HIP JOINTS

Introduction of Hip Joint

• • The hip joint, or
coxofemoral joint, is the
articulation of the
acetabulum of the pelvis
and the head of the femur.
• Ball and socket joint
• 3 degree of freedom
• Primary function: to
support HAT in static and
dynamic posture.
• Open chain-close chain
•Pathway for transmission of forces between pelvis &
LE.
•The proximal end of chain—head free to move in space
but remain upright & vertically oriented due to the
influence of tonic labyrinthine and righting reflexes.
•When head held upright & over BOS—all the segments
between head & weight bearing surface becomes part
of closed chain.
•Closed chain response can voluntarily ridden since
head is not truly fixed.
•Eg.of open chain—hip flexor tight & hip joint
maintained in flexion result in displacement of the
head from vertical.
•Require compensatory adjustment to prevent
displacement of LOG from BOS.
•Sustained hip flexion in stance accompanied by
compensatory movement of vertebral column i.e
hyperextension to maintain head in upright position &
keep LOG within BOS
Structure of Hip

Joint
 Proximal Articular Surface
• • Acetabulum-concave, at
lateral aspect of hip.
• Acetabulum=1/5 pubis+2/5
ischium +remaining illium
• Ossification at 20-25 years
• Roundness decreases with
age
• (lunate surface,
acetabularnotch,
acetabularfossa,
acetabularlabrum)
•Only horse shoe shaped portion of periphery covered
with hyaline cartilage & articulate with head of femur.
•Base of horse shoe -- acetabular notch.
•Central or deepest portion—acetabular fossa—non
articular,contains fibroelastic fat covered with synovial
membrane.
•Femoral head does not contact with this area.
Centre Edge Angle
•Acetabulum oriented on the pelvis to face
laterally,somewhat inferiorly & anteriorly.
•A line connecting lateral rim of acetabulum & center
of head form an angle with vertical =CENTRE EDGE
(CE) angle or ANGLE OF WIBERG.
•Denotes amount of inferior tilt of acetabulum.
•In adults—38 degree in men,35 degree in women.
•Small CE means motre vertical orientation results in
diminished coverage of head of femur.
•Increase risk of superior dislocation of head.
•Children have less coverage so decrease jt.stability-
congenital dislocation due to deficiencies in superior
acetabulum( decrease CE angle).
 Acetabular Anteversion
• The magnitude of
anterior orientation of
the acetabulum may be
referred to as the angle
of acetabular
anteversion
• Increase in angle-
decrease
stabilityincrease
ant.dislocation
 Acetabular Labrum
• Grasps head of femur
• Concavity-increases
• Not load bearing
• Free nerve endings
present
• Lubrication
• Transverse
acetabularligament:
serve as tension band.
Distal Articular Surface
 Head Of Femur

• Circular in shape.
• Radius of curvature of the
femoral head is smaller in
women than in men in
comparison with dimension s
of pelvis.
• Fovea/fovea capitis-not
covered with cartilage,
ligament of head of femur.
• Femoral head medialy,
superiorly,anteriorly.
• Femoral neck is 5 cm long.
Angle of Inclination
•Angle of inclination in frontal plane between axis of
femoral neck & axis of femoral shaft=125 degree .
•In women,angle is smaller in men due to greater
width of femoral pelvis.
Angle of Torsion
•Angle of torsion in transverse plane beteen axis of
f.neck & axis of condyles.increase angle- coxa
valga,decrease angle- coxa vara.
•It reflects the medial rotation of femoral
condyles=anterior torsion.
•i.e decrease lateral rotation of head & neck of
femur.
•15 degree in adults.
•Pathologic increase- ANTEVERSION.
•------------- DECREASE- RETROVERSION.
•Abnormal in angulations –alter hip jt.stability.
•Femoral anteversion(inferior femoral torsion) creates
substantial dysfunction at both knee & at foot.
 Articular Congruence
• Congruent joint
• Art.surface-head of
femur&acetabulum
• In neutral standing
position: head remains
exposed anteriorly and
somewhat superiorly.
• Maximum contact-non
wtbearing ,flx, abd, lat
rotation.
• .
•Flexion+ abd.+ slight LR=frog leg
position(quadruped)
•It’s a true physiologic position of hip jt.
•Position for immobilisation to improve jt.
Congruence in congenital dislocation or Perthe’s
disease.
•Under low loads-incongruence of surfaces—
functional advantage.
•Under high loads-flattening of articular cartilage &
subchondral bone—maximum surface contact-
decrease force per unit area.
HIP JOINT CAPSULE
• Surrounding the ball and socket joint is a capsule
that also increase stability. Within the hip joint a
negative oressures exists which contribute to the
stability of Hip joint.
The capsule of the hip joint attaches to the edges of

the acetabulum proximally.

Distally, it attaches to the intertrochanteric line

anteriorly and the femoral neck posteriorly.

ATTACHMENT

Anterosuperiorly,it is attached to the margin of the

acetabulum 5 to 6 mm. Beyond the labrum

behind; But in front it is attached to the outer

margin of the labrum ,and opposite to the notch

where the margin of cavity is deficient

• It is connected to the transverse ligament , and by a
few fibers to the edge of the Obturator foramen.
• It surrounds the neck of the femur, and is
attached ,in front ,to the intertrochanteric line ;
above to the base of the neck; Behind, to the neck,
about 1.25cm above the intertrochanteric crest ;
Below, to the lower part of the neck ,close to the
lesser trochanter.
• The capsule is much thicker at the upper and
forepart of the joint, where the greatest amount of
resistance is required ; behind and below, it is thin
and loose.
• It consists of two sets of fibers, Circular and
Longitudinal Fibers
 The external surface of the capsule is
rough, covered by numerous muscles
and seperated in front from the psoas
major and iliacus by the iliopectineal
Bursa, which not infrequently
communicates by a circular aperture
with the cavity of the joint .
 CAPSULAR LIGAMENTS

• The ligaments of the hip joint act to increase stability

• They can be divided into two groups-
1. Intracapsular
2. Extracapsular
 Intracapsular
• The only intracapsular ligament is a ligament
of head of femur . It is a relatively small
structure ,which runs from the acetabular
fossa to the fovea of the femur.
• It encloses a branch of OBTURATOR ARTERY , a
minor source of arterial supply to the hip joint.
 EXTRACAPSULAR
• There are three main extracapsular ligaments,
continuous with the other surface of the hip
joint capsule:-
1. Iliofemoral Ligament
2. Pubofemoral Ligament
3. Ischiofemoral Ligament
1. ILIOFEMORAL LIGAMENT

• Arises from the anterior inferior

iliac spine and then bifurcates
before inserting into the
intertrochanteric line of the femur .
• It has a ‘Y’ shaped appearance, and
prevents hyper extension of the hip
joint . It is strongest of the three
ligaments.
 The Iliofemoral Ligament

• It is a fan-shaped ligament that

resembles an inverted letter Y.
• It often is referred to as the Y
ligament of Bigelow.
• The apex of the ligament is
attached to the anterior
inferior iliac spine, and the two
arms of the Y fan out to attach
along the intertrochanteric line
of the femur.
• The superior band of the
iliofemoral ligament is the
strongest and thickest of the
hip joint ligaments.
 The Pubofemoral Ligament
• It is also anteriorly located,
arising from the anterior
aspect of the pubic ramus
and passing to the anterior
surface of the
intertrochanteric fossa.
• • The bands of the
iliofemoral and the
pubofemoral ligaments
form a Z on the anterior
capsule.
 2. PUBOFEMORAL LIGAMENT

• Spans between the superior pubic rami and

intertrochanteric line of the femur,reinforcing
the capsule anteriorly and inferiorly.
• It has a triangular shape, and prevents
excessive abduction and extension.
 The Ischiofemoral Ligament

• It is the posterior capsular

ligament.
• The ischiofemoral ligament
attaches to the posterior
surface of the acetabular rim
and the acetabulum labrum.
• Some of its fibers spiral around
the femoral neck and blend
with the fibers of the
circumferential fibers of the
capsule.
• Other fibers are arranged
horizontally and attach to the
inner surface of the greater
• The hip joint capsule and the majority of its ligaments are
quite strong and that each tightens with full hip extension
(hyperextension).
• The anterior ligaments are stronger (stiffer and withstanding
greater force at failure) than the ischiofemoral ligament.
• Under normal circumstances, the hip joint, its capsule, and
ligaments routinely support two thirds of the body weight
(the weight of head, arms, and trunk, or HAT).
• In bilateral stance, the hip joint is typically in neutral position
or slight extension.
• In this position, the capsule and ligaments are under some
tension.
• The normal line of gravity (LoG) in bilateral stance falls behind
the hip joint axis, creating a gravitational extension moment.
 Capsuloligamentous Tension

• Hip joint extension, with slight abduction and medial rotation,

is the close-packed position for the hip joint.
• With increased extension, the ligaments twist around the
femoral head and neck, drawing the head into the
acetabulum.
• In contrast to most other joints in the body, the close-packed
and stable position for the hip joint is not the position of
optimal articular contact (congruence).
• Optimal articular contact occurs with combined flexion,
abduction, and lateral rotation.
• Under circumstances in which the joint surfaces are neither
maximally congruent nor closepacked, the hip joint is at
 continued…
• A position of particular vulnerability occurs when
the hip joint is flexed and adducted (as it is when
sitting with the thighs crossed).
• In this position, a strong force up the femoral shaft
toward the hip joint (as when the knee hits the
dashboard in a car accident) may push the femoral
head out of the acetabulum.
• The capsuloligamentous tension at the hip joint is
least when the hip is in moderate flexion, slight
abduction, and midrotation.
WEIGHT BEARING STRUCTURE OF HIP JT.
•The trabeculae of bone line up along lines of stress
& form system to meet stress requirement.
•Most wt.bearing lines pass to acetabulum.
•Pelvic trabeculae—2 major system=medial
trabecular & lateral trabecular system.
•2 minor accessory system-medial & lateral
•Medial TS-medial cortex of upper femoral shaft &
radiate outward to cortical bone of superior aspect of
femoral head.Its vertiacal.
•Region of increase subchondral bone density in
superior acetabulum is primary weight bearing
surface found by drawing a line betw medial & lateral
edges of area increased density.
•This line is horizontal & lie directly over center of
rotation of femur.
•The medial femoral shaft undergoes compression as
weight bearing forces pass down the femur.

•LATERAL TS— lateral cortex of upper femoral

shaft,cross the MTS then to inferior aspect of head.
•2 accessory TS confined primarily to the trochanteric
area & neck.
•Area in which various trabecular system cross each
other at right angle offer greatest resistance to stress &
strain.
•An area in femoral neck where trabeculae is relatively
thin & do not cross each other=zone of weakness-
potential for injury-susceptible to bending forces can
lead to fracture.
 Functions

Support HAT.
Closed Kinematic Chain:
Both proximal and distal
end is fixed.
Provide a pathway for
both transmission of
force between the
pelvis and lower
extremity and the
thrusting propulsive
movement of the legs
are transmitted to the
body.
 Motion Of The Femur On The Acetabulum

 The femoral head will glide

within the Acetabulum in a
direction opposite to the
motion of the distal end of the
femur.
 The head spins posteriorly in
flexion and anteriorly at
extension.
 Flexion and extension from
other positions must include
both spinning and gliding of
the articular surfaces,
depending on the combination
of motions.
 ROM Of The Hip Joint (HIP KINEMATICS)

 ROM is influenced by structural elements, motion is performed

actively or passively.
 FLEXION the hip is generally about 90% with the knee extended and
120% when the knee is flexed so that passive tension in the two-
joint hamstring muscle is released.
 EXTENSION is combined with knee flexion, passive tension in the
two-joint muscle rectus femoris muscle may limit the movement.
 ABDUCTION femur can be abducted 40%-50% . It can be limited by
two-joint muscle gracilis.
 ADDUCTION 20%-30% .It is limited by tensor fascia lata muscle.
 Normal gait on the ground level requires hip joint ranges 30%
flexion ,10% extension, 5% of both adduction and abduction, and
  Motion Of The Pelvis On
Femur
 When hip joint is weight bearing, the femur is fixed
and the motion produced by movement of pelvis on
the femur.
 The proximal and distal levers move in opposite
directions to produce the same articular motion.
 The “Levers” of the hip are not in line but lie
essentially perpendicular to each other.
 The terms pelvic motions are used with weight
bearing hip motion because the hip motion is
apparent to the key to what occurs at the joint
above and below the pelvis
  Anterior And Posterior Pelvic Tilt
 Anterior and posterior pelvic tilt are motions in sagital
plane around a coronal axis. It produces hip flexion and
extension.
 Hip joint extension through posterior tilting of the pelvis
brings the symphysis pubis up and sacrum of the pelvis
closure to the femur, rather than moving the femur
posteriorly.
 Hip flexion through anterior tilting of the pelvis moves the
anterior superior iliac spines anteriorly and inferiorly.
 Anterior and Posterior tilting will result in flexion and
extension of both hip joints.
 Simultaneously in bilateral stance or can occur at the stance
hip joint alone if the opposite limb is non - weight bearing.
 Lateral Pelvic Tilt
 Lateral pelvic tilt is a frontal plane motion of the
entire pelvis around an anterioposterior axis.
 It is named by what is happening to the side of
the pelvis opposite to the weight bearing hip in
unilateral stance.
 The weight bearing hip joint serves at the pivot
joint or axis for motion of the pelvis as pelvis
elevates (pelvic hike) or drops (pelvic drop) in the
frontal plane.
 EX- If a person stands on the left limb and hikes
the pelvis , the left hip is being abducted because
the medial angle between the femur.
 The weight bearing hip joint in unilateral stance
will always be the axis of rotation and the
opposite side of the pelvis will always be the
 Lateral Shift Of The Pelvis
 Lateral pelvic tilt can also occur
in bilateral stance .
 If both feet are on the ground
and the hip and knee of one
limb are flexed , opposite limb is
largely the weight bearing limb
and the terminology is same for
unilateral stance.
 With the pelvic shift, the pelvis
cannot hike, it can only drop.
 There is a close chain between
the two weight bearing feet and
the pelvis, both hip joint will
move in the frontal plane as the
 Forward And Backward Pelvic Rotation

 Forward (anterior) rotation of the pelvis occur in

unilateral stance when the side of the pelvis opposite
to the weight bearing hip joint moves anteriorly.
 Forward rotation of the pelvis produces medial rotation
of the weight bearing hip joint.
 Backward (posterior) rotation of the pelvis occurs
when side of the pelvis opposite the weight bearing
hip moves posteriorly.
 Backward rotation of the pelvis produces lateral
rotation of the weight bearing hip joint.
 If both feet are bearing weight and the axis of motion
occurs around a vertical axis then both terms must be
used but referring the sides.
Movements of the pelvis
 Lumbo-pelvic rhythm-
Lumbopelvic rhythm refers to the way in
which the lower section of the spine, called
the lumbar spine, moves in combination with
the pelvis. When bending forward from a
standing position, both the trunk and hips
flex to produce movement. The muscles in
the lower back, called the erector spinae
muscles, contract eccentrically (actively
lengthen) to control the movement against
gravity.
At the same time that the trunk flexes, the
pelvis rotates anteriorly on the femoral
heads. The muscles that flex the hip
contract concentrically (actively shorten)
and this motion is balanced by eccentric
contraction of the muscles that extend the
hip.
• When returning to an upright position,
this lumbopelvic rhythm is reversed. The
hip extensors initiate the posterior
rotation of the pelvis until it is in a better
position for the spinal extensors to
concentrically contract without too
much stress being put on them. As
these muscles contract concentrically,
the hip flexors contract eccentrically to
help control the movement.
 • Note-
according to cailliet-

Cailliet described a specific instance of

coordinated,simultaneous activity of lumbar
flexion and anterior tilting of the pelvis in the
sagittal plane during trunk flexion an extensionn.
He called the combined lumbar and pelvic motion
lumbar-pelvic rhythm. The activity of bending Over
to touch one’s toes with knees straight depends on
lumbar-pelvic rhythm. According to Cailliet,
the firs part of bending forward consists of
lumbosacral flexion followed by anterior tilting of
the pelvis a the hip joints, a return to the erect
postur is initiated by posterior tilting of the pelvis
at the hips followed by extension of the lumbar
spine. The initia pelvic motion delays lumbar
extension until the trunk i raised far enough to
shorten the moment arm of the external load,
thus reducing the load on the erector spinae.
Lumbopelvic rhythm
Closed-chain response to motion of pelvis-

• Pelvic motion-
• Anterior pelvic tilt
• Posterior pelvic tilt
• Lateral pelvic tilt (Pelvic drop)
• Lateral pelvic tilt (Pelvic hile)
• Forward rotation
• Backward rotation
closed-chain hip joint function-
– The joints of the right and left lower limbs are part of
a true closed chain when both lower limbs are weight
bearing and the chain is defined as all the segments
between the right foot, up through the pelvis, and
down through the left foot.
– A true closed chain is formed because both ends of
the chain (both feet in this example) are “fixed” and
movement at any one joint in the chain invariably
involves movement at one or more other links in the
chain.
• It is also common usage to consider that the joints
of one or both lower limbs are part of a closed
chain whenever a person is standing (weight-
bearing) on one or both lower limbs, which leads
to inappropriately considering the terms "weight
bearing” and “closed chain” to be
interchangeable.
• For the hips (and other lower limb joints) to be in
a closed chain in standing, both ends of the chain
(the head and the feet) must be fixed.
• Consequently, in our functional closed-chain premise,
hip flexion does not occur independently (which would
move the head forward in space) but is accompanied
by motion in one or more inter-posed segments to
ensure that the head remains upright over the base of
support and that the body does not become unstable.
• A common example of closed-chain (versus open-
chain) function is seen when the hip flexor musculature
is tight and the hip joint is maintained in flexion.
• Movements and muscles
• The movement that can be
carried out at the hip joint are
listed below, along with the
principal muscles responsible
for each action
• Flexion-chiefly by psoas
major,iliacus assisted by rectus
femorious and sartorius
• Adductor longus assessed in early
flexion following full extension
• Extension-gluteus maximus
and the hamstring
• Abduction-gluteus medius and
minimus assistant by ,
sartorius,tensor fasciae latae and
priformis
• Action is limited by pubo femoral
ligament and medial band of ilio
femoral ligament
• hip joint muscles work best in the
middle of their contractile range or on a
slight stretch (at so called optimal length
tension)
• Tension generation is optimal with
ecentric contractions, followed by
isometric and then concentric
contraction
• Deep and colleagues use computer
modelling to determine that torque-
generating capability of the medial
rotators increased with increased hip
flexion, where is the torque-generating
capacity of the lateral rotators
decrease with increasing hip flexion
• It is best to examine muscle
action at the hip joint in the
context of specific functions
such as single limb support,
posture and gait.
• The muscles of Hip are 15
divided into four groups
according to their orientation
around the hip joint-
1. Gluteal group
2. Lateral rotator
3. Adductor group
4. Iliopsoas group
 GLUTEAL GROUP
• The gluteal maximum include the Glutus
maximus,gluteal medius,gluteal minimus
and tensor fasciae latae. De cover the
lateral surface of the ilium.the gluteus
maximus, which forms most of the
muscles of the buttocks, originals primarily
on the ilium and sacrum and inserts on
the gluteal tuberosityOf the femur.
 LATERAL GROUP
• This group consists of the externus and
internus obturators,the priformis,the
superior and inferior Gemelli and the
guadratus femoris. These sixoriginate
at or below the Acetabulum of the
ileum and insert on or near the greater
trochanter of the femur
 ADDUCTOR GROUP
• The adaptor barvis, adductor
longus,adductor Magnus,pectineus and
gracilis make up the adductor group. The
adductors all originate on the pubis and
insert on the medial posterior surface of
the femur, with the exception of the
gracilis which insert just below the
medial condyle of the tibia
 ILIOPSOAS GROUP
• The iliacus and psoas major comprise the
iliopsoas group. The psoas major is a large
muscle that runs from the bodies and disc of
the l1 to l5 vertebra, joins with the iliacus via
its tendon, and connect to the lesser
trochanter of the femur the iliacus originate
on the iliac fossa of the ilium. Together these
muscles are commonly referred to as
the”iliopsoas”
 OTHERS
• Additional muscles,such as the rectus femoris
and the sartorius, can cause some movement
in the hip joint. However these muscles
primarily move the knee, and not generally
classified as muscles of the hip
• The hamstring muscles, which originate mostly
from the ischial tuberosityinserting on the TV
are having a large moment assistant with hip
extension
 FLEXORS

• The collections of the hip joint

function primarily as mobility
muscles in open- chain
function
• Nine muscles have action lines
crossing the anterior aspect of
the hip joint of these,the
primary muscles of hip flexion
are the iliopsoas,rectus
femoris,tfl and sartorius.
• Consequently,the rectUs
femoris muscle makes its best
contribution to hip flexion
when the knee is maintained
in flexion
• The sartorius muscle is
considered to be a
flexor,abductor and lateral
rotator of the hip, as well as a
flexor and medial rotaTor of
the knee
 ADDUCTORS

• The hip adductor muscle group

is generally considered to
include the pectineus, adductor
longus, adductor brevis and the
gracilis muscles.the adductors
are located anterOmedially
 EXTENSORS

• The adductor group

contribute 22.5% to the total
muscle mass of the lower
extremity, in comparison with
only 18.4 percentfor the flexes
and 14.9% for the abductors
 ABDUCTORS

• Extension forces in the hip

increases by 30% if the knee is
extended during hip extension.
• The biceps femoris appears to
contribute to lateral rotation
of the hip
• The gluteus medius has anterior, medial
and posterior parts that function
asynchronously during movement at the
hip
• Isometric abduction torque in the
neutral position is 82% greater than
abduction torque when the hip is in 2as
of abduction
 LATERAL ROTATORS
• Six short muscles have lateal rotation as a
primary function. These muscles are the
obtrator internus and externus,the gemellus
superior and inferior, the quadratus femoris
and the priformis muscles
• Of the primary lateral rotators, inserts
either on or in the vicinity of the greater
trochanter.
• The lateral rotator muscles are
positioned to per-form there
rotatory function efficitevely,
given the nearly perpendicular
orientation to the shaft of the
femur
 MEDIAL ROTATORS
• There are no muscles with the primary
function of producing medial rotation of the
hip joint. The more consistent medial rotators
are the anterior portion of the gluteus
medius, gluteus minimus,and tfl muscles.
Although controversial, the weight of
evidence appears to support the adductor
massages medial rotators of the joint,with the
possible Exception of the gracilis muscle.
• The ability of hip joint muscles
to shift function with changing
creation of the hip joint is
evident when medial rotation
of the hip is examined
HIP JOINT PATHOLOGY
 mechanical articular hip
problems
• single event trauma
• dislocations/fractures/labral
tears
• think shoulder dislocation
• cumulative trauma
• labral tear
• usually in setting of too
much/too little bone
• cartilage injury
• point loading and shear
 mechanical non articular hip
problems
• ischiofemoral impingement
• sciatic entrapment
• tendon tears
• abductor
• hamstring
• fascial disruption (aka sports
hernia etc)
 common hip
pathologies
• labral tear
• GT pain
syndrome
• snapping
 GT pain
syndrome
• abductor tendon tendinopathy/tear
• bursitis
• idiopathic
• **pain with resisted abduction is their
usual pain**
• pain with high flexion and IR is usually
only at GT
 less common hip joint
pathologies
• ischiofemoral
impingement
• sciatic entrapment
• hamstring avulsions
Compile from:--
•Dr.Nandita ‘s notes
•Bhuwaneshwari
•Etisha Sharma
•Gaurav Negi
•Ishita Rawat
•Jainab Parveen
•Tanpreet
Thank You!