The document summarizes the anatomy of the hip joint. It describes the components of the hip joint including the acetabulum, femoral head, and femoral neck. It discusses the ligaments, capsule, synovial membrane, muscles, blood supply, innervation and relations of the hip joint. It also briefly covers stability, movements, fractures, hip replacements, dislocations, and the sacroiliac joint.

1. Hip Joint
Dr A J Paranagama
MBBS(Colombo),MD(Orthopaedic Surgery)
DIT(UCSC),HDIT(UCSC)
Acting Consultant Orthopaedic Surgeon

2. Learning Outcomes
• Describe the components of the hip joint.
• List the ligaments associated with the hip joint and their attachments.
• Describe the muscles acting on the hip joint according to the type and movement they
perform.
• Describe the bursae in relation to the hip joint.
• Describe the stability of the hip joint.
• Describe the blood supply and nerve supply of the hip joint.
• Describe the major palpable bony prominences of the hip joint.
• Discuss the associated clinicals of the hip joint

3. Acetabulum
-An approximately hemispherical cavity situated about -At
the centre of the lateral aspect of the hip bone
-Faces anteroinferiorly (In abduction and Inversion)
- Circumscribed by an irregular margin deficient inferiorly at
the acetabular notch.
- The acetabular fossa forms the central floor and is rough
and non-articular.
- The articular surface- Lunate surface is widest above (the
‘dome’), where weight is transmitted to the femur
• All three components of the hip bone contribute to the
acetabulum
The pubis- forms the anterosuperior fifth of the articular
surface
The ischium- forms the floor of the fossa and more than the
posteroinferior two-fifths of the articular
Surface
The ilium- postero-Superior two fifth

4. Acetabulum
Acetabulum
Lunate surface
- Articular part
Acetabular fossa
- No articular part
Acetabular rim
-Acetabular notch

5. Acetabulum
1, ilium; 2, part of triradiate growth cartilage; 3, superior
femoral epiphysis; 4, cartilaginous growth plates; 5, ossifying
greater
trochanter; 6, ischium; 7, pubis; 8, cartilage between inferior
pubic and
ischial rami.
At Birth
11 Years

6. Proximal Femur
Femoral head
-faces anteriorly
superiorly
medially to articulate with the
acetabulum
-More than half a ‘sphere’, is spheroidal. --Its –
smooth except posteroinferior and centre due
to rough fovea.
-The ligamentum teres is attached to the fovea.
- The anterior surface of the head is separated
inferomedially from the femoral artery by the
tendon of psoas major
Femoral neck
- narrowest in its mid part and widest laterally
and connects the head to the shaft at an
average angle of 130° (angle of inclination;
neck–shaft angle):
-Facilitates movement at the hip joint,

7. Femoral Neck

8. Hip Joint
• Head of the femur and the
acetabulum
• Type
• - Multiaxial Synovial Joint
– Ball and socket Variety
– High Degree of Stability and High
Degree of Movements
• Movements
– All movements(flexion, Extension,
Abduction, Adduction,
Circumduction)
– Most movable joint next to shoulder

9. Acetabular Labrum
-A ring of cartilage that surrounds
the acetabulum of the hip
- The anterior portion is most
vulnerable when the labrum tears
labrum has three surfaces:
Internal articular surface - adjacent to the joint (avascular)
External articular surface - contacting the joint capsule (vascular)
Basal surface - attached to the acetabular bone and ligaments

10. Hip Joint – Capsule
-Strong and dense
-Attached superiorly to the acetabular margin 5–6 mm
medial to the
labral attachment
- Anteriorly to the outer labral aspect and, near the
acetabular notch, to the transverse acetabular ligament
and the adjacent rim of the obturator foramen
- From its acetabular attachment, it extends laterally to
surround the femoral head and neck
- Attached anteriorly to the intertrochanteric line,
superiorly to the base of the femoral neck
- Posteriorly 1 cm superomedial to the intertrochanteric
crest
- Inferiorly to the femoral neck near the lesser trochanter

11. Hip Joint Capsule and Ligaments

12. Hip Joint:
Ligaments
• Relative strength of ligaments
compared to muscles
• Anteriorly
• Strong ligament and weak muscles
• Posteriorly
• Weak ligament and strong muscles

13. Hip Joint Ligaments
Iliofemoral
-very strong
-shaped like an inverted Y
- lying anteriorly and intimately blended with the capsule
- Its apex is attached between the anterior inferior iliac spine and acetabular margin
- Its base to the intertrochanteric line.
Pubofemoral
-is triangular,
- base is attached to the iliopubic ramus, superior pubic ramus, obturator crest and membrane.
- It blends distally with the capsule and deep surface of the descending part of the iliofemoral
ligament
Ischiofemoral
- Thickens the posterior aspect of the capsule
- The central part spirals superolaterally from the ischium
-Attached posteroinferior to the acetabulum
- courses posterior to the femoral neck to attach distally to the greater trochanter deep to the
iliofemoral ligament
Transverse acetabular ligaments
-continuous peripherally with the labrum but
does not possess any cartilage cells
-Its strong, flat fibres cross the acetabular notch,
forming a foramen through which vessels and
nerves pass to enter the joint.
ligament of the head of the femur
- triangular and flattened band of connective
Tissue
- Its apex is attached anterosuperiorly in
the fovea for the ligament of the head of the
femur
- base is attached principally to both edges of
the acetabular notch

14. Hip Joint-Synovial Membrane
-Start from the femoral articular margin
-Covers the intracapsular part of the femoral neck
-Passes to the internal surface of the capsule to cover the acetabular
labrum, ligament of the head of femur and fat in the acetabular fossa
-It is thin on the deep surface of the iliofemoral ligament where it is
compressed may be absent

15. Hip Joint: Synovial
Membrane
• Attached to articular surfaces
• Lines capsule
• Covers
• Transverse lig.
• Ligament of head of the femur
• Pad of fat in acetabular fossa
• Neck of femur
• Synovial fold (retinaculum)
• At free edge of capsule

16. Hip Joint-Bursae
- Variably Communicate with the subtendinous, iliopectineal
bursa through a circular aperture between the pubofemoral ligament
and the descending part of the iliofemoral ligament
-Distant bursae are associated with the tendons of distal attachment of
glutei medius and minimus at the greater trochanter
-Between gluteus maximus and vastus lateralis

17. Hip Joint: Bursae
• Psoas bursa
• Anterior continuation of synovial
membrane
• Bursa for obturator externus
• Posterior synovial protrusion
• Through the free capsule edge
• Obturator internus bursa

18. Hip Joint-Blood Supply & Lymphatic Drainage
Articular arteries
branches from
- Obturator
- Medial circumflex femoral
-Superior and inferior gluteal arteries
form the cruciate and trochanteric anastomoses
-venous drainage by corresponding tributeries
Lymphatics
- Anterior aspect-drain to the deep inguinal nodes
- Medial and Posterior aspects of the joint travel with the obturator and gluteal arteries
respectively
- Reach the internal iliac nodes

19. Hip Joint: Blood
Supply
• Medial & lateral circumflex
• From profundal femoris
• Artery to the head of the femur
• From obturator artery
• Retinacular arteries
• Mainly from medial circumflex
• Inter from free edge of capsule

20. Hip Joint: Arterial Anastomosis
• Trochanteric anastomosis
– Superior gluteal a.
– Inferior gluteal a.
– Medial femoral circumflex a.
– Lateral femoral circumflex a.
• Cruciate anastomosis
– Inferior gluteal a.
– Medial femoral circumflex a.
– Lateral femoral circumflex a.
– 1st perforating a. from
profunda

21. Hip Joint-Innervation
The anterior capsule of the hip joint is innervated by the
- Femoral
-Obturator and accessory obturator nerves.
The posterior capsule is innervated by the
-Sciatic
- Superior gluteal nerves
-Nerve to quadratus femoris

22. Hip Joint-Relations

23. Hip Joint-Relations
The joint capsule is surrounded by muscles
Anteriorly
-lateral fibres of pectineus separate the capsule from the femoral vein.
-Lateral to this, the tendon of psoas major, with iliacus lateral to it, descends to the
lesser trochanter, partly separated from the capsule by a bursa.
-The femoral artery is anterior to the tendon of psoas major, and the femoral nerve lies
deep in a groove between the tendon and iliacus.
- Further laterally the straight head of rectus femoris crosses the joint with a deep layer
of the iliotibial tract
blends with the capsule under the lateral border of the muscle.
Superiorly
-The reflected head of rectus femoris contacts the capsule medially, while gluteus minimus
covers it laterally

24. Hip Joint-Relations
Inferiorly
-medial fibres of pectineus close to the the capsule
postero-inferiorly obturator externus spirals obliquely to its posterior aspect.
Posteroinferiorly- the capsule is covered by the tendon of obturator externus
separating it from quadratus femoris and accompanied
by an ascending branch of the medial circumflex femoral artery.
Posterosuperiorly- The tendon of obturator internus and the gmelli
contact the joint capsule, separating it from the sciatic nerve.
The nerve to quadratus femoris is deep to the
obturator internus tendon and descends medially on the capsule.
Superior to this- the posterior surface of the joint is crossed by piriformis

25. Hip Joint-Stability

26. Hip Joint- Stability
Static Stabilizers Dynamic Stabilizers
-Muscles around
Iliopsoas
Rectus Femoris

27. Hip Joint: Stabilizing
Factors
• Acetabular labrum & transverse
lig.
• Deepens the socket
• Intracapsular lig.
• Extracapsular ligaments
• Muscles traversing hip joint
• Orientation of acetabulum to
head of femur
• Superiorly located

28. Hip Joint: Movements

29. Hip Joint- Movement Limiting Structures

30. Hip Joint:
Fracture
• Fracture of femoral neck
– Disruption of blood supply to the head
– Avascular necrosis
• Blood supply from artery to the head of the femur usually is not enough
– In elderly
– Female > Male
• Osteoporosis

31. Surgical Hip Replacement
• In traumatic injuries or
degenerative diseases
• Replace head and neck of femur
• Often acetabulum lined by metal
or plastic socket

32. Dislocation of Hip
Joint
• Congenital dislocation of hip joint
– Common 1.5/1000
– Female > Male
– Affected limb looks shorter
• Superior displacement
– Positive Trendelenburg sign
• Hip appear to drop to one side during
walking
• Inability to abduct hip
Posterior Vs Anterior

33. Dislocation of Hip
Joint
hip dislocation
– Rare
– Posterior dislocation more common
– In car accidents
– When femur is flexed, adducted, and
medially rotated
– Sciatic nerve injury

34. Sacroiliac Joint
• Auricular surfaces of the sacrum
and the iliac bone
• No movement; transmit body
weight from vertebral column to
pelvis
• In elderly people synovial cavity
disappear and becomes fibrous
joint
• Nerve supply: sacral spinal nerves

35. Sacroiliac
Joint
• Associated ligaments
– Posterior sacroiliac ligament
– Interosseous sacroiliac ligament (between
tuberosities of sacrum and iliac bone)
– Anterior sacroiliac ligament

36. Sacroiliac Joint
• Accessory ligaments
– Sacrotuberous ligament
• Greater sciatic foramen
– Sacrospinous ligament
• Lesser sciatic foramen
– Iliolumbar ligament

37. Thank You