Hip

In vertebrate anatomy, hip (or "coxa"[1] in medical terminology) refers to

Hip
either an anatomical region or a joint.

The hip region is located lateral and anterior to the gluteal region, inferior to
the iliac crest, and overlying the greater trochanter of the femur, or "thigh
bone".[2] In adults, three of the bones of the pelvis have fused into the hip
bone or acetabulum which forms part of the hip region.

The hip joint, scientifically referred to as the acetabulofemoral joint (art.

coxae), is the joint between the femur and acetabulum of the pelvis and its
primary function is to support the weight of the body in both static (e.g.
standing) and dynamic (e.g. walking or running) postures. The hip joints
have very important roles in retaining balance, and for maintaining the
pelvic inclination angle.
Bones of the hip region
Pain of the hip may be the result of numerous causes, including nervous, Details
osteoarthritis, infectious, trauma-related, and genetic.
Identifiers
Latin coxa
Greek ισχίο
Contents
MeSH D006615 (https://meshb.nlm.ni
Anatomy h.gov/record/ui?ui=D006615)
Region
Articulation TA A01.1.00.034 (http://www.unifr.c
Articulal angles h/ifaa/Public/EntryPage/TA98%
Femoral neck angle 20Tree/Entity%20TA98%20EN/
Capsule 01.1.00.034%20Entity%20TA9
Ligaments 8%20EN.htm)
Blood supply
FMA 24964 (https://bioportal.bioontol
Muscles and movements
ogy.org/ontologies/FMA/?p=clas
Clinical significance
ses&conceptid=http%3A%2F%
Sexual dimorphism and cultural significance
2Fpurl.org%2Fsig%2Font%2Ff
Additional images ma%2Ffma24964)
See also
Anatomical terminology
Notes
References
External links

Anatomy

Region
The proximal femur is largely covered by muscles and, as a consequence, the greater trochanter is often the only palpable bony
structure in the hip region.[3]

Articulation
The hip joint is a synovial joint formed by the articulation of the rounded head of
the femur and the cup-like acetabulum of the pelvis. It forms the primary
connection between the bones of the lower limb and the axial skeleton of the
trunk and pelvis. Both joint surfaces are covered with a strong but lubricated
layer called articular hyaline cartilage.

The cuplike acetabulum forms at the union of three pelvic bones — the ilium,
pubis, and ischium.[4] The Y-shaped growth plate that separates them, the
triradiate cartilage, is fused definitively at ages 14–16.[5] It is a special type of
spheroidal or ball and socket joint where the roughly spherical femoral head is
largely contained within the acetabulum and has an average radius of curvature Radiograph of a healthy human hip
of 2.5 cm.[6] The acetabulum grasps almost half the femoral ball, a grip joint
augmented by a ring-shaped fibrocartilaginous lip, the acetabular labrum, which
extends the joint beyond the equator.[4] The joint space between the femoral
head and the superior acetabulum is normally between 2 and 7 mm.[7]

The head of the femur is attached to the shaft by a thin neck region that is often prone to fracture in the elderly, which is mainly
due to the degenerative effects of osteoporosis.

The acetabulum is oriented inferiorly, laterally and

anteriorly, while the femoral neck is directed superiorly,
medially, and slightly anteriorly.

Articulal angles
The transverse angle of the acetabular inlet (also
called Sharp's angle and is generally the angle
referred to by acetabular angle without further Transverse and sagittal angles of acetabular inlet plane.
[8]
specification) can be determined by measuring
the angle between a line passing from the
superior to the inferior acetabular rim and the horizontal plane; an angle which normally measures 51° at birth
and 40° in adults, and which affects the acetabular lateral coverage of the femoral head and several other
parameters.[9]
The sagittal angle of the acetabular inlet is an angle between a line passing from the anterior to the posterior
acetabular rim and the sagittal plane. It measures 7° at birth and increases to 17° in adults.[9]
Wiberg's centre-edge angle (CE angle) is an angle between a vertical line and a line from the centre of the
femoral head to the most lateral part of the acetabulum,[10] as seen on an anteroposterior radiograph.[11]
The vertical-centre-anterior margin angle (VCA) is an angle formed from a vertical line (V) and a line from the
centre of the femoral head (C) and the anterior (A) edge of the dense shadow of the subchondral bone slightly
posterior to the anterior edge of the acetabulum, with the radiograph being taken from the false angle, that is, a
lateral view rotated 25 degrees towards becoming frontal.[11]
The articular cartilage angle (AC angle, also called acetabular index[12] or Hilgenreiner angle) is an angle formed
parallel to the weight bearing dome, that is, the acetabular sourcil or "roof",[13] and the horizontal plane,[10] or a
line connecting the corner of the triangular cartilage and the lateral acetabular rim.[14] In normal hips in children
aged between 11 and 24 months, it has been estimated to be on average 20°, ranging between 18° to 25°.[15] It
becomes progressively lower with age.[16] Suggested cutoff values to classify the angle as abnormally increased
include:
 30° up to 4 months of age.[17]
25° up to 2 years of age.[17]

Femoral neck angle

The angle between the longitudinal axes of the femoral neck and shaft, called the caput-collum-diaphyseal angle or CCD angle,
normally measures approximately 150° in newborn and 126° in adults (coxa norma).[18]

An abnormally small angle is known as coxa vara and an abnormally large angle as coxa valga. Because changes in shape of the
femur naturally affects the knee, coxa valga is often combined with genu varum (bow-leggedness), while coxa vara leads to genu
valgum (knock-knees).[19]

Changes in the CCD angle is the result of changes in the stress patterns
applied to the hip joint. Such changes, caused for example by a dislocation,
change the trabecular patterns inside the bones. Two continuous trabecular
systems emerging on the auricular surface of the sacroiliac joint meander
and criss-cross each other down through the hip bone, the femoral head,
neck, and shaft.

In the hip bone, one system arises on the upper part of the
auricular surface to converge onto the posterior surface of the
greater sciatic notch, from where its trabeculae are reflected to Changes in trabecular patterns due to
the inferior part of the acetabulum. The other system emerges altered CCD angle. Coxa valga leads to
on the lower part of the auricular surface, converges at the level
of the superior gluteal line, and is reflected laterally onto the more compression trabeculae, coxa vara
upper part of the acetabulum. to more tension trabeculae.[18]
In the femur, the first system lines up with a system arising from
the lateral part of the femoral shaft to stretch to the inferior
portion of the femoral neck and head. The other system lines up with a system in the femur stretching from the
medial part of the femoral shaft to the superior part of the femoral head.[20]
On the lateral side of the hip joint the fascia lata is strengthened to form the iliotibial tract which functions as a tension band and
reduces the bending loads on the proximal part of the femur.[18]

Capsule
The capsule attaches to the hip bone outside the acetabular lip which thus projects into the capsular space. On the femoral side,
the distance between the head's cartilaginous rim and the capsular attachment at the base of the neck is constant, which leaves a
wider extracapsular part of the neck at the back than at the front.[21] [22]

The strong but loose fibrous capsule of the hip joint permits the hip joint to have the second largest range of movement (second
only to the shoulder) and yet support the weight of the body, arms and head.

The capsule has two sets of fibers: longitudinal and circular.

The circular fibers form a collar around the femoral neck called the zona orbicularis.
The longitudinal retinacular fibers travel along the neck and carry blood vessels.

Ligaments
The hip joint is reinforced by four ligaments, of which three are extracapsular and one intracapsular.
The extracapsular ligaments are
the iliofemoral, ischiofemoral, and
pubofemoral ligaments attached to
the bones of the pelvis (the ilium,
ischium, and pubis respectively).
All three strengthen the capsule
and prevent an excessive range of Extracapsular ligaments. Anterior (left) and posterior (right) aspects of right hip.
movement in the joint. Of these,

Intracapsular ligament. Left hip joint from within pelvis with the acetabular floor removed (left); right hip joint
with capsule removed, anterior aspect (right).

the Y-shaped and twisted iliofemoral ligament is the strongest ligament in the human body. [22] In the upright position, it prevents
the trunk from falling backward without the need for muscular activity. In the sitting position, it becomes relaxed, thus permitting
the pelvis to tilt backward into its sitting position. The iliofemoral ligament prevents excessive adduction and internal rotation of
the hip. The ischiofemoral ligament prevents medial (internal) rotation while the pubofemoral ligament restricts abduction and
internal rotation of the hip joint. [23] The zona orbicularis, which lies like a collar around the most narrow part of the femoral
neck, is covered by the other ligaments which partly radiate into it. The zona orbicularis acts like a buttonhole on the femoral
head and assists in maintaining the contact in the joint. [22] All three ligaments become taut when the joint is extended - this
stabilises the joint, and reduces the energy demand of muscles when standing [24]

The intracapsular ligament, the ligamentum teres, is attached to a depression in the acetabulum (the acetabular notch) and a
depression on the femoral head (the fovea of the head). It is only stretched when the hip is dislocated, and may then prevent
further displacement. [22] It is not that important as a ligament but can often be vitally important as a conduit of a small artery to
the head of the femur, that is, the foveal artery.[25] This artery is not present in everyone but can become the only blood supply to
the bone in the head of the femur when the neck of the femur is fractured or disrupted by injury in childhood.[26]

Blood supply
The hip joint is supplied with blood from the medial circumflex femoral and lateral circumflex femoral arteries, which are both
usually branches of the deep artery of the thigh (profunda femoris), but there are numerous variations and one or both may also
arise directly from the femoral artery. There is also a small contribution from the foveal artery, a small vessel in the ligament of
the head of the femur which is a branch of the posterior division of the obturator artery, which becomes important to avoid
avascular necrosis of the head of the femur when the blood supply from the medial and lateral circumflex arteries are disrupted
(e.g. through fracture of the neck of the femur along their course).[26]

The hip has two anatomically important anastomoses, the cruciate and the trochanteric anastomoses, the latter of which provides
most of the blood to the head of the femur. These anastomoses exist between the femoral artery or profunda femoris and the
gluteal vessels.[27]

Muscles and movements

The hip muscles act on three mutually perpendicular main axes, all of which pass through the center of the femoral head,
resulting in three degrees of freedom and three pair of principal directions: Flexion and extension around a transverse axis (left-
right); lateral rotation and medial rotation around a longitudinal axis (along the thigh); and abduction and adduction around a
sagittal axis (forward-backward);[28] and a combination of these movements (i.e. circumduction, a compound movement in which
the leg describes the surface of an irregular cone).[23] Some of the hip muscles also act on either the vertebral joints or the knee
joint, that with their extensive areas of origin and/or insertion, different part of individual muscles participate in very different
movements, and that the range of movement varies with the position of the hip joint. [29] [30] Additionally, the inferior and
superior gemelli may be termed triceps coxae together with the obturator internus, and their function simply is to assist the latter
muscle.[31]

The movements of the hip joint is thus performed by a series of muscles which are here presented in order of importance[30] with
the range of motion from the neutral zero-degree position[28] indicated:

Lateral or external rotation (30° with the hip extended, 50° with the hip flexed): gluteus maximus; quadratus
femoris; obturator internus; dorsal fibers of gluteus medius and minimus; iliopsoas (including psoas major from
the vertebral column); obturator externus; adductor magnus, longus, brevis, and minimus; piriformis; and
sartorius. The iliofemoral ligament inhibits lateral rotation and extension, this is why the hip can rotate laterally to
a greater degree when it is flexed.
Medial or internal rotation (40°): anterior fibers of gluteus medius and minimus; tensor fasciae latae; the part of
adductor magnus inserted into the adductor tubercle; and, with the leg abducted also the pectineus.
Extension or retroversion (20°): gluteus maximus (if put out of action, active standing from a sitting position is
not possible, but standing and walking on a flat surface is); dorsal fibers of gluteus medius and minimus;
adductor magnus; and piriformis. Additionally, the following thigh muscles extend the hip: semimembranosus,
semitendinosus, and long head of biceps femoris. Maximal extension is inhibited by the iliofemoral ligament.
Flexion or anteversion (140°): the hip flexors: iliopsoas (with psoas major from vertebral column); tensor fasciae
latae, pectineus, adductor longus, adductor brevis, and gracilis. Thigh muscles acting as hip flexors: rectus
femoris and sartorius. Maximal flexion is inhibited by the thigh coming in contact with the chest.
Abduction (50° with hip extended, 80° with hip flexed): gluteus medius; tensor fasciae latae; gluteus maximus
with its attachment at the fascia lata; gluteus minimus; piriformis; and obturator internus. Maximal abduction is
inhibited by the neck of the femur coming into contact with the lateral pelvis. When the hips are flexed, this delays
the impingement until a greater angle.
Adduction (30° with hip extended, 20° with hip flexed): adductor magnus with adductor minimus; adductor
longus, adductor brevis, gluteus maximus with its attachment at the gluteal tuberosity; gracilis (extends to the
tibia); pectineus, quadratus femoris; and obturator externus. Of the thigh muscles, semitendinosus is especially
involved in hip adduction. Maximal adduction is impeded by the thighs coming into contact with one another. This
can be avoided by abducting the opposite leg, or having the legs alternately flexed/extended at the hip so they
travel in different planes and do not intersect.

Clinical significance
A hip fracture is a break that occurs in the upper part of the femur.[32] Symptoms may include pain around the hip particularly
with movement and shortening of the leg.[32] The hip joint can be replaced by a prosthesis in a hip replacement operation due to
fractures or illnesses such as osteoarthritis. Hip pain can have multiple sources and can also be associated with lower back pain.

Sexual dimorphism and cultural significance

In humans, unlike other animals, the hip bones are substantially different in the two sexes. The hips of human females widen
during puberty.[33] The femora are also more widely spaced in females, so as to widen the opening in the hip bone and thus
facilitate childbirth. Finally, the ilium and its muscle attachment are shaped so as to situate the buttocks away from the birth
canal, where contraction of the buttocks could otherwise damage the baby.

The female hips have long been associated with both fertility and general expression of sexuality. Since broad hips facilitate child
birth and also serve as an anatomical cue of sexual maturity, they have been seen as an attractive trait for women for thousands of
years. Many of the classical poses women take when sculpted, painted or photographed, such as the Grande Odalisque, serve to
emphasize the prominence of their hips. Similarly, women's fashion through the
ages has often drawn attention to the girth of the wearer's hips.

Additional images

Hip joint. Lateral view. Hip joint. Lateral view.

Dancers often stand with hands on

hips.

Muscles of Thigh. Illustration of Hip (Frontal

Anterior views. view).

X-ray of the hip, with

measurements used in
X-ray of hip dysplasia in
adults.[34]

See also
Belly dancer
Body shape
Bump (dance)
Femoral acetabular impingement
Hip dysplasia (human)
Hip examination
Obstetrical dilemma
 Rump (animal)
Sexual dimorphism
Snapping hip syndrome
Waist–hip ratio

Notes
1. Latin coxa was used by Celsus in the sense "hip", but by Pliny the Elder in the sense "hip bone" (Diab, p 77)
2. "hip region" (https://www.medilexicon.com/dictionary/77165). MediLexicon. Retrieved 2018-08-02.
3. Thieme Atlas of Anatomy (2006), p 381
4. Faller (2004), pp 174-175
5. Thieme Atlas of Anatomy (2006), p 365
6. Thieme Atlas of Anatomy (2006), p 378
7. Lequesne, M (2004). "The normal hip joint space: variations in width, shape, and architecture on 223 pelvic
radiographs" (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1755132). Annals of the Rheumatic Diseases. 63
(9): 1145–1151. doi:10.1136/ard.2003.018424 (https://doi.org/10.1136%2Fard.2003.018424). ISSN 0003-4967 (h
ttps://www.worldcat.org/issn/0003-4967). PMC 1755132 (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC175513
2). PMID 15308525 (https://www.ncbi.nlm.nih.gov/pubmed/15308525).
8. Figure 2 (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2739474/figure/F0002/) in: Saikia KC, Bhuyan SK,
Rongphar R (July 2008). "Anthropometric study of the hip joint in northeastern region population with computed
tomography scan" (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2739474). Indian J Orthop. 42 (3): 260–6.
doi:10.4103/0019-5413.39572 (https://doi.org/10.4103%2F0019-5413.39572). PMC 2739474 (https://www.ncbi.nl
m.nih.gov/pmc/articles/PMC2739474). PMID 19753150 (https://www.ncbi.nlm.nih.gov/pubmed/19753150).
9. Thieme Atlas of Anatomy (2006), Page 379 (https://books.google.com/books?id=mTOhk3m06IoC&pg=PA379)
10. Page 131 (https://books.google.com/books?id=rxS9EjeGhrMC&pg=PA131) in: Whitehouse, Richard (2006).
Imaging of the hip & bony pelvis: techniques and applications. Berlin: Springer. ISBN 978-3-540-20640-8.
11. [1] (http://web.jbjs.org.uk/cgi/reprint/85-B/6/826) Chosa, E.; Tajima, N. (2003). "Anterior acetabular head index of
the hip on false-profile views. New index of anterior acetabular cover". The Journal of Bone and Joint Surgery.
British Volume. 85 (6): 826–829. PMID 12931799 (https://www.ncbi.nlm.nih.gov/pubmed/12931799).
12. Page 309 (https://books.google.se/books?id=VR4PDQAAQBAJ&pg=PA309) in: Jeffrey D. Placzek, David A.
Boyce (2016). Orthopaedic Physical Therapy Secrets - E-Book (3 ed.). Elsevier Health Sciences.
ISBN 9780323286831.
13. Setia, Rahul; Gaillard, Frank. "Developmental dysplasia of the hip" (https://radiopaedia.org/articles/developmenta
l-dysplasia-of-the-hip). Radiopaedia. Retrieved 2018-03-01.
14. Figure 2 (http://www.biomedcentral.com/1471-2431/5/17/figure/F2) in: Windhagen, H.; Thorey, F.; Kronewid, H.;
Pressel, T.; Herold, D.; Stukenborg-Colsman, C. (2005). "The effect of functional splinting on mild dysplastic hips
after walking onset" (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1166563). BMC Pediatrics. 5 (1): 17.
doi:10.1186/1471-2431-5-17 (https://doi.org/10.1186%2F1471-2431-5-17). PMC 1166563 (https://www.ncbi.nlm.
nih.gov/pmc/articles/PMC1166563). PMID 15958160 (https://www.ncbi.nlm.nih.gov/pubmed/15958160).
15. Page 217 (https://books.google.se/books?id=v528wclb28IC&pg=PA217) in: Frederic Shapiro (2002). Pediatric
Orthopedic Deformities. Elsevier. ISBN 9780080538563.
16. Frank Gaillard. "Acetabular angle" (https://radiopaedia.org/articles/acetabular-angle). Radiopaedia. Retrieved
2018-03-01.
17. Page 942 (https://books.google.se/books?id=AmZgmGG4Dz0C&pg=PR942) in: Brian D. Coley (2013). Caffey's
Pediatric Diagnostic Imaging (12 ed.). Elsevier Health Sciences. ISBN 9781455753604.
18. Thieme Atlas of Anatomy (2006), p 367
19. Platzer 2004, pp. 196
20. Palastanga (2006), p 353
21. Because the neck is wider in front than at the back.
22. Platzer 2004, pp. 198
23. Platzer 2004, pp. 200
24. teachmeanatomy.net (http://teachmeanatomy.net/lower-limb/the-hip-joint/). teachmeanatomy.net. Retrieved on
2013-07-12.
25. Hip Fracture in Emergency Medicine (http://emedicine.medscape.com/article/825363-overview#aw2aab6b2b4) at
Medscape. Author: Moira Davenport. Updated: Apr 2, 2012
26. Thieme Atlas of Anatomy (2006), pp 383, 440
27. Clemente (2006), p 227
28. Thieme Atlas of Anatomy (2006), p 386
29. Platzer 2004, pp. 244–246
30. Platzer (2004), pp 244-246
31. Platzer (2004), p 238
32. "Hip Fractures" (http://orthoinfo.aaos.org/topic.cfm?topic=A00392). OrthoInfo - AAOS. April 2009. Archived (http
s://web.archive.org/web/20170629225405/http://orthoinfo.aaos.org/topic.cfm?topic=A00392) from the original on
29 June 2017. Retrieved 27 September 2017.
33. "Reproductive Anatomy and Physiology" (http://www.columbia.edu/itc/hs/pubhealth/modules/reproductiveHealth/
anatomy.html). The Harriet and Robert Heilbrunn Department of Population and Family Health. Retrieved June
2009. Check date values in: |accessdate= (help)
34. Ruiz Santiago, Fernando; Santiago Chinchilla, Alicia; Ansari, Afshin; Guzmán Álvarez, Luis; Castellano García,
Maria del Mar; Martínez Martínez, Alberto; Tercedor Sánchez, Juan (2016). "Imaging of Hip Pain: From
Radiography to Cross-Sectional Imaging Techniques". Radiology Research and Practice. 2016: 1–15.
doi:10.1155/2016/6369237 (https://doi.org/10.1155%2F2016%2F6369237). ISSN 2090-1941 (https://www.worldc
at.org/issn/2090-1941). (Attribution 4.0 International (CC BY 4.0) (https://creativecommons.org/licenses/by/4.0/)

References
Clemente, Carmine D. (2006). Clemente's Anatomy Dissector (https://books.google.com/books?id=oEMvo2exmJ
gC&pg=RA2-PA227). Lippincott Williams & Wilkins. ISBN 0-7817-6339-8.
Diab, Mohammad (1999). Lexicon of Orthopaedic Etymology (https://books.google.com/books?id=fstFQVnw8-w
C&pg=PA200#PPA77,M1). Taylor & Francis. ISBN 90-5702-597-3.
Faller, Adolf; Schuenke, Michael; Schuenke, Gabriele (2004). The Human Body: An Introduction to Structure and
Function. Thieme. ISBN 3-13-129271-7.
Field, Derek (2001). Anatomy: palpation and surface markings (3rd ed.). Elsevier Health Sciences. ISBN 0-7506-
4618-7.
"Hip Region" (http://www.medilexicon.com/medicaldictionary.php?t=77165). MediLexicon.
Palastanga, Nigel; Field, Derek; Soames, Roger (2006). Anatomy and human movement: structure and function
(https://books.google.com/books?id=rRtPExr9Hz8C&pg=PA353) (5th ed.). Elsevier Health Sciences. ISBN 0-
7506-8814-9.
Platzer, Werner (2004). Color Atlas of Human Anatomy, Vol. 1: Locomotor System (5th ed.). Thieme. ISBN 3-13-
533305-1.
Thieme Atlas of Anatomy: General Anatomy and Musculoskeletal System. Thieme. 2006. ISBN 978-1-58890-
419-5.

External links
Hip Preservation Awareness, information and support for hip impingement, hip dysplasia, and related issues in
young adults (12-adult) (http://hippreservation.org/)
Hip anatomy video (http://www.hipsknees.info/flash/HTML-HIPS/demo.html)
High-performance hips (http://machinedesign.com/ContentItem/60950/Highperformancehips.aspx)
Hip Pain ICD10 (http://www.fixedbrain.com/icd-10/hip-pain-icd-10/)
Right Ankle Pain ICD10 (http://www.fixedbrain.com/icd-10/right-ankle-pain-icd-10/)
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