The hip joint is a ball and socket synovial joint that allows high mobility. It has an articular femoral head that fits into the acetabulum of the hip bone. Strong ligaments like the iliofemoral ligament provide stability. Blood is supplied by various arteries and it is innervated by nerves from the lumbar and sacral plexuses. Common conditions affecting the hip joint include congenital dislocation, Legg-Calve-Perthes disease, osteoarthritis, and fractures of the femoral neck.

1. HIP JOINT
DR. SUNDIP CHARMODE
ASSOCIATE PROFESSOR
DEPARTMENT OF ANATOMY
AIIMS RAJKOT

2. • Type of Joint
• Articular Surfaces
• Ligaments
• Relations
• Blood Supply
• Nerve Supply
• Movements
• Applied Anatomy

3. Type
• Ball and Socket
variety of
Synovial Joint
• Multiaxial
• High Mobility
with high
stability

4. Articular Surfaces:
Reciprocal but not co-extensive
Head of Femur
• 2/3rd of a sphere with flat
• Covered by hyaline cartilage
• articular EXCEPT at fovea
capitis
Acetabulum
• Horse-shoe shaped
lunate surface (articular &
covered by hyaline
cartilage
• Deep notch with narrow
mouth
• Articular notch
• Acetabular fossa

6. Articular Surfaces
• Head is connected to shaft by an elongated
neck.
• Neck is directed upwards, medially and some
what forward.
• Neck-shaft angle – 125 degrees – determines
the range of mobility of hip joint
• In child- 160 degrees

7. ARTICULAR SURFACES: SOCKET
• Cup shaped depression, acetabulum, where
ilium, ischium and pubis meet separated by a
tri-radiate Y shaped cartilage.
• Acetabular notch:
• Acetabular labrum:
• Transverse acetabular ligament and base of
ligament of head of femur.
• Acetabular fossa is non articular.
• Articular surface – lunate surface

10. ARTICULAR SURFACES: SOCKET
• Acetabular fossa is filled with cushion of fibro-
fatty tissue covered by synovial membrane.
• Intracapsular but extra-synovial
• Haversian fat is in liquid condition at room
temperature.
• The gap between the bony notch and
Transverse ligament transmit Acetabular
branches of obturator and medial circumflex
femoral vessels.

11. LIGAMENTS
• Fibrous capsule
• Synovial membrane
• Ilio-femoral
• Pubo-femoral
• Ischio-femoral
• Ligament of head of
femur
• Acetabular labrum
• Transverse acetabular
ligament

12. FIBROUS CAPSULE
• Attachment
• On hip bone: to the acetabular margin about
5-6 mm above the labrum. Blends with
anterior surface of labrum in front and
transverse acetabular ligament below.
• To the bone above and behind the
acetabulum.
• On femur: to the inter-trochanteric line in
front and 1 cm medial to inter-trochanteric
crest behind

14. FIBROUS CAPSULE

15. FIBROUS CAPSULE
• Thick antero-superiorly : part
subjected to max tension in
standing
• Thin and loosely attached
postero-inferiorly, is stretched
in abduction.
• 2 type of fibres
outer longitudinal : many of
them reflect to neck of femur
K/s retinacula (contain blood
vessels supplying head and
neck of femur)
inner circular K/s Zona
Orbicularis

16. SYNOVIAL MEMBRANE
• Lines the inner surface of
fibrous capsule,
• Intra-capsular portion of
neck of femur,
• Both surfaces of
acetabular labrum,
• Transverse ligament
• Fat in acetabular fossa
• Round ligament of head
of femur

17. SYNOVIAL MEMBRANE
• The SM invests the ligament of head of femur
as a flattened cone and is attached to the
femoral head at the peripheral margin of the
fovea.
• Towards the transverse ligament, the layers
diverge. Inferior layer covers the fibrous
capsule and superior layer covers the
acetabular fat.
• Oval gap between Pubo-femoral and ilio-
femoral ligaments.

18. Joint Cavity
• Communicates with
the sub-tendinous
bursa beneath the
tendon of psoas
major, through a
circular opening in
the capsule between
pubo-femoral and
vertical band of ilio-
femoral ligaments.

19. Acetabular Labrum
• Cotyloid ligament
• Fibro-cartilagenous rim attached to the margins
of acetabulum, triangula rim cross-section.
• Narrows the mouthy of acetabulum which helps
in holding the head of femur in position

20. Acetabular Labrum

21. Transverse Ligament of Acetabulum
• A part of the labrum
which bridges the
acetabular notch, but it
has no cartilage cells
• The notch thus
converted into a
foramen transmits
vessels (acetabular) and
nerves to the joint.
• It blends with base of
ligament of head of
femur and lower part of
fibrous capsule.

23. Ligament Of the Head of Femur
• Round ligament or ligamentum teres femoris
• Flat, triangular ligament/ fibrous band, covered
by S Membrane.
• Apex : fovea capitis
• Base: Two ends of the the acetabular notch and
blends with transverse acetabular ligament.
• Very thin/even absent
• Transmits arteries to the head of femur from
the acetabular branches of the obturator and
medical circumflex femoral arteries.

24. Ligament Of the Head of Femur

26. Ligament Of the Head of Femur
• The ligamentum teres is stretched in
adduction of semi-flexed hip and is relaxed in
abduction.
• The ligament does not increase the stability
of the joint.

27. Ilio-femoral Ligament
• Inverted Y shaped : triangular
• Ligament of BIGELOW
• Strengthens anterior part of capsule
• Strongest ligament of body: resist the trunk
falling backwards in standing posture
• Apex/stem : AIIS
• Base: diverges below as medial and lateral
bands -- inter-trochanteric line

30. Ilio-femoral Ligament
• Medial band – vertical – lower part of
intertrochanteric line
• Lateral band – oblique – attached to tubercle
in the upper part of intertrochanteric line.
• The intermediate part is thin and attached to
the rest of line – pierced by Asc. Branch of lat.
Circumflex femoral artery.
• Tenson of ligament prevents hyper-extension
of hip joint.

31. Pubo-femoral Ligament
• Covers the joint infero-medially.
• Triangular
• Superiorly, it is attached to close to the
acetabular margin to the ilio-pubic eminence,
obturator crest and obturator membrane.
• Blends with capsule deep to the medial band
of ilio-femoral lig.
• Inferiorly, it merges with the antero-inferior
part of the capsule and lower band of
iliofemoral ligament.

33. Pubo-femoral Ligament
• A gap between pubo-femoral and medial
band of ilio-femoral ligaments.
• Psoas bursa communicates with joint cavity

35. Ischifemoral Ligament
• Comparatively weak, and
covers the joint
posteriorly.
• Fibers pass spirally
upwards and laterally
behind the neck of femur.
• Most fibers continuous
with zona orbicularis

37. Relations
• Anterior
Lateral fibres of
pectineus covered
by femoral veins
Iliopsoas with femoral
nerve separating the
iliacus bursa from
femoral artery
Straight head of rectus
femoris covering the
deep layer of
iliotibial tract

39. Relations
• Posterior
Quadratus femoris
covering obturator
externus and the
ascending branch of
medial circumflex
femoral artery
Obturator internus with
Two gemelli separate
the sciatic nerve from
the nerve to
Quadratus femoris
Piriformis

40. Relations
• Superior
1. Reflected head or
rectus femoris
covered by gluteus
minimus
• Inferior
1. Lateral fibres of
pectineus and
obturator externus

41. Blood Supply
• Obturator
• Two circumflex femoral
• Two gluteal arteries
• Medial and lateral circumflex femoral arteries form an arterial circle around the
capsular attachment on the neck of femur
• Retinacular arteries arise from this circle and supply the intracapsular neck and
greater part of the head of femur.
• A small part of the head near the fovea capitis is supplied by the acetabular
branches of the obturator and medial circumflex femoral arteries

42. Nerve Supply
• Hip joint is supplied by:
1. The femoral nerve,
through the nerve to
rectus femoris
2. Anterior division of
obturator nerve
3. Accessory obturator
nerve
4. Nerve to quadratus
femoris
5. The superior gluteal
nerve

43. Movements
• Flexion and extension occur around a
transverse axis around the neck of femur
which pass through the centre of head of
femoral head.
• Flexion with extended knee – 90-120 and 120
degrees
• Loosely packed and relaxed capsule

44. Movements
• Extension – 10-20 degrees and is limited by ilio-
femoral ligament. Closely packed capsule.
• Adduction and abduction occur around a antero-
posterior axis, passing through the centre of head
of femur.
• Medial and lateral rotations occur around a
vertical axis. Upper end - through the centre of
head of femur and lower end of axis - lateral
condyle of femur when foot is on ground.

45. Movements
• Lower end of axis – through any part of foot
when foot is above the ground.
• Circumduction is a combination of the
foregoing movements

46. Muscles producing Movement
1. Flexion-Ilio-Psoas major. Pectineus, RF, Sartorius.
Add. Longus helps in initial phase.
2. Extension-Gluteus maximus and hamstrings
3. Adduction-Adductors longus, brevis and
magnus. Medial part of pectineus and gracilis.
4. Abduction-Glutei medius and minimus
5. Medial Rotation- Tensor fasciae latae and the
anterior fibres of glutei medius and minimus
6. Lateral rotation-Two obturators, two gemelli
and quadratus femoris

48. Applied Anatomy
Diseases of the hip joint
Interesting age pattern
• Below 5 years: Congenital dislocation and
tuberculosis
• 5 to 10 years: Perthes’ disease
• 10 to 20 years: Coxa vera
• Above 40 years: Osteoarthritis

49. Congenital Dislocation
• More common in the hip than any other joint of the body
• The head of the femur slips upwards onto the gluteal
surface of the ilium because the upper margin of
acetabulum is developmentally deficient
• This causes lurching gait, and the Trendelenburg’s test is
positive.

51. Tuberculosis
• Osseous destruction & marrow edema
involving the bones forming hip articulation
along with synovial collection & reduced joint
space.

52. Perthes’ Disease(pseudocoxalgia)
• It is characterised by destruction and
flattening of the head of femur, with an
increased joint space in x-ray pictures

53. Coxa Vera & Valga
• A condition in which the
neck-shaft angle is reduced
from the normal of about
150 degree in a child and
127 degree in an adult

54. Osteoarthritis
• disease of old age
• characterised by growth of osteophytes at the
articular ends, which make the movemens
limited, grating and painful.

55. Applied Anatomy
B. Injuries of the hip joint
a definite age pattern
• Young age : Greenstick fractures of the neck,
and displacement of the head, of femur
• Adulthood : Dislocation of hip joint
• Old age : Fracture of the neck of femur

56. Dislocation of the Hip
• It may be posterior(more common),
anterior(less common), or central (rare). The
sciatic nerve maybe injured in posterior
dislocations.

57. Fracture of the Neck of Femur
• It may be subcapital(near the head), cervical (in the middle)
or basal (near trochanters).
• Damage to retinacular arteries causes avascular necrosis of
the head.
• Such a damage is maximum in subcapital and least in basal
fractures
• These fractures are common in old age, between 40 and 60
years
• Fracture-neck-femur is usually produced by trivial injuries ,
like tripping over some minor obstruction.
• The patient falls down and cannot get up.
• The limb lies helplessly rolled out, as if paralysed. X-rays
confirm the diagnosis.

58. Trochanteric Fracture
 Intertrochanteric(between the Trochanters)
 Peritrochanteric(along the Trochanters) or
 Subtrochanteric(below the trochanters).
• These fractures occur in strong, adult subjects,
and are produced by severe, violent injuries.

60. Applied Anatomy
Shortening of the lower limb
• By fractures/dislocation and tuberculosis
• The length of the lower limb is measured from
anterior superior iliac spine to medical
malleolus

61. Displacement of the greater Trochanter
(in fractures and dislocations)
Shenton’s line
Nelaton’s Line /Bryant’s triangle

62. Applied Anatomy
Disease of the hip, like tuberculosis, may cause
referred pain in the knee because of the
common nerve supply of the two joints.