HIP JOINT

DEPARTMENT OF ANATOMY
1ST MBBS
AN17.1 Describe and demonstrate the type, articular
surfaces, capsule, synovial membrane, ligaments,
relations, movements and muscles involved, blood and
nerve supply, bursae around the hip joint .
AN17.2 Describe anatomical basis of complications of
fracture neck of femur.
N17.3 Describe dislocation of hip joint and surgical hip
replacement.
 INTRODUCTION
The hip joint is a ball and socket type of synovial joint
between the head of the femur and the acetabulum of
the hip bone.
The functions are:
(a) to support the body weight during standing.
(b) to transmit the forces generated by movements of
trunk femur during walking.
TYPE: - Synovial joint of ball and socket variety.
SYNOVIAL MEMBRANE:- it lines inner aspect of
the fibrous capsule,
• The Intracapsular portion of the femoral neck,
• Glenoid labrum (both surfaces),
• Transverse acetabular ligament,
• Ligamentum teres,
• Fat in the acetabular fossa.
ARTICULAR SURFACES:-
1. The head of femur:- It is covered by the articular
hyaline cartilage except for a small pit, the fovea
capitis for ligamentumteres.
2. The acetabulum :- The depth of the acetabulum is
increased by the acetabular labrum.
 LIGAMENTS
The ligaments of the hip joint are as follows:-
1. Joint capsule.
2. Iliofemoral ligament.
3. Pubofemoral ligament.
4. Ischiofemoral ligament.
5. Transverse acetabular ligament.
6. Acetabular labrum.
7. Round ligament of the head of femur (Ligamentum
teres femoris).
1. CAPSULAR LIGAMENT:-
• On the hip bone - it is attached 5–6 mm beyond the
acetabular margin, outer aspect of the acetabular
labrum and transverse acetabular ligament.
• On the femur - it is attached anteriorly to the
intertrochanteric line and posteriorly 1 cm in front of
(medial to) the intertrochanteric crest
2. ILIOFEMORAL LIGAMENT:- it is inverted Y-
shaped ligament, which lies anteriorly & intimately
blended with the capsule.
Its apex is attached to the lower half of the anterior
inferior iliac spine & area between it & above
acetabular margin.
Its base is attached to the intertrochanteric line. This
ligament consists of three parts
1. a lateral thick band of oblique fibres,
2. a medial thick band of vertical fibres,
3. a large central thin portion
3. PUBOFEMORAL LIGAMENT:-The triangular
ligament with base above and apex below.
Base is attached to the iliopubic eminence, superior
pubic ramus & obturator crest.
Apex Inferiorly blends with the anteroinferior part of
the capsule & medial band of the iliofemoral ligament.
• It lies inferomedially & support the joint.
4. ISCHIOFEMORAL LIGAMENT:- The
ischiofemoral ligament is relatively weak and supports
the capsule posteriorly.
Above it is attached to the ischium posteroinferior to the
acetabulum. From ischium its fibres spiral behind the
femoral neck to be attached into the greater trochanter
deep to the iliofemoral ligament.

Ischiofemoral ligament
5. TRANSVERSE ACETABULAR LIGAMENT:- It is
a part of acetabular labrum, which bridges the
acetabular notch; however, it is devoid of cartilage cells.
The acetabular notch thus becomes converted into the
foramen which transmits the acetabular vessels &
nerves to the hip joint.
6. ACETABULAR LABRUM:- The acetabular labrum
is a fibrocartilaginous rim attached to the acetabular
margin. It deepens the acetabulum to hold the head of
femur.
7. ROUND LIGAMENT OF THE HEAD OF FEMUR:-
It is a flat triangular ligament.
apex attached to the fovea of the head,
base to the transverse acetabular ligament.
It transmits arteries to the head of the femur derived
from the acetabular branches of the obturator & medial
circumflex femoral arteries.
 STABILITY OF THE HIP JOINT
factors which help to prevent its dislocation:
1. Depth of the acetabulum & narrowing of its mouth by
the acetabular labrum.
2. Three strong ligaments (iliofemoral, pubofemoral, &
ischiofemoral) strengthening the capsule of the joint.
3. Strength of the surrounding muscles, e.g., gluteus
medius, gluteus minimus, etc.
4. Length & obliquity of the neck of femur.
 RELATIONS OF THE HIP JOINT
The relations of the hip joint are as follows:
Anteriorly:
1. Tendon of iliopsoas separated from joint by a
synovial bursa, pectineus (lateral part), straight head
of rectus femoris.
2. Femoral nerve in the groove between the iliacus and
the psoas.
3. Femoral artery in front of the psoas tendon.
4. Femoral vein in front of the pectineus.
Posteriorly:
1. Piriformis, obturator externus, obturator internus,
superior & inferior gemelli, quadratus femoris, &
gluteus maximus.
2. Superior gluteal nerve & vessels above the
piriformis.
3. Inferior gluteal nerve & vessels below the
piriformis.
4. Sciatic nerve, posterior cutaneous nerve of the thigh,
& nerve to quadratus femoris.
Superiorly:
1. Reflected head of rectus femoris medially.
2. Gluteus minimus, gluteus medius, & gluteus
maximus laterally.
Inferiorly:
3. Pectineus.
4. Obturator externus.
 ARTERIAL SUPPLY
The hip joint is supplied by the branches of the
following arteries:
1. Medial circumflex femoral artery.
2. Lateral circumflex femoral artery.
3. Obturator artery.
4. Superior gluteal artery.
5. Inferior gluteal artery
BURSAE AROUND THE HIP JOINT
 NERVE SUPPLY
The hip joint is supplied by the following nerves:
1. Femoral nerve via nerve to rectus femoris.
2. A branch from anterior division of obturator nerve.
3. A branch from accessory obturator nerve (if present).
4. A branch from nerve to quadratus femoris.
5. A branch from superior gluteal nerve.
6. A twig from sciatic nerve (occasional).
 MOVEMENTS
The hip joint is a multiaxial joint and permits the
following movements:
1. Flexion and extension.
2. Abduction and adduction.
3. Medial and lateral rotation.
4. Circumduction (combination of the above
movements).
 APPLIES ASPECT
Dislocation of the hip joint:
(a) Congenital dislocation: It occurs due to two reasons:
(i) The joint capsule is loose at birth.
(ii) Hypoplasia of the acetabulum & femoral head.
Clinically, it presents as:
1. Inability of the new born to abduct the thigh.
2. Affected limb is shorter in length & externally
rotated.
3. Asymmetry of skin folds of the thighs.
4. Lurching gait with positive Trendelenburg’s sign.
(b) Acquired dislocation: it may occur during an
automobile accident when one is riding in a car.
This causes shortening & medial rotation of the affected
limb.
The dislocation of the hip may be
1. posterior (most common) The sciatic nerve is
injured in posterior dislocation
2. anterior (less common),
3. central (least common).
Perthes’ disease (pseudocoxalgia): It is a clinical
condition characterized by destruction & flattening of
the head of femur with an increased joint space in the
radiograph.
Coxa vara & coxa valga: The normal neck–shaft angle is
about 120° in adults and 160° in children. This may result
from Perthes disease, softening the neck due to rickets.
If the neck shaft angle of the femur is reduced (e.g.,
fracture neck of femur, Perthes disease), it is called
Coxavara.
If the angle is increased (e.g., congenital dislocation of the
hip joint), it is called
coxa valga.
Osteoarthritis: It is a disease of the old age. It is
characterized by the growth of osteophytes at the
articular ends which not only limits the movements but
makes them grating & painful.
Referred pain of the hip joint: In diseases of the hip
joint such as tuberculosis, the pain is referred to the
knee joint because of the common nerve supply of these
two joints.
Aspiration of the joint: It is usually done by putting a
needle 5 cm below the anterior superior iliac spine,
upward, backward, and medially.
Fractures of the neck of the femur: Unfortunately, it is
referred as fractured hip implying that the hip bone is
broken. These fractures are usually common in
individuals of more than 60 years of age especially in
females because their femoral necks become weak and
brittle due to osteoporosis.
Types The fractures of the neck of femur are of four
types:-
(a) Subcapital (near the head).
(b) Cervical (in the middle).
(c) Basal (near the trochanters).
(d) Pretrochanteric fracture (just distal to two
trochanters).
 Hip replacement surgery
Hip replacement surgery is a procedure in which a
surgeon makes an incision over the side of the thigh,
removes the diseased parts of the hip joint, and replaces
them with new, artificial parts
The diagnosis is generally confirmed by X-ray by
observing following two lines:
(a) Shenton’s line: In a radiograph of the hip region, the
Shenton’s line is represented by a continuous curved
line formed by the upper border of the obturator
foramen and lower margin of the neck of the femur.
This curve is disrupted in fracture neck of the femur or
dislocation of the hip joint.
(b) Schoemaker’s line: It is a straight line that extends
from the tip of the greater trochanter to the anterior
superior iliac spine and continues upward over the
anterior abdominal wall to reach the umbilicus. If
greater trochanter is elevated (e.g., fracture of the neck
of femur) this line passes below the umbilicus.
THE END