SURGICAL ANATOMY OF THE HIP

JOINT
Ngwazi, Dr K.O. AWORI
MBChB, MMed (Surg.), Dip. SICOT,
FCS (Orth.) ECSA
 The learner
• Pro-active

• Less whining

• Focused

• Goal-oriented
 The learner
1. UNCONSCIOUSLY 3. CONSCIOUSLY SKILLED
UNSKILLED

2. CONSCIOUSLY 4. UNCONCIOUSLY
UNSKILLED SKILLED
BALL & SOCKET JOINT
 THE HIP JOINT
Stability factors
STATIC STABILIZERS
1. Labrum acetabulare

2. Ligaments: ILIOFEMORAL (of Bigelow)

PUBOFEMORAL)
ILIOFEMORAL- Anterior ISCHIOFEMORAL- Posterior
 GLUTEUS MAXIMUS
Upper fibres stabilize gait
Gluteus medius & medius and key dynamic
stabilizers
Denervation of G. max in the posterior
approach is a reality
Severing a branch of the superior gluteal
nerve in Hardinger technique is a reality
RELATIONS
Anterior
RELATIONS
Posterior
BLOOD SUPPLY
Femoral head
 BLOOD SUPPLY
Femoral head
Medial circumflex (MCF) Acetabular br. (Obt/MCF)
 THE HIP JOINT
Movement
MULTIAXIAL JOINT

• Flexion: ILIOPSOAS, rectus femoris, pectineus,

sartorius
• Adduction: GRACILIS, adductor group.
• Extension: GLUTEUS MAXIMUS, hamstrings
• Abductors: GLUTEUS MEDIUS & MINIMUS

• Internal rotation: Iliopsoas, G. medius & minimus

• External rotation: G. Maximus & small muscles
• Circumduction: ALL
 HIP
Geometry
• Femoral offset

• Femoral anteversion

• Neck-shaft angle

• Acetabular anteversion
 HIP
Femoral offset
• Femoral offset is measured from the distance
between the center of the femoral head and a
line drawn down center of femoral shaft.

• Lateralization of the femoral shaft restores

offset reduces femoropelvic impingement,
and increases abductor tension.
 HIP
Femoral offset
• Lateralization also increases the lever arm for
the abductor muscles.

• Note that increasing offset may have the

unwanted effect of increasing rotational
torque on the stem.
FEMORAL OFFSET
 GEOMETRY
Femoral anteversion
• Femoral version is defined as the angular
difference between axis of femoral neck and
transcondylar axis of the knee.

• It ranges from 30-40 degrees at birth &

decreases progressively throughout growth to
about 15 degrees at skeletal maturity
 GEOMETRY
Femoral anteversion
 GEOMETRY
Neck-shaft angle
• The femoral neck extends inferolaterally from
head to meet shaft of femur at angle of about
125 degrees. (120-130)

• This angle varies with age, stature, & width of

pelvis.

• It is less in adults, in persons with short limbs,

and in women.
 GEOMETRY
Neck-shaft angle
 GEOMETRY
Acetabulum & cup positioning
• A factor of abduction & version

• Abduction of 45 degrees

• Version is a combination of flexion & rotation

• Version of 25 degrees

• Combined acetabular & femoral anteversion is 40

degrees
ACETABULAR VERSION
 Anatomic guides
• McCollum's line extends from anterosuperior
iliac spine to the sciatic notch.

• This gives a reproducible landmark to help the

surgeon gauge the proper angle of reaming

• Generally the line of reaming and cup insertion is

either perpendicular to McCollum's line or is
slightly anterior to the line.
McCollum's line
 Anatomic guides
• Ischium flush with posterior acetabular wall

• The notch acetabular angle is a line from the

posterior rim of the acetabulum into the
sciatic notch.
THANK YOU