Jantop, Hieber Gall A ore HIP + Acetabulum HIP COMPLEX reine + Ball and socket joint + 3 degrees of freedom Ma. Belinda C. Fidel, M.D. Lecturer University of Santo Tomas ACETABULUM ACETABULUM + Formed by the 3 parts of the pelvis sasaki — 15 pubis Wedge shaped fibrocartilage at the entire. 26 lehlum eer area “a6 ium —Despens the socket + ACETABULAR ANTEVERSION Toragps the HOF to maintain contact ‘The degree of enter tation of the «TRANSVERSE ACETABULAR LIGAMENT acetabulum Part of the labrum: —18.Sdeg for males. 21.5 for females —Bridges the gap at the base of the articular \ increase in angle horseshoe + decreases jt. stability and increase —Forms the roof of the tunnel which blood tandeny fr anterorcstocatons vessels and nerves enter to the hip jt. ACETABULUM + CENTER EDGE ANGLE OF THE ACETABULUM/ANGLE OF WIBERG Lateral rim of the acetabulum and the center of the femoral condyes in relation vith the vertical ~ Amount of inferior tit ofthe acetabulum -=38deg in males, 35deg in females “increases as we age \Saller angle * Common in young (Congenital Dislocation) + Risk in supetior dislocation FEMUR HOF Covered with hyaline cartilage Larger thana true hemisphere! 2/9 of a sphere ~EOVEA CAPITIS *Roughened pit + Atthe most medial point f the head + LIGAMENTUM TERES.FEMUR FEMUR + NECK OF THE FEMUR + Ranales ofthe femur =S.m|ong Frontal —Angulates medially, superiorly and *ANGLEOENCLMATION | anteriorly sth sayy = between the axes of nec! Sedat) eo =125degin adult Pica h ment —120degin the elderly ~COXAVALGA - increase in angle —COXA VARA — decrease in the angle FEMUR @repront if ee HIP JOINT ransverse + ARTICULAR CONGRUENCE “ANGLE OF /ANGLE OF = eee eee tea Cinereasein acu contack San + Flexion, Abduction, sight ER Pager the medial rotation of the conde in + Frog leg position et + Position of immobilization for GERSHVERSION - Patios peese eaeRen eaeaaone © Synonymous foMR/ iy RETROVERGION —Pathlope dactasbo Synonymous OER) ext u t FRM pomlon 2 tang, HIP JOINT AND CAPSULE ANTERIOR EC ewer le + Strong and dense articular capsule + Reinforced’ rong capsular + Capsule is attached to the whole periphery ligaments ofthe acetabulum Covers the femoral neck + The femoralnack's intracapsular pa + The trochanters are sidracapeular -sApex- attached to the Alls. * Capsules thickened anteroguperioly’ fand »Twoarms- to the intertrochanteric line of thin psterinteriny / the femuse <= Posterior is reinforced by 1 + ILIOFEMORAL LIGAMENT tera orbvoulans — ctrelor bars farm nol covind He Rott adhANTERIOR PORTION OF THE CAPSULE + ILIOFEMORAL LIG- “ ISCHIOFEMORAL LIG Posterior surface of the acetabular sim and ‘acetabular labrum ~Fiberd spa) around the fermoralneck and blend with the: (Groular fibers which form ‘collar around the Ferioral neck) scolar |. LIGAMENTUM TERES Does not provide stability ofthe hip, ~ Conduit for blood supply and nerve supply bane — secdabuler wth > medial X trae teases beral eh oto, toy (pth bok St) CAPSULAR LIGAMENTS. * tip eension or hyperesension (in \ upright position), further coils and tighten these ligaments > making hip ‘extension (ne, Sipee-Packed postion and position of lity WEIGHT BEARING STRUCTURE OF THE HIP + Trabeoulae of bone line up along the lines of stress”WEIGHT BEARING STRUCTURE OF THE HIP + The region of i su increased subchondral bone in the superior acetabulumis the surface of the acetabulum : ‘OF WEAKNESS- has less feinforcement and thus more potential for injury 4 —At the femoralneck’s susceptible and fracture commonly occur NORMAL ROM IN GAIT ON FUNCTION OF THE HIP JOINT OND~ + ARTHROKINEMATICS LEVEL GROU —CONCAVE-CONVEX Rule + F=30DEG + OSTEOKINEMATICS + E=10DEG ~MGTION OF THE FEMUR AT THE HIP + ABDIADD = SDEG +F with knee-extended = 20deg RADE, +F with knee flexed = 120-135deg = 10-30deg = 4§-60deg ; Mrot = 30-45deg + Abd-=30-50deg; Add'=10-0deg ANTERIOR/POSTERIOR q PELVIC TILTING LATERAL PELVIC TILT + Occursin the AP axis > feted + ANTERIOR + Normally aligned iliac crests is horizontal —COUNTERNUTATION Hip hiking + POSTERIORSF WA COORDINATED MOVEMENTS PELVIC ROTATION OF THE FEMUR, PELVIS AND SPINE + Occur in the transverse plane around a vertical axis + LUMBOPELVIC RHY" wa Si “insiaases the ROM avaible by adding (wx yy. { i) the pelvic.and lumbar motion aw Farmed Retain qe ules occa ee fe Fhe | te pole bm 5 ae eo Ae S protien mabe Aaketim i He sopperkng bog jhe COORDINATED MOVEMENTS OF THE FEMUR, PELVIS AND SPINE aaa =When the results in displacennent of the COG, a cre ocsoraipana y aneeocen a Se eeree el cere ace ad etc open — susdoaitae ten pelvis is nutated/the ~When ambulating, the pelvis drops on the NWB. side and the lumbar sideflexes to the WB = llopséas,RF. sartorius, + PRIMARY MUSCLES FO} Gluteus Max, Hamstrings + GM has greater MA at neutral and decrease beyond it ‘+ Hamstrings increase their MA as the hip flexes to 38de9 + ADDUCTORS: Pectineus, Adductor Longus, Brevis, HIPE Magnus, Gracilis MUSCLES + ABDUCTORS Poe ne ~Gluteus medius sd minimus #4 OFe =TELis an abductor when the hips F + LATERAL ROTATORS 6 Main muscles ~Obturatorinternus, externus,pirformis, ‘Gemellus superior, inferior, quadratus, femoris + MEDIALROTATORS —gntn’mey MUSCLE FUNCTION IN STANCE SAGITTAL PLANE + Bilateral erect standing, the LOG falls, posterior to the axis of the hip joint + This creates an extension torque > posterior tit the pelvis on the femoral heads + Thereis litle muscle activity fo maintain ‘AP equilibrium as long as LOG remains behind —Adductors , qlafeat Mie TFL oC war 3 banalis tml firing dining Bmal edn dewprals = eee Jo! Yee dadigsMUSCLE FUNCTION IN STANCE FRONTAL PLANE + HAT is 2/3 of the body weight + Each of the femoral heads receives 1 the weight of HAT MUSCLE FUNCTION IN STANCE + Unilateral stance (gait), muscle actity is needed te contol the motion of the hips elvis. shifting fesults in adduction of the WB hip ‘and abduction ofthe NW hip Return peut i etabished by active contraction ofthe abductors of the WB hip and ‘2dductors of the NWB hip + BUT in a superimposed body weight, only the s have the capacity to establish hip joint ‘tabi in unilateral stance Total hip joint compression are generally considered to be 2 %to 3 times the body weight The magnitude of the hip abduction force can be affected by the angle of pull ofthe muscles, angle of inclination, angle of torsion Gon e(x04) Helm oe REDUCTION OF MUSCLE FORCES IN UNILATERAL STANCE + NOT only is weight reduction important to reduce joint compression which may lead to osteoarthritis BUT abductor muscle force is also important + May use assistive devices to reduce muscle torque REDUCTION OF MUSCLE FORCES IN UNILATERAL STANCES rsimin dittine (fie REDUCTION OF MUSCLE FORCES IN UNILATERAL HIP JOINT PATHOLOGY STANCE ~ARTHROSIS Deterioration ofthe articular cartilage = OSTEOARTHRITIS. DEGE! ARTHRITIS = Causes are mostly idiopathic but most closely associated with ‘age and increased ‘weight to height ratio Most commonly sean area of cartaginos deterioration is at theperiphery of the femur ndat epatiovesl nea soot Most common defects in acetabular cartlage were at the superior margin (dome) + prey /matn ut. bearing Ghai, HIP JOINT PATHOLOGY + FRACTURES: mek Site is at the zone of weakness or the areas of thinner trabecular distribution Mortality of femoral neck fractures is. 20%