HIP: Anatomy

Bones: From the fusion of 3 bones ILIUM, ISCHIUM and PUBIS. At birth the 3 bones are joined by hyaline cartilage, at puberty they still separated by a Y shape triradiate cartilage (secondary ossification), they ossify btw 15 and 17 and are completely fused by 20 / 25. Lines are still visible in adults. The obturator foramen: It is bounded by a thin fibrous sheet; the obturator membrane. The membrane attaches post, ant and inf of the foramen leaving a canal superiorly; the obturator canal where the obturator artery, obturator vein and obturator nerve pass through. The hip joint: Axx btw head of femur and acetabulum. Acetabulum made of articular cartilage, except the lower lip which makes the acetabular notch. Both margins of the notch are bridged by the transverse ligament forming the acetabular foramen. The ligamentum teres has part of it's origin from the acetabular notch. The femur: Longest and heaviest bone in the body, and transmit weight from hip to tibia when standing. The head of the femur consist of articular cartilage and a fovea for the ligament teres, important in early life as the lig gives passage to an artery supplying the epithysis. Type of joint: Synovial ball and socket. Providing stability and mobility via the femoral head.

Angle of inclination of hip (dif stages):

In 3 year old: 145 degree (some text book mention 135). In adult: 126 degree. In old age: 120 degree.

Weight bearing line of femur: In a healthy leg, the line should lie along a straight line from the middle of the fem head through the middle of the knee jt to the middle of the calcaneus. Function: The main functions of the hip jt are.

Force transmition: Torque momentum from the UEx movements and LEx on locomotion, so require stability. Stability: Determined by the shape of the acetabulum and the articular surface. Strength: Determined by ligs and muscles. Locomotion: This require A/P and lat movements from the hip to allowed forward movement of the body and the side to side transmission of weight required by bipedal stance.

How is all this maintained? By a strong 3 layered capsule that unite the bones and constrict the head while protecting the blood vessels. On extension the ligs close packed the jt. Muscles, influencing hips orientation and power, act shock absorber and proprioception aid. On the other hand they might play a role in leg length. Blood supply which varied through life and important to understand in clinical setting. Bone (trabeculae) and how they respond to body weight and dissipate forces. Neurology: Propriocptive feedback from ligs, muscles, capsule, essential for hip activity/locomotion. Ligaments of the hip.

When standing, the 3 ligs are moderately tense and becomes relax on flexion, and they all become taut on extension with the inf band of the iliofemoral lig being under the greatest tension as it runs almost vertically. Ischiofemoral
Less defined than the others.

Iliofemoral
Strong triangular lig.

Pubofemoral

Function Becomes taut on medial rotation. Relax on add / taut on abd. Relax on lat rotation. Relax on medial rotation. Sup band taut on add, inf band slightly / relax on abd. Taut on lat rotation. Relax on medial rotation. Relax on add / taut on abd. Taut on lat rotation.

Attachment Body of ischium behind and below the acetabulum to sup part of the neck and greater trochanter. From lower AIIS and adjacent acetabular rim to the base of introchanteric line From iliopubic eminence and sup pubic ramus to lower part of intertrochanteric line

Inguinal lig: From pubic tubercle to ASIS. It forms the base of the inguinal canal through which an indirect inguinal hernia may develop. It is formed by the external abdominal oblique aponeurosis and is continuous with the fascia lata of the thigh. Superiorly it formed the femoral triangle. The fem artery / vein / nerve and deep inguinal lymph nodes pass underneath within the femoral sheath.

Bursa of the Hip.

Iliopsoas bursa: Largest in the body, lies in front and deep to the hip joint. Trochanteric bursa: Adjacent to femur, btw insertion of glud med / min into the greater trochanter of the femur and the femoral shaft. Sub glut med bursa: underneath glut med and located supraposteriorly of proximal edge of greater trochanter Ischiogluteal bursa: between the pelvic bone and hamstring tendon. Also presence of glut min and sub glut max bursa.

Muscles of the hip. Function Hip Flexors Names Psoas. TFL. Sartorius. Rec Fem. Gracilis. Pectineus. Adductor Long. Adductor Brevis. Biceps Fem. Long head. Biceps Fem. Short head. Add Magnus. Semmimembranosus. Semitendenosus. Nerve supply Ant Rami L1,2,3. Sup glut L5, S1. Fem L2,3. Fem L2,3,4. Obturator L2,3. Obturator L2,3. Obturator L2,3,4. Obturator L2,3,4. Tibial S1,2,3. Common Fibula L5, S1,2. Obturator L2,3,4 + Tibial L4. Tibial L5, S1,2. Tibial L5, S1,2.

Hip Extensors

Hip Adductors

Hip Abductors

Medial Rotators

Lateral Rotators

Gracilis. Pectineus. Adductor Long. Adductor Brevis. Adductor Magnus. Periformis. Obturator Internus. Glut Max. Glut Med. Glut Min. TFL. Sartorius. Glut Med. Glut Min. Gracilis. All Adductors. Periformis. Gemellus Inf. Obturator Int. Gemellus Sup. Obturator Ext. Quadratus Femoris. Glut Max.

Ventri Rami S1,2. From sacral plexus L5, S1. Inf Glut L5, S1, S2. Sup Glut L5, S1. Sup Glut L5, S1.

Branch of Quadratus Fem. Branch of Obturator L5, S1. Obturator L3, 4. Branch of Sacral Plexus L5, S1.