• Identify major anatomy of the hip joint
• Identify blood supply and nerve supply to the hip joint
• Recognize major hip pathology
• Evaluate hip joint abnormality and special test
• Identify THR precautions
• Design treatment protocole to total hip replacement

THE HIP
This joint is multiaxial with 3 degrees of •
freedom.
It is designed for maximal stability while •
providing considerable mobility.
Primary functions of the hip include weight- •
bearing support of the upper body during static and dynamic erect or semi-erect postures and serving as a force transmission pathway

• Pain in the hip region can be referred from the lumbo-sacral region as well as from the knee.
• Likewise, hip pathology can refer pain into the groin, the anterior-medial-lateral thigh, the knee, the buttock and some say even to the foot/ankle joint.

ANATOMY
Non-Contractile
• Acetabulum
• Femoral Head
• CAPSULE
•
•
• thickened anterior-superiorly, thin and loosely attached posterior-inferiorly
Significantly restricts joint distraction reinforced by strong ligaments
• Extensive synovial lining

3 primary ligaments contributing to stability, 2 are anterior and 1 posterior
• ilio-femoral
• pubofemoral
• Ischiofemoral
• Ligament of the head of the femur
(ligamentum teres)
• Transverse acetabular ligament

• Trochanteric (most extensive posterolateral to the greater trochanter)
• Iliopectineal (often continuous with joint capsule anteriorly)
• Iliopsoas (often overlooked; located closer to the tendinous insertion of the muscle)
• Ischiogluteal

• 2 pathways:
• ligament of the head of the femur artery and
• neck of the femur artery
• Contributory to hip pathologies if compromised by fracture, capsular tension or constriction.

•
•
•
Innervated by structures representing spinal segments L1 through S1.
Primary innervation of the hip joint is L1/L2 nerve root
Consequently significant potential referral
pattern of pain to and from the hip

Femoral Angles
ANGLE OF INCLINATION

• Pathological INCREASE in this angle results in
COXA VALGA. >135 degrees
• Pathological DECREASE in this angle results in
COXA VARA:< 135 degrees

ANGLE OF TORSION
• A Transverse Plane referenced angulations of the Femur
• The normal is 12 degrees
• INCREASE in this angle results in FEMORAL
ANTEVERSION.
• DECREASE in this angle results in
RETROVERSION.

• OA of the hip joint
• Fractures neck of the femur
• Congenital Dislocation (CDH and DDH)
• ACUTE PYOGENIC ARTHRITIS OF THE HIP
• Legg-Calve-Perthes Disease (avascular necrosis)
•
•
• SLIPPED FEMORAL head EPIPHYSIS
• Traumatic dislocation/fx's (avascular necrosis)
• Bursitis/tendinitis
Trochanteric bursitis
Tinsofascitis (Ilio-tibial band)
• Synovitis

• Appear mostly in the superior anterior of the head of femur
• Tested by Jansen’s test
• Usually end with TOTAL HIP REPLACEMENT
• Treated at the beginning before surgery with
SWD
AROM
Swimming and hydrotherapy

• Physical therapy
Hydrotherapy and swimming
Deep heat SWD
Strengthening exercise
Active ROM and using assistive devices
• Surgical management (Total hip replacement)
Ostenmore surgery (partial hip replacement)

• avoid hip adduction, flexion more than 90 degree, and internal rotation. Advise your patient to use high commode and high chair to avoid hip flexion.
• Use pillow or wedge between the legs to avoid adduction when he/she is in the bed.
• Required to use front wheeled walker for a while

THR treatment
• AAROM for all lower extremity joints
• AROM for all lower extremity joints
• Strengthening exercise with slight manual resistance
• Isometric for quad and gluteus max and medius
Avoid SLR exercise
• Bed Mobility and transfer training
• Sit to stand training
• Gait training with F W W and PWB
• Ambulation with quad cane

• This is a disease of adolescence and is a commoner in boys than in girls.
• The attachment of the femoral neck loosens, so that the head appears to slide down wards on the femoral neck, giving rise eventually to a coax vara deformity of the hip,

• Pain may occur in the groin or knee, and if the onset is very acute weight bearing may become impossible,
• there is usually restriction of internal rotation and abduction in the affected hip.
• The diagnosis is confirmed by X ray; the earliest changes being seen in the lateral projection,
• late complication of slipped femoral epiphysis include a vascular necrosis of the femoral head and chondrolysis.

• Results of mechanical error
• Related to OSTEOPOROSIS
• Treated surgically by nail and plate
• PT treatment include
• Mobility (ROM) to all joints
• Strengthening to the quadriceps and hip extensors and abductors