3. MOB TCD
Hip Joint
ā¢ Synovial ball and socket
joint
ā¢ Multiaxial
ā¢ Three degrees of freedom
ā¢ Movement in three planes
ā¢ Close pack extension and
medial rotation
ā¢ Least pack semiflexion
4. MOB TCD
Hip Joint
ā¢ One of most stable joints in
the body
ā¢ Articular surface of hip joint
are reciprocally curved
ā¢ Superior surface of femur and
acetabulum sustain greatest
pressure
5. MOB TCD
Acetabulum
ā¢
ā¢
ā¢
ā¢
ā¢
Y-shaped epiphyseal cartilage
Start to ossify at 12 years
Fuse 16-17 years
Acetabular notch is inferior
Nonarticular fossa, thin related
medially to obturator internus
ā¢ Pad of fat, proprioceptive nerves
6. MOB TCD
Articular Surface of Hip Joint
ā¢ Semilunar articular surface
covered with hyaline
cartilage
ā¢ Deepened by acetabular
labrum
ā¢ Wedge shaped fibrocartilage
7. MOB TCD
Articular Surface
ā¢
ā¢
ā¢
ā¢
ā¢
Head of femur 2/3rd of sphere
Pit for ligamentum teres
Covered with articular cartilage
Cartilage thicker posterior superior
Epiphyseal line for head
intracapsular
8. MOB TCD
Femur
ā¢ Trabeculae develop along lines
of stress
ā¢ Calcar femorale is the cortical
bone on inferior aspect of neck
ā¢ Neck is cancellous bone
9. MOB TCD
Capsule of Hip
ā¢ Proximally attached
ā¢ Margins of the acetabular
fossa
ā¢ Base of labrum
ā¢ Distally, anterior to the
intertrochanteric line
ā¢ Inferiorly, femoral neck close
to lesser trochanter
10. MOB TCD
Capsule of Hip
ā¢ Posterior
ā¢ Free border, fingerās breath
from trochanteric crest due
to insertion of obturator
externus
ā¢ Into trochanteric fossa and
ā¢ Root greater trochanter
11. MOB TCD
Capsule of Hip
ā¢ Strongest superiorly
ā¢ Anteromedially, deep fibres
reflected head of rectus
femoris
ā¢ Iliopsoas is anterior
ā¢ Lateral deep fibres of gluteus
minimus
12. MOB TCD
Retinacular Fibres
ā¢ Fibres of capsule reflected along
neck to articular margin called
retinacular fibres
ā¢ Blood supply to head run under
retinacular fibres
13. MOB TCD
Ligaments of Hip
ā¢
ā¢
ā¢
ā¢
ā¢
ā¢
ā¢
Acetabular labrum
Transverse ligament
Ligament of head
Iliofemoral ligament
Pubofemoral ligaments
Ischiofemoral ligaments
Zona orbicularis
14. MOB TCD
Ligaments of Hip
ā¢ Transverse ligament is part of
the labrum
ā¢ Ligamentum teres is
triangular, its base is attached
to transverse ligament, and
the apex to the pit on the
head of femur
ā¢ Blood supply to epiphysis
from obturator artery
ā¢ Only supplies a flake of bone
in elderly
15. MOB TCD
Iliofemoral Ligament
ā¢ Thickening of capsule
ā¢ Lower half of anterior
inferior iliac spine and
adjoining acetabulum
ā¢ Distally
ā¢ Upper and lower parts of
inter trochanteric line
16. MOB TCD
Iliofemoral Ligament
ā¢ One of strongest
ligaments in body
ā¢ Tightens in extension
ā¢ Helps maintain erect
posture
ā¢ Facet on anterior aspect
of neck
ā¢ Prevents hyperextension
ā¢ Fulcrum reducing hip
17. MOB TCD
Pubofemoral Ligament
ā¢ Superior pubic ramus
ā¢ Inferior part of inter
trochanteric line and upturned
part
ā¢ Relatively weak
ā¢ Prevents abduction
ā¢ Bursa between it and
iliofemoral
18. MOB TCD
Ischiofemoral Ligament
ā¢ Ischium to posterior part of
joint (weak)
ā¢ Circular fibres called zona
orbicularis
ā¢ Centre of gravity in front of
head
ā¢ Synovial under obturator
externus
19. MOB TCD
Synovial Membrane
ā¢ Lines inner portion of capsule
and non articular structures
ā¢ Ligament of head
ā¢ Fat in acetabular fossa
ā¢ May communicate with psoas
bursa
ā¢ Bursa under obturator
externus
20. MOB TCD
Bursa Under Gluteus Maximus
ā¢ Trochanteric bursa
ā¢ Posterolateral aspect of
greater trochanter
gluteofemoral
ā¢ Vastus lateralis ischial bursa
ā¢ Ischial tuberosity
21. MOB TCD
Blood Supply to Head of Femur
ā¢ Child, obturator artery via
ligamentum teres supplies
epiphysis
ā¢ Elderly, main supply via
retinacular vessels from
trochanteric and cruciate
anastamoses
ā¢ Medial and lateral circumflex
femoral vessels
22. MOB TCD
Blood Supply
ā¢ Superior gluteal supplies the upper
part of the acetabulum
ā¢ Inferior gluteal supplies the inferior
and posterior and the capsule
ā¢ Transverse and ascending
branches of lateral circumflex
femoral artery
ā¢ Transverse and ascending branch
of medial circumflex femoral
ā¢ Cruciate and trochanteric
anastomosis
23. MOB TCD
Blood Supply
ā¢ Fractures of neck may cause
avascular necrosis, extra
capsular arteries enter the
trochanter at the base of neck
ā¢ Medial and lateral circumflex
femoral vessels and superior
gluteal
24. MOB TCD
Nerve Supply
ā¢
ā¢
ā¢
ā¢
ā¢
Femoral nerve
Obturator nerve
Superior gluteal nerve
Nerve to quadratus femoris
Posterior dislocation may
damage sciatic
ā¢ Pain in hip referred to knee
26. MOB TCD
Inferior and Posterior Relations
ā¢ Obturator externus
ā¢ Passes inferior and then posterior
to joint
ā¢ Superior gluteal nerve
ā¢ Inferior gluteal nerve
ā¢ Sciatic nerve
ā¢ Posterior cutaneous nerve thigh
ā¢ Nerves to obturator internus and
quadratus femoris
ā¢ Pudendal nerve
27. MOB TCD
Lateral Relations
ā¢ Gluteus minimus
ā¢ Gluteus medius
ā¢ Superior gluteal vessels and
nerves between
ā¢ Iliotibial tract
ā¢ Superficial three quarters of
gluteus maximus
30. MOB TCD
Movements: Extension
ā¢ Hamstrings first 10Ā°
ā¢ Long head of biceps
ā¢ Semitendinosus
ā¢ Semimembranosus
ā¢ 123, extended knee ++
ā¢ Adductor magnus
ā¢ Gluteus maximus most efficient when hip is
flexed 45Ā°
37. MOB TCD
Hip Problems in Children
ā¢
ā¢
ā¢
ā¢
Apophysitis
Avulsion fractures
After 13 years
11-40% of all hip and pelvic fractures
Boyd et al., 1997
ā¢ Anterior superior iliac spine
ā¢ Anterior inferior iliac spine
ā¢ Ischial tuberosity commonest
39. MOB TCD
Pain in a Child
ā¢
ā¢
ā¢
ā¢
ā¢
ā¢
5-10 year old child
Aching pain in hip
Limp
Limitation of movement
Pertheās
Osteochondritis of head of femur
40. MOB TCD
Stability of Hip
ā¢ One of the most stable
joints
ā¢ Congenital dislocations is
common
ā¢ 1.5 per 1000 live births
ā¢ Female : male = 8:1
ā¢ Ultrasound best method of
detecting
41. MOB TCD
Femoral Anteversion
ā¢ Femoral version is the angular difference between axis
of femoral neck and transcondylar axis of the knee
ā¢ Femoral anteversion ranges from 30 Āŗ - 40 Āŗ at birth
ā¢ Decreases progressively 15 Āŗ at skeletal maturation
ā¢ Adults
ā¢ Anteversion
ā¢ Average of 8 Āŗ in men and 14Āŗ in women
ā¢ Most common cause of in-toeing
ā¢ If associated with internal tibial torsion, may lead to
patellofemoral subluxation due to an increase in the
Q-angle
42. MOB TCD
Tumors and Neoplasms
ā¢
ā¢
ā¢
ā¢
Young, healthy athletes do get cancer!
Fortunately most tumors are benign!
Bone pain at night
Tumor till proved otherwise
Renstrƶm, 2008
43. MOB TCD
Hip Joint Labral Tear
ā¢ Chronic
ā¢ Secondary to acetabular
dysplasia
ā¢ Part of ārim lesionā complex
Renstrƶm, 2008
44. MOB TCD
Labrum Tears and Cartilage Loss
ā¢ Labrum tears and cartilage loss are
common in patients with mechanical
symptoms in the hip
ā¢ In young, active patients with a
complaint of groin pain
ā¢ The diagnosis of a labrum tear
should be suspected and
investigated as radiographs and the
history may be nonspecific for this
diagnosis
Burnett et al., J Bone Joint Surg (Am), 2006
45. MOB TCD
MR-Arthrography (MRA)
ā¢ MR arthrogram has an
accuracy of 91% for labral
tears
Chan et al, Arthroscopy 2005
ā¢ Sensitivity labral tear
ā¢ MR 25%,
ā¢ MRA 92%
Toomayan et al., Am J Roentgenol 2006
46. MOB TCD
Pincer Impingement
ā¢ The acetabulum covers too much of the
ā¢
ā¢
ā¢
ā¢
femoral head
Secondary to āretroversionā, of the
socket
Or a āprofundaā socket that is too deep
Most of the time the cam and pincer
forms exist together
Female, 30-40 years
Renstrƶm, 2008