Transcript Hip joint

Hip joint
Lecture 2
The thigh bone is femur.
It is long bone, which participates
in formation of two joints: the hip
and knee.
Proximal end has:
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Head with the fovea capitis
Neck,
Greater trochanter,
Lesser trochanter.
Connecting the two trochanters are
the intertrochanteric line anteriorly,
where the iliofemoral ligament is attached.
a prominent intertrochanteric crest
posteriorly, on which is the quadrate
tubercle.
The femur
On the posterior surface of the shaft
below the greater trochanter is the
gluteal tuberosity for the attachment
of the gluteus maximus muscle.
gluteal tuberosity
The shaft of the femur is smooth
and rounded on its anterior surface but
posteriorly has a ridge, the linea
aspera, to which are attached muscles
and intermuscular septa.
 The medial supracondylar ridge
(to the medial epicondyle).
The lateral supracondylar ridge
(to the lateral epicondyle).
The femur
Hip joint
Articular surfaces: the head of
the femur and the acetabulum of
the pelvic bone.
Kind of joint: synovial ball and
socket joint.
Movements:
 Flexion-extension,
 Abduction-adduction,
 Medial-lateral rotation,
 Circumduction.
The acetabulum almost entirely
encompasses the head of the femur
and contributes to joint stability.
The nonarticular acetabular
fossa provides attachment for the
ligament of the femoral head.
The lunate surface is covered
by hyaline cartilage.
Except for the fovea, the head of
the femur is also covered by hyaline
cartilage.
Hip joint
The rim of the acetabulum is raised slightly by a fibrocartilaginous collar
(the acetabular labrum).
Inferiorly, the labrum bridges across the acetabular notch as the
transverse acetabular ligament and converts the notch into a foramen.
The ligament of the head of the
femur is a flat band of delicate
connective tissue that attaches at one
end to the fovea on the head of the
femur ,
and at the other end to the acetabular
fossa, transverse acetabular ligament,
and margins of the acetabular notch.
It carries a small branch of the
obturator artery, which contributes to
the blood supply of the head of the
femur.
The synovial membrane
attaches to the margins of the
articular surfaces of the femur and
acetabulum, forms a tubular
covering around the ligament of the
head of the femur,
lines the fibrous membrane of
the joint.
From its attachment to the
margin of the head of the femur, the
synovial membrane covers the neck
of the femur .
The fibrous membrane that
encloses the hip joint is strong and
generally thick.
Medially, it is attached to:
-margin of the acetabulum,
- the transverse acetabular ligament, the adjacent margin of the obturator
foramen.
Laterally, it is attached to:
-intertrochanteric line
- the neck of the femur just proximal to
the inter-trochanteric crest on the
posterior surface.
Three ligaments reinforce the external surface of the fibrous membrane and
stabilize the joint:
 Iliofemoral (anterior to the hip joint),
 Pubofemoral (anteroinferior to the hip joint ),
 Ischiofemoral (reinforces the posterior aspect of the fibrous membrane ).
Hip joint
It is common in older patients
with osteoporosis.
In majority of cases, the cause of
fracture neck of femur is falls.
Major trauma in young adult like
road traffic accidents, falls etc.
Patient presents to the doctor
with pain and restricted movement
of affected hip joint.
There is minimal shortening of
limbs.
The goal of treatment is to
obtain the fixation of the fractured
fragment and restore the normal
functioning of the bone joint.
Femoral neck fracture
The fracture is not treated
conservatively.
conservative treatment: doesn't
include any operation or
intervention.
if the patient is in the 65+ age
category, the best option is to go
for a total hip replacement
procedure.
Femoral neck fracture
Developmental dysplasia of the hip (DDH) is a dislocation of
the hip joint that is present at birth.
The condition is found in babies or young children.
One or both hips may be involved.
The cause is unknown –idiopathic - .
Low levels of amniotic fluid in the womb during pregnancy and
immaturity can increase baby's risk of DDH.
Other risk factors include:
 Being the first child
 Being female
 Breech position during pregnancy,
in which the baby's bottom is down
 Family history of the disorder
The goal of treatment is to
keep the femoral head in good
contact with the acetabulum.
The hip should be :
- flexed to 95 degrees
- abducted (apart) at least 90
degrees.
This position keeps the femoral
head in the best position and
allows the ligaments and joint
capsule to tighten up.
Treatment of the DDH
The neck of the femur is
inclined at an angle with the shaft;
the angle is about 160° in the
young child and about 125° in the
adult.
An increase in this angle is
referred to as coxa valga.
In this condition, adduction of the
hip joint is limited.
A decrease in this angle is
referred to as coxa vara.
In this condition, abduction of the
hip joint is limited.
Coxa Valga and Coxa Vara
Coxa vara
Coxa valga
X-ray examination of the hip