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The HIP JOINT

Dr. Waleed M. Renno

wrenno@hsc.edu.kw
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The Hip Joint
Is a synovial, multi-axial, ball
and socket joint

Designed for support as

opposed to the gleno-humeral
joint, designed for mobility

Articular surfaces of the hip

are the acetabulum and the
head of the femur .
Netter 472
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The Hip Joint
Thick hyaline cartilage covers
articular surfaces
Cartilage covers head of the femur
(about 2/3 of it) but not the fovea
capitis (round ligament of the head
of the femur)

Fibrocartilaginous rim, the

acetabular labrum:
- Attaches to the margins of
the acetabulum
- Deepens and increases the
stability of the hip joint
- Continuous with the
transverse ligament of
the acetabulum Netter 469
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The Hip Joint
Fibrous capsule is thick and strong
Proximally:
it attaches to the acetabulum, the outer
margin of the labrum and the transverse
ligament of the acetabulum
Distally:
posteriorly to the
femoral neck and
anteriorly to the Netter 469
intertrochanteric line

Longitudinal and circular

fibers with some well
developed circular fibers
(zona orbicularis)
 Netter 469
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Ligaments
Round ligament of the head of the
femur attaches on the transverse transverse
ligament of the acetabulum (transverse acetabular
ligament
acetabular ligament), on the margins of
the acetabular notch and in the pit of the
fovea capitis

Allows the passage of a small

artery branching off the obturator
artery, from the acetabular notch obturator
Round
into the femoral head ligament of
artery
the head
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Anterior Ligaments
1. Iliofemoral ligament or Y-shaped
ligament of Bigelow
From AIIS to the lower parts of the
intertrochanteric line inferiorly.
Prevents overextension of the
joint (becomes taut) in standing
position

2. Pubofemoral ligament:
from the superior ramus of the
pubis to the inferior part of the
intertrochanteric line
limits hip abduction at the
end range of this movement
Netter 469
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Posterior Ligament
Ischiofemoral ligament:
Spiral shaped ligament
attached on the body of
the ischium, near the
superior border of the
acetabular margin

Fibers passes upward and

laterally to attach to the
greater trochanter

Limits extension of the

hip Netter 469
 Ligaments
1 iliofemoral lig strong & Y-shaped
from ant inf iliac spine to
intertrochanteric line
prevents overextension during standing
2 ischiofemoral lig spiral in shape
from body of ischium to greater
trochanter
limits extension
3 pubofemoral lig triangular in shape
from sup ramus of pubis to
intertrochanteric line
limits extension & abduction
4 tnvs acetabular lig formed by acetabular labrum
bridges acetabular notch
5 lig of head of femur from tnvs lig to fovea capitis
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Nerve supply to the hip
The femoral nerve (directly or through muscular
branches)
The obturator and accessory obturator nerves
The sciatic nerve
The nerve to the quadratus femoris.
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Blood Supply
Directly or through anastomosis from
branches of the:
obturator
medial and lateral circumflex
femoral Obturator
superior and inferior gluteal artery
arteries
Small arteries, called retinacular
arteries (branches of the lateral and
medial femoral circumflex arteries)
penetrate the length of the neck and
small branch from the obturator artery
provide blood supply to the head of the Retinacular
femur arteries
Netter 486
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Blood Supply
Fractures of the neck of the femur can damage the
retinacular arteries

Dislocation of the hip can tear the acetubular

branch of the obturator artery

With time, the neck and/or the

head will become necrotic
(pain in standing position,
discomfort at the end range of
motion, etc) and the patient
will need to receive a total hip
replacement Netter 486
 Stability
Relatively stable joint
Stability maintained by several factors
1 bony factors acetabulum is deep
additional depth provided by acetabular labrum
provide snug fit for head of femur

2 capsule Encloses joint

strong anteropost, thin & loosely attached posteroinf
3 ligaments 1) Iliofemoral
2) Ischiofemoral
3) Pubofemoral
4 muscles anteriorly - iliopsoas - rectus femoris
anterolat - gluteus medius - gluteus minimus
posteriorly - piriformis - obturator internus
- gemelli - quadratus femoris
covered by gluteus maximus
posteroinf - obturator externus

5 synovial fluid provides strong cohesive force

 Movements
Wide range of movements, but less than shoulder joint some of the movement
sacrificed for stability
movements muscles responsible
1 Flexion 125 Iiopsoas (prime movers)
Rectus femoris + Sartorius + Adductor muscles (brevis & longus)
Pectineus + Tensor fasciae lata
2 Extension 15 - 20 Gluteus maximus
Hamstrings (not including short head of biceps)
3 Abduction 45 Gluteus medius
Gluteus minimus + Tensor fasciae lata
4 Adduction 15 - 30 Adductor longus & brevis + Pectineus + Gracilis
Adductor fibers of adductor magnus
5 Lat rotation 45 Piriformis + Gemellus sup & inf + Obturator int & ext +
Quadratus femoris + Gluteus maximus
Sartorius & biceps long head
6 Med rotation 30 - Tensor fasciae lata
40 Gluteus minimus
Ant fibers of gluteus medius
Semitend & Semimemb
7 circumduction combination of the above movements
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Angle of inclination of femur
Definitions:
The angle formed by the meeting
of the axis of the shaft of the
femur with the long axis of the
femoral neck and head.

An increased angle is coxa

varus; a decreased angle
constitutes coxa valgus.

Abnormal angles increase

stress on the hip joint and
affect gait.