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THE HIP JOINT

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THE HIP JOINT
(part 1)
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 Is an amphiarthrodial or ball and socket joint
3 degrees of freedom of motion:
1. Sagital plane (flexion-extension)
2. Frontal plane (abduction-adduction)
3. Transverse plane (internal-external rotation)

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 Connect the trunk and lower extremity, formed by the
articulation of the head of the femur with the cup-shaped

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acetabulum

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The articulating
surfaces
Approximately
congruent and are
covered with hyaling

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cartilage
Intersect with the
sagital plane at an
angle of 40 (post)
and with the
transverse plane at
an angle of 60 (lat)
Deepned by
fibrocatilaginous ring
(labrum acetabulare)
encircles the lip of
acetabulum except
incissura acetabuli 5
 The acetabulum is a part of pelvis
Pelvis ring which the sacrum implanted ( sacroiliaca joint)
3 bones of the sacrum :
- ilium
- pubis

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- ischium

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 Head of the femur is almost a perfect globe
Center of the head of femur coincides with the center of the
acetabulum angular value of 180
Atmospheric pressure 22kg
Vacuum like suction all position in locomotion

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Supporting ligaments & strong muscles

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The femoral neck
Development depends on normal distribution of the forces of
gravity and muscle actioan

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The head and neck of femur become angulated in 2 pales :
frontal and transverse

FRONTAL
Angle of inclination
Formed by the long axes of the femoral neck & shaft
in newborn its average 150
in adult its average 125
Facilities the freedom of motion 9
1. Coxa Valga ( exceed the normal range)
e.g: dysplasias & cerebral palsy
2. Coxa Vara ( less than the normal range)
e.g: congenital & metabolic disorders

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TRANSVERSE
Angle of Antetorsion ( Declination)

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Is the projection of the angle between the long axis of the
femoral neck and the axis through the femoral condyles
- In adult approximately 12
- In infant / young children : F: 26 M: 23

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The Femoral Shaft
- Quite irreguler
- Its upper end greater and lesser
trochanter beetween which the

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femoral neck is inserted at angle
125
- Curved both in frontal and sagittal
plane static significance
- Outward curving of the upper
end increase the ability of the
bone to receive weight stress
froam above and transmit them to
the knee joint
- Forward curving increase its
ability to resist bending and
shearing stress which is received in
sagittal direction like walking,
running, jumping 13
Internal Architecture ot the Upper
End of the Femur
Two prominent principal trabecular systems :
1. Primary trabecular system

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- medial : medial cortex of the proximal femoral shaft,
streams in divergent layers into the medial half of the neck, and
ends at the subchondral layer of the head.
- lateral : lateral cortex, passes up the lateral part of the
neck, and crosses the medial system to end at the subchondral
layer of the head and its lower inner quadrant.

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2. Secondary trabeculae system
- Medially and extending into the region of the greater

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trochanter
- Laterally and extending into the trochanteric region and
femoral neck

Wollffs Law : bone trabeculae are oriented along lines of stress

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Axes of the Femur
Anatomical axis:
Femoral neck

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Femoral shaft
Mechanical axis:
Form by a line drawn
from the center of the
head of the femur
dirctly to the midpoint
between the femoral
condyles
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Articular Capsule and Ligaments
1. Iliofemoral ligament (Y
ligament of Bigelow)

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- Prevent hyperextend of hip
- Maintain an erect posture
without need of constant
muscular effort

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2. Pubofemoral ligamen
- Prevent excessive abduction

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of the hip
- Assist the Y ligament in
checking extension

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3. Ischiofemoral ligament
- Help to prevent extreme

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flexion

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4. Ligamentum teres
- Found in the head of femur

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- Consist of weak connective
tissue fibers surrounded by
synovial membrane
- Attached to both side of
acetabulum notch

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Muscle of the Hip
Devided into three groups:
1. the anterior flexor group

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- sartorius
- tensor fascia lata
- iliopsoas
- quadriceps femoris
- pectineus * sometimes included in medial group

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Sartorius
- Pes anserinus : insertion of 3 tendons ( gracilis, semitendinosus),
surrounded by bursa pes anserine bursitis

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Tensor Fascia Lata

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Iliopsoas
Also causes an increase in the lumbar lordosisin the lumbar
spines

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Quadriceps femoris
Consist of : - rectus femoris
- vastus medialis

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- vastus intermedius
- vastus lateralis

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Pectineus

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 5/30/2014
THE HIP JOINT
(part 2)
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The Medial (Adductor) Group
Muscles
M. adductor longus
M. adductor brevis

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M. adductor magnus
M. gracilis
M. obturator
externus

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 M. Adductor Longus
O : Pubis
I : Middle third of the

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linea aspera
A : Hip adduction
N : Obturator nerve
(L3, L4)

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M. Adductor Brevis
O : Pubis
I : Pectineal line and

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proximal linea aspera
A : Hip adduction
N : Obturator nerve
(L3, L4)

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M. Adductor Magnus
O : Ischium and pubis
I : Entire linea aspera

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and adductor
tubercle
A : Hip adduction
N : Obturator and
sciatic nerve (L3, L4)

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M. Gracilis
O : Pubis
I : Anterior medial

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surface of proximal
end of tibia
A : Hip adduction
N : Obturator nerve
(L2, L3)

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The Posterior (Extensor) Group
Muscles
M. gluteus maximus
M. gluteus medius
M. gluteus minimus

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Hamstrings
M. semitendinosus
M. semimembranosus
M. biceps femoris
Short external rotators of
the hip
M. pyriformis
M. obturator internus
M. obturator externus
M. gemellus superior
M. gemellus inferior
M. wuadratus femoris 34
M. Gluteus Maximus
O : Posterior sacrum and
ilium
I : Posterior femur distal

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to greater trochanter
and to iliotibial band
A : Hip extension,
hyperextension, lateral
rotation
N : Inferior gluteal nerve
(L5, S1, S2)

Trochanteric bursitis 35
M. Gluteus Medius
O : Outer surface of
the ilium

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I : Lateral surface of
the greater
trochanter
A : Hip abduction
N : Superior gluteal
nerve (L4, L5, S1)

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M. Gluteus Minimus
O : Lateral ilium
I : Anterior surface of

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the greater
trochanter
A : Hip abduction,
medial rotation
N : Superior gluteal
nerve (L4, L5, S1)

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Hamstrings

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Deep Rotator Muscles

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 The Blood Supply
Epiphysial arteries (lateral,
medial)

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Metaphysial arteries (
superior, inferior)

Damage aseptic necrosis

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The Nerve Supply
John Hiltons law (1861) :
A joint receives its proprioceptif & pain fibers from the same

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nerves which supply the muscles moving the joint
reflex spasm
refer pain

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1. Branches from the femoral nerve to the lower part of the
iliofemoral ligament, as well as some to the posterior
superior part of the capsule and to the region of the
pubofemoral ligament

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2. A distribution from the obturator & the accessory obturator
to the region of the pubofemoral ligament
3. A branch of the superior gluteal nerve to the superior lateral
region of the capsule
4. Branches from the nerve to the quadratus femoris which
supply the posterior capsule including the ischiofemoral
ligament

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Forces Acting on the Hip Joint
Forces : static or dynamic
Center of gravity (C.G) to hip joint : 8.5-10 cms horizontally, 3

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cms vertically
Walking :
Weight of the body shifted to weight-bearing femur
C.G. is moved toward the weight-bearing side
The unsupported side of pelvis drops 40 from the horizontal

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Static force
balanced, not subject to acceleration and deceleration
Normal standing on both feet : the force exerted on each hip

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joint 1/3 of the total body weight
Standing on one leg : 2,5-4x the body weight

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Dynamic force
Unbalanced, associated with acceleration and deceleration of
extremity

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During walking : 5-6x the body weight

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Osteoarthritis of the Hip
Physiologic imbalance between the mechanical stress in the
hip and the capacity of the joint tissues

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2 solution methods:
weight bearing area (external support)
load on the joint ( body weight)

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 5/30/2014
TERIMA KASIH
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