The Hip joint-

basic concept

Prof . Hironmoy Roy

 How we will describe a joint?

• Who makes it?

• What is the type of joint?
• Who stabilizes it?
• What are the movements?
• Who moves it?
• What are the blood supply & nerve supply?
• Applied
Who makes it?

• Acetabulum
• Head of Femur
 What is the type of joint?

Structurally-
• Synovial
• Simple
• Ball & socket variety

Functionally-
• Polyaxial
 The synovial membrane

Lines the
• inner surface of fibrous
capsule,
• both surfaces of
acetabular labrum
• intracapsular part of
neck of femur
• ........
 The synovial membrane

• Lines the
lig.teres.femoris by
wrapping conically

• Ceases at the
periphery of the
articular cartilage
50% of the body weight is
transmitted through a hip
joint
The weight transmission line
The weight transmission line
 Who stabilises it ?

• It’s labrum of socket

• It’s capsule
• It’s ligaments
• Supporting muscles
 (1) The Labrum

• The acetabular
margin gives
attachment to fibro-
cartilaginous rim, the
acetabular labrum

• It deepens the socket

• It covers the head

beyond its equator
 (2) The capsule/ capsular ligament

• Surrounds overall
• Fibres are spirally
arranged
• Modified in some
places....
 Modification 1- Retinacular fibres

• Reflected fibres from capsule, which drags the blood

vessels from trochanter to the head of femur.
 Modification 2 - Zona orbicularis

• Circularly arranged
deep fibres of
capsule, producing
hour-glass
constriction around
the neck
 Modification 3 –

it is weakest infero-medially
so, hyper abduction may leads to dislocation
(3) ligaments- the main ‘three’s
(3) ligaments- the main ‘three’s
(3) ligaments- the main ‘three’s
(3) ligaments- others
(3) ligaments- others
(3) ligaments- others

It carries blood vessel

to femoral head. Not
helps in stability
directly.
Ilio-psoas
Rectus femoris & Gluteus maximus
Sartorius
Pectineus (lateral Hamstrigs
fibres)*
seating to standing....

Hip extension by gluteus maximus

 Gluteus Adductor....longus/
medius/minimus brevis/ magnus
Tensor fascia lata Gracilis
Pectineus (medial
Sartorius
fibres)*
Gluteus maximus All Abductors
& muscles under Gl. Medius/ minimus
its cover Tensor fascia lata
The psoas major & axis of rotation
• Psoas major is inserted lateral to the axis of
rotation
So,
When,
• Foot on the ground- medial rotator (m-n)
• Foot off the ground- lateral rotator
The pectineus

Lateral part
Extensor
Femoral nerve

Medial part
Adductor
Obturator nerve
• Enumerate the ligaments of hip joint
• Describe the synovial membrane of hip joint
• What are the stability factors of the hip joint
• Enumerate the movements of hip joint & the movers
• Why Pectineus is a hybrid muscle?
• What is the action of psoas major on hip joint?
(1) The neck of femur
1.A. Blood supply & applied
 Lateral
epiphyseal Medial
artery epiphyseal
(0 to adult life) artery
(after 7th yr)

Metaphyseal
artery
For neck:
0 to adult life
For head:
(0 to 3rd yr)
So the top of the globe.....

• The blood supply of the head of the femur

depends on
1. Metaphyseal artery
2. Medial & Lateral epiphyseal artery
• With the maturation of growth disc by 3 yrs, the
metaphyseal artery feeding to the head of femur
(HOF) gets cut off.
• Lateral epihyphyseal artery supplies the HOF from
birth
• The medial epiphyseal artery doesnot develop
before 7 yrs
• So between 3 to 7 years- a vulnerable period,
when femoral head is nourished only by lateral
epiphyseal artery
 Artery
feeding the Birth 3 to 7 yrs After 7 yrs
head of to 3 yrs
femur
Metaphyseal PRESENT
artery

Lateral
epiphyphyseal PRESENT PRESENT PRESENT
artery

Medial
epiphyphyseal PRESENT
artery
 Leg calve Perthe’s disease
• a childhood condition
when blood supply to
femoral head is
temporarily interrupted
and the bone begins to
die.
• This weakened bone
gradually breaks apart
and can lose its round
shape.
• Typically seen 3 to 7 yrs
age
1.B. Neck shaft angle & fracture
120- 135 degree
 Valgus deformity Varus deformity distal
distal to hip (coxae) to hip (coxae)
Increased NSA decreased NSA
The Shenton’s line
 Sub
capital

Basi
cervical
Inter
trochanteric

Sub
trochanteric
Hip replacement
(2) The ‘abductor mechanism’
of hip &
the Trendelenburg sign
A lever of first order
A lever of first order
 The ‘Trendelenburg sign’

Not get confused with ‘Trendelenburg test’,

which is done for the perforator weakness of leg
The + ve ‘Trendelenburg sign’
represents

Damaged abductor mechanism

Either, or, in club with...

•Superior gluteal nerve palsy
•Gluteus medius laceration
•Fracture neck of femur
(3) The dislocation of hip joint
Hip dislocation
Anterior (subpubic) dislocation
Posterior dislocation
• What does positive Trendelenburg sign represent?
• Short note- Abductor mechanism of hip
• Why Perthe’s disease commonly found in 3-7 yrs of
age group?
• Describe the blood supply of neck of femur.
• Why subcapital fracture of neck femur is more
dangerous than subtrochanteric fracture?
• What is Shenton’s line in a radiograph? What is its
importance
• Dislocation of hip & its mechanism of injury