MOB TCD

Hip Joint
Professor Emeritus Moira OBrien
FRCPI, FFSEM, FFSEM (U!, FTCD
Trinit" Co##e$e
Du%#in
Hip Joint
&
S"no'ia# %a## an( so)*et
+oint
&
Mu#tia,ia#
&
T-ree (e$rees of free(om
&
Mo'ement in t-ree p#anes
&
C#ose pa)* e,tension an(
me(ia# rotation
&
.east pa)* semif#e,ion
MOB TCD
&
One of most sta%#e +oints in
t-e %o("
&
/rti)u#ar surfa)e of -ip +oint
are re)ipro)a##" )ur'e(
&
Superior surfa)e of femur an(
a)eta%u#um sustain $reatest
pressure
Hip Joint
MOB TCD
/)eta%u#um
&
01s-ape( epip-"sea# )arti#a$e
&
Start to ossif" at 23 "ears
&
Fuse 24125 "ears
&
/)eta%u#ar not)- is inferior
&
6onarti)u#ar fossa, t-in re#ate(
me(ia##" to o%turator internus
&
Pa( of fat, proprio)epti'e ner'es
MOB TCD
/rti)u#ar Surfa)e of Hip Joint
&
Semi#unar arti)u#ar surfa)e
)o'ere( 7it- -"a#ine
)arti#a$e
&
Deepene( %" a)eta%u#ar
#a%rum
&
8e($e s-ape( fi%ro)arti#a$e
MOB TCD
&
Hea( of femur 39:
r(
of sp-ere
&
Pit for #i$amentum teres
&
Co'ere( 7it- arti)u#ar )arti#a$e
&
Carti#a$e t-i)*er posterior superior
&
Epip-"sea# #ine for -ea(
intra)apsu#ar
/rti)u#ar Surfa)e
MOB TCD
Femur
&
Tra%e)u#ae (e'e#op a#on$ #ines
of stress
&
Ca#)ar femora#e is t-e )orti)a#
%one on inferior aspe)t of ne)*
&
6e)* is )an)e##ous %one
MOB TCD
Capsu#e of Hip
&
Pro,ima##" atta)-e(
&
Mar$ins of t-e a)eta%u#ar
fossa
&
Base of #a%rum
&
Dista##", anterior to t-e
intertro)-anteri) #ine
&
Inferior#", femora# ne)* )#ose
to #esser tro)-anter
MOB TCD
&
Posterior
&
Free %or(er, fin$ers %reat-
from tro)-anteri) )rest (ue
to insertion of o%turator
e,ternus
&
Into tro)-anteri) fossa an(
&
Root $reater tro)-anter
Capsu#e of Hip
MOB TCD
&
Stron$est superior#"
&
/nterome(ia##", (eep fi%res
ref#e)te( -ea( of re)tus
femoris
&
I#iopsoas is anterior
&
.atera# (eep fi%res of $#uteus
minimus
Capsu#e of Hip
MOB TCD
Retina)u#ar Fi%res
&
Fi%res of )apsu#e ref#e)te( a#on$
ne)* to arti)u#ar mar$in )a##e(
retina)u#ar fi%res
&
B#oo( supp#" to -ea( run un(er
retina)u#ar fi%res
MOB TCD
.i$aments of Hip
&
/)eta%u#ar #a%rum
&
Trans'erse #i$ament
&
.i$ament of -ea(
&
I#iofemora# #i$ament
&
Pu%ofemora# #i$aments
&
Is)-iofemora# #i$aments
&
;ona or%i)u#aris
MOB TCD
&
Trans'erse #i$ament is part of
t-e #a%rum
&
.i$amentum teres is
trian$u#ar, its %ase is atta)-e(
to trans'erse #i$ament, an(
t-e ape, to t-e pit on t-e
-ea( of femur
&
B#oo( supp#" to epip-"sis
from o%turator arter"
&
On#" supp#ies a f#a*e of %one
in e#(er#"
.i$aments of Hip
MOB TCD
I#iofemora# .i$ament
&
T-i)*enin$ of )apsu#e
&
.o7er -a#f of anterior
inferior i#ia) spine an(
a(+oinin$ a)eta%u#um
&
Dista##"
&
Upper an( #o7er parts of
inter tro)-anteri) #ine
MOB TCD
&
One of stron$est
#i$aments in %o("
&
Ti$-tens in e,tension
&
He#ps maintain ere)t
posture
&
Fa)et on anterior aspe)t
of ne)*
&
Pre'ents -"pere,tension
&
Fu#)rum re(u)in$ -ip
I#iofemora# .i$ament
MOB TCD
Pu%ofemora# .i$ament
&
Superior pu%i) ramus
&
Inferior part of inter
tro)-anteri) #ine an( upturne(
part
&
Re#ati'e#" 7ea*
&
Pre'ents a%(u)tion
&
Bursa %et7een it an(
i#iofemora#
MOB TCD
Is)-iofemora# .i$ament
&
Is)-ium to posterior part of
+oint (7ea*!
&
Cir)u#ar fi%res )a##e( <ona
or%i)u#aris
&
Centre of $ra'it" in front of
-ea(
&
S"no'ia# un(er o%turator
e,ternus

MOB TCD
S"no'ia# Mem%rane
&
.ines inner portion of )apsu#e
an( non arti)u#ar stru)tures
&
.i$ament of -ea(
&
Fat in a)eta%u#ar fossa
&
Ma" )ommuni)ate 7it- psoas
%ursa
&
Bursa un(er o%turator
e,ternus
MOB TCD
Bursa Un(er =#uteus Ma,imus
&
Tro)-anteri) %ursa
&
Postero#atera# aspe)t of
$reater tro)-anter
$#uteofemora#
&
>astus #atera#is is)-ia# %ursa
&
Is)-ia# tu%erosit"
MOB TCD
B#oo( Supp#" to Hea( of Femur
&
C-i#(, o%turator arter" 'ia
#i$amentum teres supp#ies
epip-"sis
&
E#(er#", main supp#" 'ia
retina)u#ar 'esse#s from
tro)-anteri) an( )ru)iate
anastamoses
&
Me(ia# an( #atera# )ir)umf#e,
femora# 'esse#s
MOB TCD
B#oo( Supp#"
&
Superior $#utea# supp#ies t-e upper
part of t-e a)eta%u#um
&
Inferior $#utea# supp#ies t-e inferior
an( posterior an( t-e )apsu#e
&
Trans'erse an( as)en(in$
%ran)-es of #atera# )ir)umf#e,
femora# arter"
&
Trans'erse an( as)en(in$ %ran)-
of me(ia# )ir)umf#e, femora#
&
Cru)iate an( tro)-anteri)
anastomosis
MOB TCD
&
Fra)tures of ne)* ma" )ause
a'as)u#ar ne)rosis, e,tra
)apsu#ar arteries enter t-e
tro)-anter at t-e %ase of ne)*
&
Me(ia# an( #atera# )ir)umf#e,
femora# 'esse#s an( superior
$#utea#
B#oo( Supp#"
MOB TCD
&
Femora# ner'e
&
O%turator ner'e
&
Superior $#utea# ner'e
&
6er'e to ?ua(ratus femoris
&
Posterior (is#o)ation ma"
(ama$e s)iati)
&
Pain in -ip referre( to *nee
6er'e Supp#"
MOB TCD
/nterior Re#ations
&
Re)tus femoris
&
/((u)tor #on$us
&
Pe)tineus
&
Psoas an( i#ia)us
&
Femora# s-eat-
&
Femora# ner'e
MOB TCD
Inferior an( Posterior Re#ations
&
O%turator e,ternus
&
Passes inferior an( t-en posterior
to +oint
&
Superior $#utea# ner'e
&
Inferior $#utea# ner'e
&
S)iati) ner'e
&
Posterior )utaneous ner'e t-i$-
&
6er'es to o%turator internus an(
?ua(ratus femoris
&
Pu(en(a# ner'e
MOB TCD
.atera# Re#ations
&
=#uteus minimus
&
=#uteus me(ius
&
Superior $#utea# 'esse#s an(
ner'es %et7een
&
I#ioti%ia# tra)t
&
Superfi)ia# t-ree ?uarters of
$#uteus ma,imus
MOB TCD
Posterior Re#ations
&
Piriformis
&
Superior $eme##us
&
O%turator internus
&
Inferior $eme##us
&
@ua(ratus femoris
&
/((u)tor ma$nus
&
O%turator e,ternus
&
=#uteus ma,imus
MOB TCD
Mo'ementsA F#e,ion
&
.imite( %" anterior a%(omina#
7a##
&
Psoas
&
I#ia)us
&
Pe)tineus
&
/((u)tor #on$us an( %re'is
&
Re)tus femoris
MOB TCD
Mo'ementsA E,tension
&
Hamstrin$s first 2BC
& .on$ -ea( of %i)eps
& Semiten(inosus
& Semimem%ranosus
&
23:, e,ten(e( *nee DD
&
/((u)tor ma$nus
&
=#uteus ma,imus most effi)ient 7-en -ip is
f#e,e( EFC
MOB TCD
&
O%turator ner'e
&
/((u)tor #on$us
&
/((u)tor %re'is
&
/((u)tor ma$nus
&
Can f#e, or e,ten( (epen(in$
on position of -ip
Mo'ementsA /((u)tion
MOB TCD
&
=#uteus me(ius
&
=#uteus minimus
&
Stan(in$ on #e$, $#uteus me(ius an(
minimus a%(u)tion
&
B" pre'entin$ a((u)tion
Mo'ementsA /%(u)tion
MOB TCD
&
I#iopsoas
&
/((u)tors
&
/nterior fi%res of $#uteus me(ius
Mo'ementsA Me(ia# Rotation
MOB TCD
&
O%turator internus
&
Piriformis
&
Superior $emme#us
&
O%turator Internus
&
Inferior $emme#us
&
@ua(ratus femoris
Mo'ementsA .atera# Rotation
MOB TCD
Tren(e#en%ur$ Tests
MOB TCD
Fra)ture( 6e)* of Femur
MOB TCD
Hip Pro%#ems in C-i#(ren
&
/pop-"sitis
&
/'u#sion fra)tures
&
/fter 2: "ears
&
221EBG of a## -ip an( pe#'i) fra)tures
Bo"( et a#H, 2II5
&
/nterior superior i#ia) spine
&
/nterior inferior i#ia) spine
&
Is)-ia# tu%erosit" )ommonest
MOB TCD
Hip Pro%#ems
MOB TCD
Pain in a C-i#(
&
F12B "ear o#( )-i#(
&
/)-in$ pain in -ip
&
.imp
&
.imitation of mo'ement
&
Pert-es
&
Osteo)-on(ritis of -ea( of femur
MOB TCD
Sta%i#it" of Hip
&
One of t-e most sta%#e
+oints
&
Con$enita# (is#o)ations is
)ommon
&
2HF per 2BBB #i'e %irt-s
&
Fema#e A ma#e J KA2
&
U#trasoun( %est met-o( of
(ete)tin$
MOB TCD
Femora# /nte'ersion
& Femora# 'ersion is t-e an$u#ar (ifferen)e %et7een a,is of femora#
ne)* an( trans)on("#ar a,is of t-e *nee
& Femora# ante'ersion ran$es from :B L 1 EB L at %irt-
& De)reases pro$ressi'e#" 2F L at s*e#eta# maturation
& /(u#ts
& /nte'ersion
& /'era$e of K L in men an( 2EL in 7omen
& Most )ommon )ause of in1toein$
& If asso)iate( 7it- interna# ti%ia# torsion, ma" #ea( to pate##ofemora#
su%#u,ation (ue to an in)rease in t-e
@1an$#e
MOB TCD
Tumors an( 6eop#asms
& 0oun$, -ea#t-" at-#etes (o $et )an)erM
& Fortunate#" most tumors are %eni$nM
& Bone pain at ni$-t
& Tumor ti## pro'e( ot-er7ise
RenstrNm, 3BBK
MOB TCD
Hip Joint .a%ra# Tear
& C-roni)
& Se)on(ar" to a)eta%u#ar
("sp#asia
& Part of Orim #esionP )omp#e,
RenstrNm, 3BBK
MOB TCD
.a%rum Tears an( Carti#a$e .oss
.a%rum Tears an( Carti#a$e .oss
&
.a%rum tears an( )arti#a$e #oss are
)ommon in patients 7it- me)-ani)a#
s"mptoms in t-e -ip
&
In "oun$, a)ti'e patients 7it- a
)omp#aint of $roin pain
&
T-e (ia$nosis of a #a%rum tear
s-ou#( %e suspe)te( an(
in'esti$ate( as ra(io$rap-s an( t-e
-istor" ma" %e nonspe)ifi) for t-is
(ia$nosis
Burnett et a#H, J Bone Joint Sur$ (/m!, 3BB4
MOB TCD
MR1/rt-ro$rap-" (MR/!
& MR art-ro$ram -as an
a))ura)" of I2G for #a%ra#
tears
C-an et a#, /rt-ros)op" 3BBF
& Sensiti'it" #a%ra# tear
& MR 3FG,
& MR/ I3G
Tooma"an et a#H, /m J Roent$eno# 3BB4
MOB TCD
Pin)er Impin$ement
& T-e a)eta%u#um )o'ers too mu)- of t-e
femora# -ea(
& Se)on(ar" to Oretro'ersionP, of t-e
so)*et
& Or a Oprofun(aP so)*et t-at is too (eep
& Most of t-e time t-e )am an( pin)er
forms e,ist to$et-er
& Fema#e, :B1EB "ears
RenstrNm, 3BBK
MOB TCD
& .oss of roun(ness )ontri%utes to
a%norma# )onta)t %et7een t-e -ea( an(
so)*et
& Ma#e, 3B1:B "ears
RenstrNm, 3BBK
Cam Impin$ement
MOB TCD
P Renstrom BK
Cam Impin$ement
MOB TCD
OBMJ Pu%#is-in$ =roup .imite( (OBMJ =roupP! 3B23H /## ri$-ts reser'e(HP