HIP JOINT

…..sendi paling
besar
 Hip joint adalah sambungan tulang yang terletak
diantara pinggul dan pangkal tulang paha atas.
 ARTICULATION
 Hemispherical
head of Femur
 Cup-shaped
acetabulum of
the hip bone
 Articular
surfaces covered
with hyaline
cartilage
 Head of Femur
 Globular, more than a
hemisphere
 Directed upward, medially,
and a little forward
 Surface is smooth, covered
with hyaline cartilage,
except over an ovoid
depression, the fovea capitis
femoris, which is situated a
little below and behind the
center of the head
 The fovea gives attachment
to the ligament of the
head of femur
 ACETABULUM
Horse- Deepened by
shoe fibro-
shaped cartilaginous
articular rim called
surface acetabular
labrum

Deficient inferiorly
as the acetabular
notch that is filled
Nonarticular part, up by transverse
acetabular fossa, acetabular
lodges pad of fat ligament
 CAPSULE
 Encloses the joint
 Attachment:
• Medially: Acetabular labrum
• Laterally:
• Anteriorly: to the
intertrochanteric line.
Some fibers reflect
upward along the neck,
form ‘retinacula’ (carry
blood vessels for head &
neck of femur)
• Posteriorly halfway along
the posterior aspect of
neck
 LIGAMENTS

 Iliofemoral

 Pubofemoral

 Ischiofemoral

 Transverse acetabular
 Ligament of head of femur
 Iliofemoral Ligament
o Strong, Y-shaped
o Attachment:
 Base to anterior
inferior iliac spine
 Two limbs to
upper & lower
ends of
intertrochanteric
line
Prevents over-extension
during standing
 Pubofemoral Ligament
o Triangular in
shape
o Attachment:
 Base to superior
ramus of pubis
 Apex to lower
part of inter-
trochanteric line

Limits extension & abduction

 Ischiofemoral Ligament
o Spiral in shape
o Attachment:
 Medially to the
body of the
ischium near
acetabulum
 Laterally to the
greater
trochanter

Limits extension
 Transverse Acetabular Ligament
o Formed by
acetabular
labrum
o Bridges
acetabular notch,
converting it into
tunnel through
which vessels
and nerves enter
the joint
 Ligament of Head of Femur
o Flat & triangular
o Attachment:
 Apex to the pit
(fovea) on the head
of femur
 Base to transverse
ligament & the
margin of
acetabulum
o Intracapsular,
ensheathed by
synovial membrane
Carries articular branch of
obturator artery to the joint
 SYNOVIAL MEMBRANE
 Lines the capsule
 Attached to
margins of
articular surfaces
 Covers
intracapsular part
of the neck of
femur
 Ensheaths
ligament of head
of femur
 Covers pad of fat
in acetabular fossa
 Protrudes
anteriorly
through gap
between
pubofemoral &
iliofemoral
ligaments and
forms psoas
bursa
 RELATIONS
Anterior

Iliopsoas
Inferior
Pectineus

Rectus
femoris

Obturator
externus
 Posterior Superior
Sciatic
nerve Gluteus
minimus
Obturator
internus Piriformis

Superior
& inferior
Gemelli
Quadratus
femoris
 BLOOD SUPPLY
 Head & intra-capsular
part of neck receives
its blood supply from
trochanteric
anastomosis, mainly
from branches of
medial circumflex
artery
 A branch from
obturator artery in the
ligament of head of
femur is importanat in
young child
 NERVE SUPPLY
Apply Hilton’s law
• Femoral
The nerve • Obturator
supplying a joint • Sciatic
also supplies both • Nerve to quadratus
the: femoris
 Muscles that move These nerves also
the joint & supply knee joint &
 Skin covering the therefore pain arising
articular insertion in the hip joint may
(area of action) of be referred to the
those muscles knee
 STRENGTH & STABILITY

Depends largely on the:

 Shape of the bones

 Ligaments
 MOVEMENTS
 Wide range (less than shoulder joint)
 Some movements sacrificed in order
to provide strength & stability
 Movements are:

 Flexion/Extension
 Abduction/Adduction
 Lateral/Medial rotation
 Circumduction
 FLEXION
 Flexors:
 Iliopsoas
 Rectus femoris
 Sartorius
 Adductor muscles

Limitation: with the knee flexed: Anterior

surface of thigh coming in contact with the
anterior abdominal wall
with the knee extended: Tension of
hamstring group of muscles
 EXTENSION
 Extensors:

 Gluteus
maximus
 Hamstring
muscles

Limitation: Tension of
iliofemoral, pubofemoral
& ischiofemoral ligaments
 ABDUCTION
 Abductors:

 Gluteus
medius &
minimus
 Piriformis
 Sartorius
 Tensor fascia
lata
Limitation: Tension of
pubofemoral ligament
 ADDUCTION
 Adductors:

 Adductors
(longus, brevis &
adductor part of
magnus)
 Pectineus

 Gracilis

Limitation: Contact with the

opposite limb & by tension
in ligament of head of femur
 LATERAL ROTATION
 Lateral Rotators:
 Piriformis
 Obturator internus
& externus
 Gemilli
 Quadratus femoris
 Gluteus maximus

Limitation: tension in
iliofemoral & pubofemoral
ligaments
 MEDIAL ROTATION
 Medial Rotators:
 Anterior fibers of
gluteus medius
& minimus
 Tensor fascia
lata.

Limitation: tension of
ischiofemoral ligament.
CLINICAL ANATOMY
Referred Pain From the Hip Joint
 The pain originating in the hip joint
to be referred to the front and
medial side of the thigh (femoral
nerve)
 The hip joint disease may give rise
to pain in the knee joint (posterior
division of the obturator nerve
supplies both the hip and knee
joints)
 Congenital Dislocation
 Affects 1-2 babies in every
1000
 Associated with a shallow
acetabulum and an altered
angle of the femoral head
 May be bilateral
 Females affected more
than males
 May be caused by
mechanical factors i.e.
malformed uterus
 The affected limb is
shorter than the normal
limb
• Capsule is loose
• Upper lip of
acetabulum is not
developed properly
(hypoplasia).
• Head of femur moves
up out of acetabulum
and lies against the
gluteal surface of
ilium.
• Characteristic clinical
sign is the inability to
abduct the hip
 Traumatic Dislocation
 Rare, because of the
strength of joint
 Occurs when joint is
flexed & abducted.

This can occur in a car

crash where the knee
is pushed backwards,
often breaking off the
posterior rim of the
acetabulum
• The head of femur is
displaced posteriorly and
rests on the gluteal surface
of ilium (posterior
dislocation).
• Sciatic nerve is prone to
get injured.
• Lower limb is flexed,
adducted & medially
rotated and is shorter than
the normal limb
• Positive Trendelenburg’s
sign
• ‘Dipping’ (unilateral
dislocation) or ‘waddling’
(bilateral dislocation) gait
 Osteoarthritis
 Most common disease
of hip joint in the adults
 Results in:
Pain
Stiffness (due to pain
and reflex spasm of
muscles)
Deformity i.e. flexion,
adduction & external
rotation (due to
muscle spasm & later
on muscle
contractures)
 Arthritis of the Hip Joint
 A patient with an inflamed hip joint
will place the femur in the position
that gives minimum discomfort (the
position in which the joint cavity
has the greatest capacity to contain
the increased amount of synovial
fluid secreted).
 The hip joint is partially flexed,
abducted, and externally rotated
Tenderness over the head of the femur (on the
anterior aspect of the thigh just inferior to the inguinal
ligament and just lateral to the pulsating femoral
artery) usually indicates the presence of arthritis of
the hip joint.
Thank You & Good Luck