Hip joint anatomy

Dr Md Ruhul AminAssistant RegistrarDept of MedicineJRRMCH,SYLHET.

Surface anatomy

Hip joint

• Hip joint is a ball-and-socket joint that is relatively fixed to the body by the pelvic girdle

• Largest and strongest joint of body

• Structures of the hip can be divided into several categories, These include;–bones and joints – capsules and ligaments –muscles –nerves –blood vessels –bursae

acetabulum

• Acetabulum is deficient inferiorly by acetabular notch which is bridged with transverse acetabulur ligament.

• Ligamentum teres passess through acetabular notch which goes to fovea on the femoral head

• Articular cartilage covers the horse-shoe shaped articular surface of acetabulum

• The center is free of cartilage-acetabular fossa which is filled with fibrofatty tissue.

Acetabular labrum:• fibrocartilage• Deepens the acetabulum• Distributes stresses to the joint during joint

loading• Maintains intra-articular pressure

Femur head

• The femoral head articulates with the cup-shaped (cotyloid) acetabulum,

• its Centre lying a little below the middle third of the inguinal ligament.

• The femoral head is covered by articular cartilage, except over the rough pit where the ligamentum teres is attached

SYNOVIAL MEMBRANE

• Starting from the femoral articular margin, the synovial membrane covers– intracapsular part of the femoral neck, – internal surface of the capsule – acetabular labrum,– ligamentum teres and– fat in the acetabular fossa.

capsule

• There is a strong dense fibrous capsule• This is attached proximately to the acetabulum,

the glanoid & the transverse ligament• Distally it covers the lateral margin of the

femoral head & most of the neck• Anteriorly it is attached to the intertrochanteric

line & posteriorly to the neck just above this

ligament

Capsule is reinforced by

• iliofemoral ligament,-infront • pubofemoral ligament- inferiorly • ischiofemoral ligament- behind

• iliofemoral (Y-shaped ligament of Bigelow)— which arises from the anterior inferior iliac spine, bifurcates, and is inserted at each end of the trochanteric line (Fig. 167);

• pubofemoral—arising from the iliopubic junction to blend with the medial aspect of the capsule;

• ischiofemoral—arising from the ischium to be inserted into the base of the greater trochanter.

the iliofemoral is by far the strongest and resists hyperextension

• Ligamentum teres is an intracapsular ligament arises from the transverse ligament of the acetabular rim, attaching to a pit in the head of the femur, & carries blood vessels which provide nourishment for a small area of the head

Muscle

Muscles causing movement of the Hip joint

Nerve supply

Hilton’s law nerves crossing a joint – supply the muscles acting on it,– the skin over the joint and – the joint itself.

• The hip is no exception and• receives fibres from the femoral, sciatic and

obturator nerves.•

• The femoral nerve (L2-L4) supplies the quadriceps and pectineus muscles of the anterior thigh

• The sciatic nerve (L4-S3) supplies the long head of biceps femoris, hamstring muscles common, to supply the hip flexors and muscles of the lower leg(peroneal and tibial nerves

• superior gluteal nerve (L4,5)- gluteus medius, minimus and

TFL.• Inferior gluteal nerve (L5, S1) - gluteus maximus.• The obturator nerve (L2-4) -anterior division-- hip joint and adductor longus,

brevis, and gracilis, - posterior division obturator internus and adductor

magnus.

Blood supply

• Major blood supply to the head and neck of the femur is usually the medial femoral circumflex artery, a branch of the common femoral artery

• Fracture of the femoral neck can disrupt the blood supply and result in osteonecrosis

bursae

• Approximately 18 bursae have been identified• Clinically most important – Iliopectineal or iliopsoas bursa – Trochanteric bursa– Ischiogluteal bursa

• Iliopectineal bursa • It lies over the anterior surface of the articular capsule beneath the deep surface of the iliopsoas muscle between the iliofemoral & pubofemoral ligament

• It is the largest & most constant bursa• In 15% cases communicate with the hip joint

Trochanteric bursa

• Trochanteric bursa

– Situated between the posterolateral surface of the greater trochanter & the gluteus maximus muscle

– Actually comprises three bursae, the principal being the gluteus maximus bursae; the bursae of gluteus medius & gluteus minimus are at sites of the prospective tendon attachment

• Ischiogluteal bursa– Over the ischial

tubersity & overlies the sciatic nerve

– Facilitates gliding of the gluteus maximus over the tuberosity

Criteria for Diagnosis of Trochanteric Bursitis

1.Lateral hip pain2.Distinct tenderness about the greater trochanter3.Pain at the extreme of rotation, abduction, or adduction,especially positive Patrick-FABERE test4.Pain on hip abduction against resistance5.Pseudoradiculopathy–pain radiating down the lateral aspect of the thigh6.Patrick-FABERE (Flexion, abduction, external rotation, extension)Need first 2 criteria plus one of the remaining criteria to make diagnosis

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