BIOMECHANICS

OF HIP
Dr Siju K M
Anatomy
Ball and socket
synovial joint
Head of the
femur articulates
with the
acetabulum
Provides a high
degree of
STABILITY &
MOBILITY


JOINT SURFACES
HEAD : >1/2 of sphere
Covered by hyaline articular cartilage
ACETABULUM : Lunate articular
surface covered by articular cartilage
latin : vinegar cup
SOURCIL :the area of bone above the
socket which bears the maximum load of
the BW.. Entirely from the iliac bone

STABILITY & MOBILITY
Depth of acetabulum , narrowing of
mouth by acetabular labrum
Tension & strength of ligaments
Surrounding muscles
Length and obliquity of neck of femur
MOBILITY DUE TO THE LONG NECK
WHICH IS NARROWER THAN THE
DIAMETER OF THE HEAD


LIGAMENTS
FIBROUS CAPSULE
ILIO FEMORAL LIGAMENT
PUBOFEMORAL LIGAMENT
ISCHIOFEMORAL LIGAMENT
LIG OF HEAD OF FEMUR
ACETABULAR LABRUM
TRANSVERSE ACETABULAR
LIGAMENT

CAPSULE
PROX:
acetabular labrum
including the
transverse acetabular
lig
DIST :
intertrochanteric line
anteriorly
1 cm medial to
intertrochanteric crest
posteriorly
Synovial membrane
lines the capsule
Iliofemoral lig (Bieglow)
One of the strongest
ligaments of the body
Prevents trunk from
falling backwards in
standing posture
Inverted Y shaped
APEX: lower part of
AIIS
BASE :
Intertrochanteric line
as upper oblique and
lower vertical bands
Pubofemoral ligament
Support
inferomedially
Illiopubic
eminence,obtura
tor crest
&membrane to
anteroinf part of
capsule
Ischiofemoral ligament
Covers
posteriorly
Ischium to
acetabulum
Ligament of head of femur

Flat &triangular
Fovea capitis to
transverse acet lig &
acetabular notch
Transmit arteries to
the head of the
femur

Acetabular labrum
Fibrocartilaginous rim
attached to the
margins of the
acetabulum

Holds the head of
femur in position

Narrows the mouth of
acetabulum
Transverse ligament of
acetabulum
Part of the
acetabular labrum
which bridges the
acetabular notch
converting it to a
foramen which
transmits vessels
to the joint
The neck of Femur
Angulated in relation to the shaft in 2
planes : sagittal & coronal

Neck Shaft angle
Anteversion
Neck shaft angle
Angle between the
neck and the shaft
in sagittal plane
(viewed from the
front or back)

140 deg at birth
125-135 deg in
adult
Anteversion
Angle between the
neck and shaft in
the coronal plane
(viewed from
above)
Axis of the neck
and the
transcondylar axis

Anteverted 40 deg at birth
20 deg in adults(15-25)

Ante version : ER of the head of
femur in relation to the condyles
Retroversion : IR of the head of the
femur

Acetabular Direction
Similar rotational
differences may also
be found in the
acetabulum
Usually long axis of
the acetabulum points
forwards :
ANTEVERTED

The Acetabular axis is
more variable
ante version
retroversion
Flexion 120 degree


Extension 20 degree


Abduction 50 degree


Adduction 30 degree


ER/IR 45 degree

Chief muscle access ms
Flexion iliacus,psoas major pectenius,rectus
femoris,sartorius
Extension Gl maximus,hamstrings
Adduction Add longus.magnus,brevis pectinius,gracilis
Abduction Gl med,min TFL,sartorius
IR TFL,ant fibres of
gl med,min
ER 2 obturators,gamelli, piriformis,glmaximus,sartorius
quadratus femoris
BIOMECHANICS
Center of mass
The center of mass is the unique point at
the center of a distribution of mass in
space that has the property that the
weighted position vectors relative to this
point sum to zero.
Center of mass is the mean location of a
distribution of mass in space.

Center of gravity
Center of gravity is the point in a body
around which the resultant torque due to
gravity forces vanish.
Subject standing on both
legs
Little or no
muscular forces
req to maintain
equilibrium

If support is
symmetrical each
hip carries abt
31% of the BW
Trunk+UL 4/6 bwt
LL 2/6
Each hip 1/3
Single leg stance 5/6
Subject standing on one
leg
Loaded hip supports the
mass of the head , trunk ,
UL and the other leg
CoG lies farther away
from the loaded hip
Lever arm of BW is 3
times the abductor lever
arm

Centre of gravity S5

BW vector K :
(BW-Wt of loading leg)
runs thru S5 ..
medial to the non wt
bearing hip

Muscle balance
vector M : Muscle
force to prevent
the left side of the
pelvis from falling
downward
Provided by the
abductors acting
laterally to the hip
jt
Compressive force R
Force acting on the hip Jt

Body Wt lever arm h

Muscular lever arm h

h=3h
in equilibrium

Kh=Mh
M=K (h/h)
Since h/h =3
M=3K
=3 times the body wt


Total force acting on the
Joint R = K + M
= K+3K
= 4K
4 times the body Wt

Total force acting on the joint when the
Subject stands on one leg is almost
Equal to 4 times the body Wt
Coxa vara
GT is higher than
normal
Lenghtens the
abductor lever arm
Changes the
direction of the
force M
Decrease in forceM
Larger wt bearing
surface
Resultant force R is less than
a normal hip
Coxa valga
GT is lower
Shortens the
abductor lever arm
Changes the
direction of the
force M
Increase in force M
Resultant force R is more than
a normal hip
Biomechanics in limping
PAIN
MUSCLE WEAKNESS
Pelvis tilts to the AFFECTED side
The body wt lever arm h is shorter
in a limping patient.
The abductor lever arm is unaltered

During the single
support phase of
gait the patient
displaces the trunk
to the affected side
bringing the CoG
nearer the affected
joint which
requires less
muscle force to
balance the BW

Body wt K can be counterbalanced by a smaller
muscular force and the resultant R is less
Biomechanics in limping
Limp is defined as any deviation from
the normal effortless gait
Clinically we come across 3 types of
limp
ANTALGIC
SHORT LIMB
TRENDELENBERG
May be present as single or in
combination

ANTALGIC GAIT
DECREASED STANCE PHASE
Bears wt on the affected side for as
short a period as possible
Allows the load to remain the normal
hip for a longer time
Attempts to protect the hip by tilting
towards the AFFECTED SIDE
SHORT LIMB GAIT
Equal amt of load bearing on either
side
NORMAL STANCE PHASE
Lurches towards the AFFECTED
SIDE

TRENDELENBERG GAIT
NORMAL HIP
DEPENDS ON

FULCRUM : hip jt
LEVER : Neck of
femur
POWER : abductors
TRENDELENBERG GAIT
STANDING ON NORMAL
LEG
The CoG falls towards the
opp hip.The pt tries to
maintain the equilibrium
by the power of the
abductors which pull the
origin to their insertion
thereby raising the opp
pelvis
TRENDELENBERG GAIT
STANDING ON
AFFECTED LIMB

Opposite pelvis
DIPS DOWN due to
the abnormal
abductor
mechanism of the
wt bearing hip
normal
affected
TRENDELENBERG GAIT
disorders causing the pelvis to sag on
the unsupported (opposite) side.
This creates an uncompensated
Trendelenberg gait and a positive
Trendelenberg sign.
If the upper body leans over the
affected (weak) hip, the pelvic sag is
compensated for and this is a so called
compensated Trendelenberg gait or
sign.
Causes
1) Suprapelvic.
Costopelvic impingement as in scoliosis
2) Pelvic.
This is due to loss of the fulcrum as
in developmental dysplasia of the hip; or
of the lever mechanism as in nonunion of
the femoral neck; or of power as in
poliomyelitis or muscular dystrophy.

3) Infrapelvic. This is caused by medial
deviation of the mechanical axis of the
lower limb.
GAIT CAUSES STANCE
PHASE
PELVIC
DIP
ANTALGIC Pain
anywhere
in the limb
DECREASED AFFECTED
SIDE
SHORT
LIMB
Shortening
of any
cause
NORMAL AFFECTED
SIDE

TRENDEL-
ENBERG
Abn in
fulcrum ,
lever,power
NORMAL NORMAL
SIDE
Walking stick
Use of a walking stick in the opposite
hand can reduce limping

It lessens the displacement of the
trunk to the affected side during the
single support period

Exert force C on the stick with a lever arm f
Forces C & K are vertical & opposite

The moment Cf tends to
Rotate the pelvis upward
While the moment Kh tends
To rotate the pelvis down
The resultant force F = K-C :
F acts with a lever arm s which is
smaller than h
The force K which normally rotates
the pelvis clockwise with a moment
Kh is replaced by F
Moment FS is smaller as
F<K and s<h
Stick and Limp
Both decrease the moment of force
exerted by the body wt on the
loaded hip
Stick :transmit part of the force to
the ground thereby decreasing the
muscular force req for balancing
Limping shortens the lever arm by
shifting the centre of gravity to the
loaded hip


p
Thank you