Hip Joint
Dr. Rakhi More
Assoc. Prof., Anatomy
KJSMC, Mumbai
Type & Subtype
• Synovial
• Ball & Socket
Articular surfaces
• Head of
femur
• Acetabulum
of Hip bone
Stability of the joint
Depends on
• Depth of the acetabulum & narrowing of the
mouth by the acetabular labrum
• Tension & strength of the ligaments
• Strength of surrounding muscles
• Length & obliquity of the neck of femur
• Atmospheric pressure
Ligaments
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Fibrous capsule
Iliofemoral ligament
Pubofemoral ligament
Ischiofemoral legament
Ligament of head of femur
Acetabular labrum
Transverse acetabular ligament
Ligaments – Fibrous Capsule
Attachment on the
• Hip bone – acetabular
labrum & transverse
acetabular ligament &
bone above & behind
the acetabulum
• Femur –
intertrochantreric line
in front & 1 cm medial
to the intertrochanteric
crest behind
Ligaments – Fibrous Capsule
• Anterosuperiorly
– Capsule is
thick & firmly
attached
• Posteroinferiorly
– Thin & loosely
attached
Ligaments – Fibrous Capsule
• Made up of 2 types of
fibers
• Outer longitudinal –
Best developed
anterosuperiorly where
they are reflected along
the neck to form the
retinacula along which
the blood vessels
supplying the head &
the neck of femur travel
• Inner circular
Ligaments – Iliofemoral ligament
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Ligament of Bigelow
Present anteriorly
Inverted ‘Y’ shaped
One of the strongest
ligaments in the body
• Attached above to the
lower half of the
anterior inferior iliac
spine & below to the
intertrochanteric line
Ligaments – Pubofemoral ligament
• Present medially
• Triangular in shape
• Attached superiorly to the
iliopubic eminence,
obturator crest &
obturator membrane &
inferiorly merges with the
anteroinferior part of the
capsule& with the lower
band of iliofemoral
ligament
Ligaments – Ischiofemoral ligament
• Present
posteriorly
• Fibers extend
from ischium to
acetabulum
Ligaments - Ligament of the head of
femur
• Round ligament/
ligamentum teres
• Flat & triangular
• Apex attached to the
fovea capitis & base to
the transverse ligament
& margins of the
acetabular notch
Ligaments - Acetabular labrum
• Fibrocartilaginous rim
attached to the margins
of the acetabulum
• Narrows the mouth of
the acetabulum
Ligaments - Transverse ligament of
acetabulum
• Bridges the acetabular
notch
• Converts it into foramen
which transmits
acetabular vessels &
nerves
Relations
Blood supply
• 2
4
5
2
3
1
Nerve supply – Femoral Nerve
Movement
Chief muscle
1 Flexion
Psoas major & iliacus
Accessory muscle
Pectineus, rectus femoris
& sartorius, adductors
2 Extension
Gluteus maximus &
hamstrings
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3 Adduction
Adductor – Longus,
brevis, magnus
Pectineus & gracilis
4 Abduction
Glutei – medius &
minimus
Tensor fascia lata &
sartorius
5 Medial
rotation
Tensor fascia lata &
anterior fibers of glutei
medius & minimus
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6 Lateral
rotation
Two obturators , two
gemelli & quadratus
femoris
Piriformis, gluteus maxius
& sartorius
Applied anatomy
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Congenital dislocation
Trendenlenberg test
Perthe’s disease
Coxa vara & coxa valga
Referred pain to knee
Aspiration of hip joint
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Arthritis
Fracture
Shenton line
Hip joint replacement
Hip diseases
Congenital Dislocation
• More common in hip than
in any other joint
• Upper margin of
acetabulum is
developmentally deficient
• Hence head of femur slips
upwards onto the gluteal
surface of the ilium
• Sciatic nerve injured in
posterior dislocations
Trendenlenberg’s test
• A positive Trendelenburg
sign is identified when the
patient is unable to
maintain the pelvis
horizontal to the floor while
standing first on one foot
and then on the other foot
Perthe’s Disease
• Pseudocoxalgia
• Destruction & flattening
of head of femur
• X ray shows increased
joint space
Coxa Vara and Coxa Valga
• Coxa vara is a deformity of
the hip, whereby the angle
between the head and the
shaft of the femur is reduced
to less than 120 degrees
• Coxa valga describes a
deformity of the hip where
there is an increased angle
between the femoral neck
and femoral shaft.
Referred pain to Knee
• Pain referred to the
knee because of the
common nerve supply
Aspiration of Hip Joint
• Done by passing the
needle from a point 5 cm
below the ASIS, upwards,
backwards & medially
• Can also be done from
the side by passing the
needle from the posterior
edge of the greater
trochanter, upwards &
medially, parallel with the
neck of the femur
Arthritis
• The position of the joint is partially flexed,
abducted & laterally rotated
Fracture
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Subcapital
Cervical
Basal
Damage to retinacular
arteries causes
avascular necrosis of
the head
• Common in old age
Shenton Line
• In an X ray picture, a
continuous curve
formed by upper
border of obturator
foramen& lower
border of neck of
femur is seen
• This line is distorted
in fracture neck
femur
Hip joint replacement
• In case of avascular
necrosis of the head of
femur, hip joint
replacement can be
done
Hip Diseases
• Hip diseases show an interesting age pattern:
A. Below 5 years of age : Congenital Dislocation
and Tuberculosis
B. 5 to 10 years : Perthe’s disease
C. 10 to 20 years : Coxa Vara
D. Above 40 years : Osteoarthritis
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