The document discusses hip biomechanics, including the anatomy of the hip joint, angles such as the angle of inclination and torsion, and positions such as anteversion and retroversion. It also covers the hip joint capsule and ligaments.
The document discusses hip biomechanics, including the anatomy of the hip joint, angles such as the angle of inclination and torsion, and positions such as anteversion and retroversion. It also covers the hip joint capsule and ligaments.
The document discusses hip biomechanics, including the anatomy of the hip joint, angles such as the angle of inclination and torsion, and positions such as anteversion and retroversion. It also covers the hip joint capsule and ligaments.
The document discusses hip biomechanics, including the anatomy of the hip joint, angles such as the angle of inclination and torsion, and positions such as anteversion and retroversion. It also covers the hip joint capsule and ligaments.
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Hip Biomechanics
Intro • Coxofemoral joint • Three degrees of freedom • Primary function: support weight of the HAT both in static and dynamic postures. Proximal Articular Surface • Acetabulum • Lined with hyaline cartilage, allows for uniform distb of contact forces. • Inferior aspect interrupted by acetabular notch. • Fibrous band – transverse acetabular lig spans the notch. Creates fibro-osseous tunnel through which blood vessels pass centrally to acetabular fossa. • Acetabular labrum at periphery. • Acetabular dysplasia, coxa profunda & acetabular protrusion, anteversion and retroversion. • Dysplasia- shallow acetb • Acetb depth: Center edge angle of Wiberg <16 deg- definite dysplasia 16-25 deg- possible dysplasia >25 deg- normal >40 deg- overcoverage. (limited rom and impingement) • Fovea – attachment of ligamentum teres • Angle of inclination • Angle of torsion • In women, the angle of inclination is somewhat smaller than it is in men, owing to the greater width of the female pelvis.
• With a normal angle of inclination, the greater trochanter lies at the level of the center of the femoral head. The angle of inclination of the femur changes across the life span; it approximates 150° at birth and gradually declines to about 125° at skeletal maturity.
• This angle can continue to decline again in the elderly.
• In coxa valga, the angle of inclination in the femur is greater than the normal adult angle of 125°. • The increased angle diminishes the shear, or bending force across the femoral neck. • Decreased distance between the femoral head and the greater trochanter decreases the length of the moment arm of the hip abductor muscles. Increased demand for muscular force generation to maintain sufficient abduction torque during single-limb support. Either total joint reaction force within the hip joint will increase or the abductor muscles will be unable to meet the increased demand and will be functionally weakened. • As the femoral head points more superiorly, there is a decreasing amount of coverage from the acetabulum superiorly. • Consequently, coxa valga decreases the stability of the hip and predisposes the hip to dislocation • Coxa vara is considered to give the advantage of improved hip joint stability • The decreased angle between the neck and shaft of the femur will turn the femoral head deeper into the acetabulum, decreasing the amount of articular surface exposed superiorly and increasing coverage from the acetabulum. • The increased moment arm decreases the amount of force that must be generated by the abductor muscles in single-limb support and reduces the joint reaction force. • The increased shear force along the femoral neck will increase the predisposition toward femoral neck fracture. Angle of Torsion • Femoral anteversion is considered to exist when angle of anterior torsion is greater than 15° to 20°. A reversal of anterior torsion, known as femoral retroversion, occurs when angles are less than 15° to 20° • Femoral anteversion is associated with increased medial rotation ROM and decreased lateral rotation • Anteversion of the femoral head reduces hip joint stability because the femoral articular surface is more exposed anteriorly Congruence • Closed pack position of hip joint • True physiological position of hip joint: flexion, abduction, and slight lateral rotation (frog leg position) • The pressure within the joint must be broken before the hip can be dislocated. The labrum enhances joint stability not only by deepening the acetabulum but also by acting as a seal to maintain negative intra-articular pressure • Hip joint extension, with slight abduction and medial rotation, is the close-packed position for the hip joint • In contrast to other joints in the body, the close-packed position is not the position of optimal articular contact (congruence). • Dashboard injury (flexion and adduction)- posterior dislocation • Position assumed by the hip when there is pain arising from capsuloligamentous problems: flexion, abduction and midrotation. This minimizes intra-articular pressure, decreases pain in the joint and prevents the excessive pressure from compressing the intra-articular blood vessels and interfering with the blood supply to the femoral head Hip Joint Capsule • The articular capsule of the hip joint is an irregular, dense fibrous structure with three thickened regions that constitute the capsular ligaments. • Fibers form a tight ring just below the femoral head known as the zona orbicularis. Primary role: stability during distraction • Capsule thick anterosuperiorly • The superior and inferior gluteal arteries supplied the hip capsule more proximally, whereas the medial and lateral circumflex arteries supplied the capsule more distally. Ligaments • Lig Teres: IA but extra synovial • Traditionally it has been believed that the sole purpose of the ligamentum teres was to serve as a conduit for blood supply to the femoral head. Recent studies- it has a role in stab head. • Because of its laxity, pinching of the ligamentum teres between the femoral head and acetabulum can occur, causing complaints of pain and clicking. • Ischiofemoral ligament is the primary restraint to medial rotation of the hip regardless of hip position in flexion or extension. • On the anterior side of the hip joint, the pubofemoral ligament controls lateral rotation in an extended position. • the iliofemoral ligament is capable of providing resistance to excessive motion in both medial and lateral rotation.
