It's a brief overview of hip joint anatomy and congenital conditions specially prepared for undergraduates

1. ANATOMY OF HIP JOINT, IT’S
ROM & DDH
BIBEK LAMA (BHULAN)
INTERN
SHREE BIRNEDRA HOSPITAL, CHHAUNI
DATE : 2080-01-28

2. Table of content
• INTRODUCTION
• ARTICULAR SURFACE OF HIP JOINT
• SUPPORTING STRUCUTRES OF HIP JOINT
• BLOOD SUPPLY OF HIP JOINT
• NERVE SUPPLY OF HIP JOINT
• BURSAE AROUND HIP JOINT
• MUSCLES AROUND HIP JOINT
• RANGE OF MOTION OF HIP JOINT
• COMMON CONGENTIAL ANOMALY OF HIP JOINT: DDH

3. INTRODUCTION
• Largest joint of human body
• Formation: Head of femur and
acetabulum of pelvis
• Type: Synovial; multiaxial ; Ball &
socket
• Designed for stability and weight
bearing at expense of mobility

4. ARTICULAR SURFACE OF HIP JOINT
• Spherical head of femur
• Lunate surface of
acetabulum of pelvic bone

5. ACETABULUM
• Depression or fosaa where the
femoral head articulates
• Formed by fusion of 3 pelvic
bones : illium, Ischium and pubis
• Position downward and outward
direction

6. • Deepened by fibrocartilaginous rim
called acetabular labrum
• Deficient inferiorly as acetabular
notch that is bridged by transverse
acetabular ligament
• Horse shoe shaped articular
surface
• Non articular part, acetabular
fossa, lodges pad of fat

7. SUPPORTING STRUCTURES OF HIP JOINT
• Articular capsule: fibrous capsule and
synovial membrane
• Ligaments : Intraarticular and
extraarticular

8. FIBROUS CAPSULE
• Attaches proximally to the
acetabulum, close to the rim
• Attaches distally around the
proximal end of the femur

9. EXTRA ARTICULAR LIGAMENTS

10. INTRA ARTICULAR LIGAMENT
• Ligament of teres / Ligament
of femoral head: carries artery
to femoral head
• Transverse ligament of
acetabulum : convert
acetabular notch into
acetabular foramen

11. BLOOD SUPPLY OF HIP JOINT
• Originate from common iliac artery
which bifurcate into external and
internal iliac artery.
• Internal iliac artery:
o Gluteal artery : superior and inferior
branches
o Obturator artery: Artery of head of femur
• External iliac artery femoral artery
• Profunda femoris ( deep branch )
• Medial circumflex femoral artery
• Lateral circumflex femoral artery
• Vein of hip joint accompany arteries in
trajectory and name.

13. NERVE SUPPLY OF HIP JOINT
• Femoral and obturator nerves
arising from lumbar plexus (T12-
L4)
• Multiple small nerve arising from
sacral plexus (L4-S4)
• Femoral nerve : anterior aspect of hip
joint
• Obturator nerve: inferior aspect
• Superior gluteal nerve : superior
aspect
• Quadratus femoris nerve: posterior
aspect

14. BURSAE AROUND HIP JOINT
• Small , synovial fluid filled sac that
reduce friction between bony
component of joints and
surrounding muscles .

15. MUSCLES AROUND THE
HIP JOINT
• Flexor muscles :
• iliopsoas
• Rectus femoris
• Extensors muscles :
• Gluteus maximus
• Hamstring muscles

16. • Abductor muscles :
• Gluteus Medius
• Gluteus minimus
• Pyriformis
• Adductor muscles :
• Adductor group
• Gracilis
• Pectineus
• External rotator muscles :
• Obturators
• gemelli

17. RANGE OF MOTION AROUND HIP JOINT
• MOTION AROUND HIP JOINT:
• Flexion and extension
• Abduction and adduction
• Internal rotation and external
rotation
• Circumduction

18. • Hip flexion: 120º
• Extension: 5-20º
• Abduction: 40º
• Adduction: 25º
• Internal rotation at 90º hip flexion: 45º; in extension: 35º
• External rotation at 90º hip flexion: 45º ; in extension: 45º
NORMAL RANGE OF MOTION

19. CONGENITAL ANOMALY OF HIP JOINT: DDH
•INTRODUCTION:
• Dysplasia of hip occurring before, during or shortly after
birth
• Older terminology : congenital dysplasia of hip
• Comprises spectrum of disorders including:
• Acetabular dysplasia: shallow or underdeveloped acetabulum
• Subluxation
• Dislocation
• Teratologic hip : dislocated in utero and irreducible on neonatal
examination

20. ETIOLOGY
• Risk factors: 4 f : first born, female ,foot presentation (breech ), family
h/o
• SOME PROPOSED HYPOTHESIS:
• Hereditary predisposition to joint laxity
• Hormone induced joint laxity
• Breech malposition
• Postnatal position of babies

21. PATHOLOGICAL CHANGES
• Femoral head dislocated upwards and laterally, its’s epiphysis : small
and ossifies late
• Acetabulum : shallow with step sloping roof
• Capsule of hip joint : stretched
• Ligamentum teres : hypertrophied
• Fibrocartilaginous labrum of acetabulum : folded into cavity of
acetabulum
• Muscles around hip joint: adductors : adaptive shortening

22. CLINICAL FEATURES
• Depends upon the age of presentation:
• At birth (<6 months):
• Routine screening is necessary
• Asymptomatic
• Barlow sign: provocation test
• Ortolani sign : relocation manuevere

23. • Early childhood (6-18 months):
• Asymmetrical gluteal folds
• Inability to abduct the hip ( noticed
while changing diaper)
• Clicking of hip
• Prominent Galeazzi sign : unequal
knee height and apparent shorter
femur when child lies supine with hips
and knees flexed .

24. OLDER CHILD (> 18 MONTHS)
• Hip pain , some times referred up
to knee and /or anterior thigh
• Apparent once child start walking
• Typical gait: due to weak abductors
and/or limb length discrepancy
• Unilateral: Trendelenburg's gait
• B/l : waddling gait
• Leg length discrepancy , toe
walking ( to compensate for
difference in leg length)
• Lumbar lordosis of spine

25. DIAGNOSIS
• Physical examination + imaging
• Imaging :
• Hip ultrasound : IOC in all infants < 6
months
• Pelvic X ray :IOC in infants > 6 months
• Common x- ray findings :
• Asymmetrical ossification center of
head of femur
• Sloping acetabulum
• Ossified nucleus of femoral head lies
upper outward quadrant formed by
intersection of Hilgenreiner and
Perkin line
• Interrupted shenton’s line

26. MANAGEMENT
• PRINCIPLES :
• Achieve reduction of head into
acetabulum and maintain it
until hip becomes clinically
stable and a round acetabulum
covers head
• T/t varies according to age at
which patient presents:
• < 6 months ( and reducible
hip) : abduction splinting /
bracing: Pavlik harness, von
rosen harness

27. • 6-18 months ( or failure of bracing ): closed
reduction followed by immobilization with
hip spica cast
• > 18 month (failure of closed reduction ):
Surgical mx ( open reduction possibly with
pelvic / femoral osteotomy) followed by
immobilization with hip spica cast
• Older adolescent or adults : THR OR
arthrodesis

28. THANK YOU