ANATOMY

OF Hip DR KULDEEP M JOSHI

1 ST YR ORTHO

JOINT
RESIDENT
NAMS BIR HOSPITAL
 Articulating surfaces
Hip joint is a type of synovial ball
and socket joint.
It meets the four characteristics of
a synovial or diarthrodial joint:
it has a joint cavity;
joint surfaces are covered with
articular cartilage;
it has a synovial membrane
producing synovial fluid, and;
it is surrounded by a ligamentous
capsule.
● Formed by
● Pelvic acetabulum
● Femoral head
 Articulating Surfaces
●Pelvic acetabulum -ilium (40% ), ischium
(40%) and the pubis (20%).
● articular surface appears a lunate or horse shoe shaped and
its fat filled centre provides attachment for ligamentum
teres.
● Labrum- surrounds the acetabular rim separately from
articular cartilage , except inferiorly where transverse
acetabular ligament completes the circumference . The
labrum receives a vascular supply from the obturator and the
superior and inferior gluteal arteries.
● ‘watershed region’- junction of labrum and articular cartilage
● The labrum has been closely studied as tears of the labrum
are the most common indication for hip arthroscopy.
 Acetabulum contd…..

● Orientation of acetabulum
● In the erect position, the
anterior-superior iliac spines
and the symphysis pubis lie in
the coronal plane and the
acetabulum opening is
directed approximately 45°
laterally ( inclination )and 15°
forward (anteversion).
● When the pelvis is flexed, as it
is in sitting, the forward
facing of the acetabulum is
accentuated
Articulating surface contd….
●Head of femur
● 60-70% Fits into the acetabular
cup.
● Incovered central fovea capitis
provides attachement to ligmentum
teres.
● The head is attached to the shaft by
the femoral neck forming neck-
shaft angle which steadily decreases
from 150° after birth to 125° in the
normal adult,
● . The femoral neck in the average
person is also rotated slightly
anterior to the coronal plane. This
medial rotation is referred to as
femoral anteversion (15 to 20°.)
● The neck is most narrow midway
down the neck.
Blood supply of head neck
of femur
▪ upto 4 month
metaphyseal arteries,
lateral epiphyseal
artery ,scanty vessels in
ligmentum teres
▪ 4-7 yr mostly by lateral
epiphyseal artery.
▪ Adult medial femoral
circumflex to lateral
epiphyseal artery.
Capsule and ligament
● fibrous capsule
encloses hip joint & greater
part of neck of femur;
- it encloses the
femoral head and most of
its neck;
- capsule is attached
anteriorly at the
intertrochanteric line;
- posteriorly the
lateral half of the femoral
neck is extracapsular;
Ligaments
Intracapsular
▪ Transverse
acetabular
ligament

▪ ligament of
head of femur
 Ligaments contd..
● Anteriorly and superiorly
Iliofemoral ligament –
strongest , inverted ‘Y’. It
spans, in a spiralling fashion,
from its proximal attachment
to the ilium to insert along the
intertrochanteric line.prevent
hyperextension of hip joint.
Anteriorly inferiorly
pubofemmoral ligament –
arises from the obturator crest
and merge with joint capsule
and medial iliofemoral
ligament . Prevent
overabduction.
Postreiorly
Ischiofemoral –weakest , arises
from ischial part of acetabular
rim and inserts to base of
greater trochanter.
pyriformis Pelvic Medial Lateral Nerve to
surface of surface of rotator pyrifoemis
sacrum GT

Suprior Ischial GT Nerve to

gellimus spine obturator

Obturator Internal GT Nerve to

internus aspect of obturator
obturator
foramen

Inf Ischial GT Nerve to

gemellus tuberosity quadratus
femoris

Quadratu Ischial Quadrate Nerve to

s femoris tuberosity line quadratus
lateral femoris
aspect
 Nerve supply of hip joint
The anterior and posterior portions
of the hip have separate
innervations.

Anteromedially -articular braches of

the obturator nerve.

anterior aspect- branches of the

femoral nerve.

posterior aspect –
laterally by branches of the
superior gluteal nerve.
Medially -articular branches
from the nerves to quadratus
femoris and also articular branches
from the sciatic nerve.
Normal Hip Range of
Motion
Patient supine
Hip flexion: 110 to 120 degrees
Hip abduction: 30 to 50 degrees
Hip adduction: 20-30 degrees
Patient in lateral decubitus position
Hip extension: 10 to 15 degrees
Patient sitting or supine with hip flexed to 90 degrees
and knee flexed to 90 degrees
Hip external rotation (lateral): 40 to 60 degrees
Hip internal rotation (medial): 30 to 40 degrees
Biomechanics of hip
● The forces acting across
the hip joint are :
● Body weight
● Abductor muscles force
● Joint reaction
force( equals sum of
body weight & abductor
force)
Biomechanics of hip
Hip joint as first order
lever with
● fulcrum as hip joint
● Forces on either side of
fulcrum ie body weight
and abductor tension.
stable hip -= weight x lever
arm1 = Abductor force x
lever arm2
practical aspect Biomechanics
Double stance
Forces acting across hip joint
Lower limb 1/6 +16=2/6
Upper limb & trunk =4/6.
double leg stance - body weight is distributed
equally , each hip carries 1/3 body weight.
● Single stance
● Shifting of the centre of
gravity toward the swing
leg Increasing Torque of
the weight arm
significantly.
● This torque is balanced
by abductor arm torque
by significant increase in
the abductor force
Cane
Use of cane in opposite hand .
There reduction of the total body weight as some the
weight is transmitted though cane .
● Limping
● the effective loading is
decreased by moving the
centre of gravity of body
close to the centre of
femoral head.
References
Clinically oriented Anatomy Keith L Moore arthur F Dally 5 th ed
Miller’s Review Of Orthopedics 7th ed .
Apley’s system of orthopedic and fracture 9th ed.
Anatomy and Biomechanics – The open Sports Journal 2010,4,51-57
Thank you