The hip joint is a ball and socket synovial joint that connects the femur to the pelvis. It has two articular surfaces: the proximal surface is the acetabulum of the pelvis, and the distal surface is the head of the femur. The acetabulum is cup-shaped and deepened by the acetabular labrum. The head of the femur fits into the acetabulum and is connected to the femoral shaft by the femoral neck. The angle of inclination and torsion of the femur can vary between individuals and abnormalities in these angles can impact joint mechanics and cause pathology.

1. HIP JOINT
• INTRODUCTION
• STRUCTURES OF THE HIP JOINT
Proximal articular surface
Distal articular surface
~PRESENTED BY CHRISLYN

2. INTRODUCTION
JOINT OF THE
LOWER LIMB

3. DIARTHRODIAL
JOINT
BALL AND
SOCKET
JOINT

5. 1. ARTICULATING SURFACES:Acetabulum of pelvis and
head of femur
2. TYPE OF JOINT: Ball and socket diarthrodial synovial
joint
3. DEGREE OF FREEDOM
 Flexion/ Extension in sagittal plane
 Abduction/ Adduction in frontal plane
 Medial/ Lateral rotation in transverse plane

6. Comparison between hip and
shoulder joints

7. SHOUDER JOINT
Ball and socket joint
It is made up of the head
of the humerus which rests
in the glenoid fossa of the
scapula
More mobility, less stability
More unstable
Shoulder injuries are more
such as dislocations
Main role: to provide a
stable base with a wide
range of motions . Open
change function
HIP JOINT
Ball and socket joint
It is the head of femur that fits
into the acetabulum of the
ilium (pelvic bones )
More stability, less mobility
Less unstable
Joint can suffer from
degeneration, femoral
acetabular impingement
Primary function: support
weight of the head, neck and
trunk (HAT) in static and
dynamic positions. WEIGHT
BEARING FUNCTION( more
muscles surrounding)
SHOULDER JOINT HIP JOINT
Ball and socket joint, synovial joint Ball and socket joint, synovial joint
It is made up of the head of the humerus which rests
in the glenoid fossa of the scapula
It is the head of femur that fits into the acetabulum of
the ilium (pelvic bones )
More mobility, less stability More stability, less mobility
More unstable Less unstable
Shoulder injuries are more such as dislocations Joint can suffer from degeneration, femoral
acetabular impingement
Main role: to provide a stable base with a wide range
of motions . Open chain function
Primary function: support weight of the head, arms
and trunk (HAT) in static and dynamic positions.
WEIGHT BEARING FUNCTION( more muscles
surrounding)

8. STRUCTURE OF THE HIP JOINT
COMPRISES OF TWO ARTICULAR SURFACES
• PROXIMAL ARTICULAR SURFACE (Acetabulum, Acetabular labrum )
• DISTAL ARTICULAR SURFACE ( Head of femur )

9. PROXIMAL
ARTICULAR
SURFACE
1. ACETABULUM

10. ACETABULUM

11. ACETABULUM (horse shoe shaped)

13. PROXIMAL ARTICULAR SURFACE
ACETABULUM OF PELVIC BONE FORMS PROXIMAL ARTICULAR SURFACE
1.Cuplike concave socket of the hip joint
2. Present on the lateral aspect of the pelvic bone
3. Three bones make up the pelvis that contribute to the structure of the acetabulum
a) Ischium (2/5 th of acetabulum)
b) Pubis (1/5 th of acetabulum)
c) Ilium ( remainder)

14. The periphery of the acetabulum called the lunate surface is covered with
hyaline cartilage
The acetabulum (horse shoe shaped) articulates with the head of femur
The inferior aspect of the lunate surface( ie base of horseshoe) has a notch
called acetabular notch. It is like a gap
The acetabular is spanned by a fibrous band called transverse acetabular
ligament that connects two ends of the horseshoe.
The transverse acetabular ligament creates a kind of tunnel under which
blood vessels pass beneath and reach the deepest of the acetabulum called
acetabulum fossa
The acetabular fossa ( innermost part) doesn’t take part in the articulation
The fossa contains fibroelastic fat covered with synovial membrane
The acetabular labrum deepens the acetabulum and surrounds its periphery.

15. POSITION: positioned laterally with inferior and anterior tilt
INCLINATIONS:
.50 degree laterally inclined
.20 degree anteriorly rotated (anteversion)
.20 degree anteriorly tilted in the frontal, transverse and sagittal

16. FEMORAL HEAD COVERAGE IS LARGELY DETERMINED BY
ACETABULAR DEPTH

17. ACETABULAR ABNORMALITIES that lead to
pathology including excessive cartilage wear
ACETABULAR DYSPLASIA
COXA PROFUNDA
ACETABULAR PROTRUSIO
ANTEVERION
RETROVERSION

18. ACETABULAR
ABNORMALITIES

20. ACETABULAR DYSPLASIA:
 Abnormally shallow acetabulum that results in lack of
coverage
 Dysplasia is the basic mechanical abnormality for instability
and disproportionate loading of the superior acetabular rim
COXA PROFUNDA AND ACETABULAR PROTRUSIO:
 Here the acetabulum excessively covers the femoral head
 Acetabular over coverage can lead to limited ROM and
internal impingement (thinning) between femoral and
acetabulum junction
ABNORMALITIES IN ACETABULAR DEPTH

21. ABNORMALITIES IN ACETABULAR POSTIONING
( INCLINATION AND VERSION- abnormal positioning in
the transverse plane)
ANTEVERSION
Anteversion of acetabulum exists when the acetabulum is
positioned too far anteriorly in the transverse plane
RETROVERSION
Retroversion of the acetabulum exists when the
is positioned too far posteriorly in the transverse plane

22.  ACETABULUM WITH
ANTEVERSION LESS INCLINATION LEAD TO INSTABILITY
INCLINATION/ RETROVERSION
OVER COVERAGE AND IMPINGEMENT
BETWEEN JOINT

25. CENTER EDGE ANGLE OF WIBERG
 Acetabular depth can be measured using Center Edge Angle of Wiberg
 It is the measure of depth of acetabulum with that of the femur head
 It is formed by a line connecting the lateral rim of the acetabulum and center of the
femoral head and a vertical line from the center of the femoral head
CENTER EDGE ANGLES CLASSIFIED AS FOLLOWS:
 DEFINITE DYSPLASIA: angle less than 16 degree
 POSSIBLE DYSPLASIA: 16-25 degree
 NORMAL: greater than 25 degree
 ABNORMAL OVERCOVERAGE: greater than normal. But not well defined
 EXCESSIVE ACETABULAR COVERAGE: greater than 40 degree

26. PROXIMAL
ARTICULAR SURFACE
2. ACETABULAR
LABRUM

27. Acetabular labrum: A ring of fibrocartilage (fibrous
cartilage) that runs around the acetabulum (cup) of
the hip joint and increases its depth. The head of
the femur (the bone in the thigh) fits in
the acetabulum.
ACETABULAR LABRUM ( C SHAPED)
The labrum deepens this cavity and
effectively increases the surface (and
strength) of the hip joint. the labrum acts
like a rubber seal or gasket to help hold
the ball at the top of your thighbone
securely within your hip socket.

28. The knee meniscus and glenoid labrum are anatomically distinct yet
analogous structures. Although the gross anatomy differs, both tissues are
composed of fibrocartilage with a complex but well-organized collagen
microstructure. The meniscus and labrum function to increase congruity and
stability, decrease contact stresses, and distribute load across their
respective joints.
Meniscus of knee
Labrum of glenohumeral joint
ANALOGOUS STRUCTURES ( same function, different structure)

29. 2. ACETABULAR
LABRUM
 The entire periphery of the acetabulum is rimmed by a wedge shaped
fibrocartilage called acetabular labrum
 The labrum of the hip to a large extent is analogous to the meniscus of the knee
and labrum of the glenohumeral joint
 The labrum is attached to the periphery of the acetabulum by a zone of
calcified cartilage
 The labrum not only deepens the socket but also increases concavity of the
acetabulum through its triangular shape, grasping head of femur to maintain
contact with acetabulum
 It enhances joint stability by acting as a seal to maintain intra articular pressure
 It also decreases force transmitted to articular cartilage and provides
proprioceptive feedback

30. Nerve endings within the labrum not only provide proprioceptive
feedback but can also act as a source of pain
An abnormally shallow acetabulum will increase stress on the
surrounding capsule and labrum
The transverse acetabular ligament is considered to be a part of the
acetabulum labrum although unlike the labrum, it contains no
cartilage cells
Although it is positioned to protect the blood vessels travelling
beneath to reach the head of the femur, experimental data does
not support the notion of the transverse acetabular ligament as a
load bearing structure

31. The cause of a hip labral tear might be:
Trauma.
Injury to or dislocation of the hip joint
— which can occur during car accidents or from
playing contact sports such as football or hockey,
yoga not done properly
Degenerative health conditions: Osteoarthritis
is a chronic (long-term) wearing down of the
cartilage between the joints. As cartilage slowly
erodes over time, it becomes more prone to
tearing
The symptoms of a hip labral
tear include:
•Hip pain or stiffness
•Pain in the groin or buttocks
•A clicking or locking sound
hip area when you move
•Feeling unsteady on your

32. DISTAL ARICULAR
SURFACE
HEAD OF FEMUR

33. HEAD OF FEMUR
The distal articular surface is formed by the head of the femur.
The head of femur is spherical in shape covered by hyaline
cartilage
The articular area forms 2/3 rd of the sphere
Head of femur is connected to shaft by the neck
Inferior to the medial point of the head is a small depression
called fovea or fovea capitis.
The femoral neck is attached to the shaft of femur between
greater and lesser trochanters
The fovea is site of attachment of ligamentum teres.

34. ANGLE OF INCLINATION ANGLE OF TORSION
The magnitude of medial inclination and torsion of distal femur wrt head
and neck of femur depends on the embryonic growth, fetal position during
uterine life
The development of angulations continue after birth and during early
stages of development
Both normal and abnormal angles of inclination and torsion are properties
of femur alone

35. ANGLE OF INCLINATION

36. FIRST AXIS:
Passing
through the
center of
the femur
head and
neck
SECOND
AXIS:
Longitudin
al axis
passing
through
femur,
parallel to
shaft
ANGLE OF INCLINATION( femur ):
The angle formed between an axis
passing through the head and neck
of the femur and the longitudinal
axis
 NORMAL VALUE OF THIS ANGLE: 125
DEGREE
 It can have a variation from 110 -
144 degree
 It varies between individuals and
within person
 It is lesser in females ( wider pelvis )
 It decreases with age ( At birth-
150, reaches 125 with maturity)
 Abnormal increase in the angle -
COXA VALVA
 Abnormal decrease in the angle –
COXA VARA
ANGLE OF
INCLINATION

37. COXA VALGA
 It’s a condition in which angle of inclination increases
 The angle is >125
 The contact between articulating surfaces decreases ( exposure of
femoral head) therefore decrease in stability
 Trabecular system density decreases( line of weight bearing
changes, less strain on oblique axis, decrease in density).
Therefore weakness in neck of femur/ bone
 Moment arm of abductors ( lateral muscles )decreases ( as head
tilts upwards, distance decreases) , dec in muscles efficiency.. and
therefore muscle weakness ( stability )
 Gravitation adduction moment is unbalanced .. leads to instability
 Joint reaction force increases, leads to degenerative changes (
impingement, labral tear)

38. COXA VARA
 Pathological condition in which angle of inclination of femur
decreases
 Angle <120
 Increase in stability ( the head of femur sits inside completely)
 Increase in muscles efficiency ( increase in moment arm)
 Decrease in joint reaction forces ( less degenerative chances)
 But if it decreases too much then there are stability issues
 Increase in bending moment, lead to fracture of neck of femur
3 types of Coxa Vera
 CONGINETAL ( present since birth)
 DEVELOPMENTAL ( during bone fusing .. Developmental period)
 ACQUIRED ( due to diseases like rickets.. Vit D deficiency, calcium
def)

39. ANGLE OF TORSION

40. AXIS THROUGH
FEMORAL CONDYLES
AXIS THROUGH FEMORAL
HEAD AND NECK
ANGLE OF TORSION
 ANGLE OF TORSION (femur): Angle formed between axis passing through femoral condyles and the
axis through femoral head and neck
 Normal value: 10 – 20 degrees ( 15 deg in males and 18 deg in females )
 Femur is slightly anteverted
 30 – 40 degrees at birth
 Decreases with age : About 1.5 deg until maturity till 10 to 20
 Angle of torsion is similar btw both legs but angle of inclination differ

41. ANTEVERSION & RETROVERSION
◦ If the axis through femoral condyles lies in the frontal plane then the head and neck of the
femur are torsioned anteriorly, on the condyles.
◦ At birth it is 30-40 deg. This decreases about 1.5 per year until skeletal maturity
◦ Condition in which angle of anterior torsion increases is anteversion (>15 in males , >18 in
females)
◦ Articulating surfaces instable because large portion of femoral head is tilted outward, exposed
◦ When angle of torsion decrease..less than 15-20 it is called retroversion
◦ Variations in degree of Anteversion and retroversion also depends on assessing methods like CT
scan, radiograph, ultrasound to measure angle of femoral torsion
◦ Femoral anteversion is correlated with increase medial rotation ROM and decrease lateral
rotation so total hip rotation remains the same
◦ Femoral anteversion and coxa valga are commonly found togther but they function
independently
◦ can lead to dysfunction in distal and proximal parts of hip + knee +foot
◦ Other pathological angulations ( retroversion, coxa valga n coxa vara ) can also affect proximal
and distal parts of hip joint

42. RETROVERSION (AOT < 15-20)
………………………………………………………….
Retroversion refers to an abnormal backward rotation of the hip relative to the knee
This condition can affect patients of all ages and leads to abnormal stress in the low back, hip and
knee, as well as an abnormal gait (walking stance).
Femoral retroversion (also known as hip retroversion) is a rotational or torsional deformity in which
the femur (thighbone) twists backward (outward) in relation to the knee. Because the lower part of
the femur is connected to the knee, this also means that the knee is twisted outward relative to the
hip.
Femoral retroversion can occur in one or both legs
Femoral retroversion is often a congenital condition, meaning children are born with it. It also
appears to be related to the position of the baby as it grows in the womb. Torsional deformity can
also occur after a fracture, if a broken bone heals with incorrectly (called malunion).

43. Symptoms -out-toeing or "duck walk" – walking with the foot pointed outward instead of straight
ahead, learning to walk late (in children), flatfeet, difficulty with running, fatigues easily with physical
activity, poor balance or coordination ,hip and knee pain , low back pain degeneration or arthritis of
the hip
Diagnosis -The doctor will go through the developmental and family history and also observe the
patient’s gait (manner of walking) to look for signs of out-toeing or gait compensation. The physician
may also order an X ray or CT scan
Treatment - Many children born with femoral retroversion grow out it. An excessive femoral
retroversion can place stress on hip and knee joints, often leading to joint pain and abnormal wear..
labral tear. In these situations, a surgical procedure known as a femoral osteotomy may be used

44. Left: Position of an anteverted femoral head with the
foot facing straight forward. In this position, the femoral
head subluxes out of the front of the hip joint.
Right: Most patients with excessive hip anteversion
compensate by walking in-toed. This position keeps the
femoral head within the socket, which minimizes pain.

45. ANTEVERSION (AOT> 15-20)
…………………………………………………………………..
• Femoral anteversion is a forward (inward) rotation in the femur (thighbone), which connects to
the pelvis to form the hip joint. In other words the knee is excessively twisted inward relative to
the hip.
• Femoral anteversion can occur in one or both legs.
• Many children are born with femoral anteversions that they eventually grow out of. In people
who do not grow out of it, a mildly anteverted femoral head may cause no significant health
problems.
• But an excessive anteversion of the femur overloads the anterior (front) structures of the hip
joint, including the labrum and joint capsule.When the foot is positioned facing directly
forward, the femoral head may sublux (partially dislocate) from the socket of the hip joint,
called the acetabulum.This torsional malalignment places abnormal stress on both the hip and
knee joints, often leading to pain and abnormal joint wear.
•

46. • Symptoms- In-toeing, in which a person walks "pigeon-toed," with each foot
pointed slightly toward the other, Bowlegs (also called bowed legs), Keeping the
legs in this position often helps a patient maintain balance, Pain in the hips,
knees and/or ankles.
• Treatment- While many children grow out of their femoral anteversion
conditions, excessive anteversion may require surgical correction, as a
procedure known as a femoral osteotomy
Reduces hip stability
Articulating surfaces instable because large portion of femoral head is tilted outward,
exposed
Hip abductors fall more posteriorly to the joint, reducing moment arm for abduction
Affects the knee joint.When femoral head is anteverted, pressure from
capsuloligaments and ant musculature may push it into acetabulum causing entire
femur to medially rotate. Medial rotation of the condyles alters plane of knee flexion
therefore.. in toe gait. Abnormal position of knee joint axis ..medial femoral torsion.
Anteverted femur also affects biomechanics of patellofemoral joint at knee and
subtlar joint at foot

48. •INTRODUCTION- articulation, movements, comparison
between shoulder and hip joint
•ARTICULAR SURFACES
•Proximal articular surface- acetabulum( dysplasia, coxa
profunda, anteversion, retroversion), center edge angles
,labrum
•Distal articular surface- femur, angle of inclination( coxa
valga, coxa vara),angle of torsion (anteversion,
retroversion)

49. THANK YOU..