The Hip Joint

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The Hip Joint

• Sarah Ruff
• Crystal Hillyard
• Nicole Harre
• Erin Adles

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The Hip Joint

• The hip joint is formed by the articulation of
  the head of the femur into the acetabulum of the
  hip.
• ball-and-socket joint.
• Synovial joint

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Bones

• Ilium
• Ischium
• Pubis
• Femur
• The acetabulum is formed by the pubis, ischium
  and ilium bones

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Joint Capsule

• Strong fibrous sleeve
• specialized thickening, called ligaments, add
  stability
• Anteriorly
• proximally to the bone surrounding the
  acetabulum.
• Distally to the trochanteric line
• Posteriorly
• to the margins of the acetabulum and surrounding
  bone
• neck of the femur- not to the trochanteric crest

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Ligaments

• Iliofemoral ligament- strongest ligament in the
  human body. It attaches to the illium between the
  two heads of the rectus femoris muscle. It is Y
  shaped. One goes to the base of the greater
  trochanter and the other to the base of the
  lesser trochanter. Seeks to resist excessive
  extension of the hip joint.
• Ischiofemoral ligament- attaches from the ischial
  part of the acetabular rim to the femur.
  Posterior joint capsule is reinforced by this
  ligament.
• Pubofemoral ligament- attaches to the base of the
  lesser trochanter and the superior ramus of the
  pubis, just above the obturator foramen. It is
  inferior to the iliofemoral ligament and
  reinforces the inferior part of the hip joint
  capsule. It also blends with the medial parts of
  the iliofemoral ligament

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Ligaments (cont.)

• The round ligament of the head of the femur is
  attached to the transverse acetabular ligament
  and extends to the fovea centralis on the head of
  the femur
• A fibrocartilaginous ring called the acetabular
  labrum deepens the acetabulum and clasps the head
  of the femur which makes the joint more stable

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Muscles

• External rotators piriformis, quadratus femoris,
  Obturator internus and externus, gemellus
  superior and inferior,
• Flexors iliopsoas, rectus femoris
• Adductors adductor magnus, adductor longus and
  brevis, pectineus, gracilis
• Internal rotators gluteus medius, gluteus
  minimus, tensor fascia latae
• Extensors semitendinosus and semimembranosus,
  biceps femoris, gluteus maximus
• Abductors gluteus medius, gluteus minimus

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Nerves

• Femoral
• Obturator
• Sciatic
• Nerve to quadratus femoris
• Direct branches of sacral plexus

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Blood Supply

• Medial Circumflex
• Lateral Circumflex
• Obturator
• Inferior gluteal

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Movements
The hip joint is the most mobile joint in the
lower limb. It is capable of flexion and
extension, abduction and adduction, medial and
lateral rotation and all of these in a circular
motion- circumduction second largest
range of movement (second only to the shoulder)
supports the weight of the body, arms and head.
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Movements

• Flexion- mainly due to contraction of the
  iliopsoas muscle, with help from the sartorius,
  rectus femoris, and pectineus
• Extension- chiefly by the guteus maximus muscles
  with help by the hamstrings
• Adduction- by the adductor longus, brevis, magnus
  and the gracilis
• Abduction- by the gluteus medius and gluteus
  minimus
• Lateral rotation- by the gluteus maximus,
  quadratus femoris, piriformis, obturator internus
  and externus, gemelli
• Medial rotation- by the anterior part of the
  glueteus minimus and medius and tensor fasciae
  latae muscles

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What causes Hip pain?(refer to your Hip handout)

• Arthritis
• Throchanteric Bursitis
• Tendonitis
• Osteonecrosis
• Lumbar pain- referred symptoms
• Snapping hip syndrome
• Muscles strains
• Hip fracture
• Childhood hip problems
• Developmental dysplasia
• Legg-calve-perthes disease

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Treatments

• Rest
• Ice and heat application
• Stretching
• Physical Therapy
• Anti-inflammatory Meds
• Hip Replacement

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Treatments (cont.)

• Hip Replacement
• First performed in 1960
• More than 193,000 total hip replacements each
  year
• Benifical if
• Hip pain limits ADLs like walking or bending
• Hip pain continues while resting, either day or
  night
• Stiffness in hop limits mobility
• Little relief from medications
• No relief after physical therapy or use of gait
  aid such as a cane

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Treatments (cont.)

• Hip Replacement
• Surgery
• Admission into hospital
• General anesthesia or spinal anesthesia
• Usually takes a few hours
• Process- removal of damaged cartilage and bone,
  they then position new metal, plastic, or ceramic
  joint surfaces to restore alignment and function.
  A ball and socket component is used. Surgical
  cement may be used to fill the gap between
  prosthesis and remaining bone to secure the new
  joint
• In younger- more active patients, non-cemented
  prosthesis so the bone can grow into the
  prosthesis.

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Dissection
With Cadaver in Supine position, find the Rectus
Femoris muscle (1) and the Sartorius muscle (2)
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Reflect the Rectus Femoris and Sartorius muscles
to expose the Pectineus and Iliopsoas muscles.
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Reflect the Iliopsoas and Pectineus muscles to
expose the hip joint capsule.
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Identify the following pubofemoral ligament (2)
which is partially seen inferiorly and the
ischiofemoral ligament (1) which is viewed
posteriorly.
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Open the Capsule along in the same direction of
the capsular ligaments to expose the head of the
femur. The arrow points to where the hip capsule
has been opened.
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Then evulse the head of the femur to view the
internal structure of the joint including the
round ligament of the femur.
http//www.meddean.luc.edu/lumen/meded/grossanatom
y/dissector/labs/le/joint/main.html
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Final Note

• Refer to the handout that was given to us last
  Monday in class regarding hip injuries and
  diseases. We found this very helpful as well!