joint can be imaged under various angles. A standard
hip X-ray examination generally includes an anteroposterior
(PA) image and a lateral image. Ideally, the AP image shows
both hip joints (which strictly speaking makes it a pelvis X-ray)
to allow comparison with the other hip. The lateral direction
may be opted for in axiolateral images or a frog leg lateral
image. The various directions are explained in more detail
below.

AP Image
The patient is placed on his/her back and the X-rays will pass
through the hip joint from anterior to posterior (fig. 1). The leg is
internally rotated 15˚ - 20˚ to achieve femoral anteversion. This
will extend the femoral neck (collum), improving its evaluability.
When the leg is rotated externally, the greater trochanter will
project over the neck and improve imaging of the lesser
trochanter (fig. 2).

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Figure 1. Technique for AP image of the hip.

Figure 2. Hip image with internal rotation and external rotation. Note that internal rotation
improves the evaluability of the femoral neck because the greater trochanter does not project
over the neck.

Lateral Image
There are various techniques for lateral imaging. The most
commonly used images are the axio lateral image, the frog-leg
lateral image and the Lauenstein image.

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Axio lateral image
The patient is placed on his/her back. The unaffected hip is
abducted and lifted (using a cushion/block as support), allowing
a medial view of the affected hip (fig. 3). The X-ray machine is
positioned so as to direct the X-ray beams exactly through the
femoral neck (horizontal beam), achieving optimal unobstructed
images and minimizing overprojection of the lesser/greater
trochanter.
The primary benefit is that the patient can leave the painful leg
flat. After trauma or in immobile/postoperative patients
therefore, the axiolateral image is first choice for lateral
imaging.

Figure 3. Technique for axiolateral hip X-ray.

Frog leg lateral image

The hip is abducted (about 45˚) with the knee in flexion (about
30˚- 45˚). The foot can rest on the inside of the contralateral
knee (fig. 4). The X-rays pass through the hip joint from medial
to lateral.
This technique can also be used to image both hip joints; the
so-called Lauenstein image (= frog-leg image). The feet are
positioned together (fig. 5). This image is particularly useful to

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evaluate the shape of the femoral heads and head/neck
transitions; e.g. to confirm epiphysiolysis and Perthes disease
(= avascular necrosis).

Figure 4. Technique for frog-leg lateral image.

Figure 5. Technique for Lauenstein image.

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 The names of some hip joint fractures

1. Intra capsular fractures

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2. Extra capsular Fractures

3. Subrochanteric Fractures

References

https://www.startradiology.com/internships/general-
surgery/hip/x-hip/index.html
https://teachmeanatomy.info/?s=the+hip+joint

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