Hip joint capsule & ligaments:

Capsule:
• Strong & dense
• Substantial contributor for joint stability
• It is attached to the entire periphery of the
acetabulum
• It covers the femoral neck like a sleeve and
attaches to the base of the neck – femoral neck is
intracapsular whereas greater and lesser
trochanters are extracapsular
• It is thick anterosuperiorly where predominant
stresses occur while it is thin and loose
posteroinferiorly
Ligaments:
Ligamentum teres/ligament of head of femur
Doesn't play a significant role in stabilization
Functions primarily as a conduit for the
secondary blood supply from the
obturator artery and for the
nerves that travel along the
ligament to reach the head
through the fovea
• Hip joint capsule is reinforced by 3 ligaments
– 2 anteriorly and 1 posteriorly
Anterior:
• Ilio femoral ligament(Y lig.of Bigelow)
• Pubofemoral ligament
• Fibers of both these ligaments
form a Z on the anterior capsule
Posterior:
• Ischiofemoral ligament
• Hip joint capsule and ligaments are quite
strong
• Joint is difficult to traumatically dislocate
• In bilateral stance, hip is typically in neutral
position or slight extension – in this position
ligaments and capsule are under some tension
• LOG in bilateral stance falls behind the hip
joint axis, creating a gravitational extension
torque
Weight-bearing structure of Hip Joint:
• Internal architecture of pelvis and femur reveal
remarkable adaptations occurred to accommodate
mechanical stresses ‘n’ strains created by
transmission of forces between femur and pelvis
• Trabeculae of bone line up along lines of stress
and form systems to meet stress requirements
• Weight bearing occurs through vertebrae to the
sacral promontory and on through the sacroiliac
joints
• Weight bearing lines of both pelvis and femur are
evident by the arrangement of trabeculae
• Most of the weight bearing stresses in the
pelvis pass from the sacroiliac joints to the
acetabulum, although the trabeculae show
evidence of some forces along the pubic
ramus and along the ischial tuberosities
• The pelvic trabeculae that pass through
the acetabulum of the pelvis form two
major systems within the femur:
c) Medial trabecular system
d) Lateral trabecular system
• There are two minor accessory systems of
trabeculae
Trabecular system
• In bilateral static stance, weight of HAT is
distributed between left and right hip joints
with the force of at least half the
superimposed body weight, travelling down
the femoral head, while the ground reaction
force (GRF) travels up the shaft
• The distance between the super imposed
body weight on the head and the GRF up
the shaft creates a bending force at the
femoral neck
• The trabecular systems must resist this
bending force
Medial and lateral trabecular systems not
only contribute to the structure of head and
neck of femur but also help resist bending
stresses as the weight of HAT passes down
on the femoral head
Areas in which various trabecular systems
cross each other at right angles are areas
that offer greatest resistance to stress and
strain
An area in the femoral neck in which
trabeculae are relatively thin and do not
cross over is called as ‘Zone of weakness’
Zone of weakness:
Area where trabeculae don't cross at right
angels
Less reinforcement by trabeculae
More potential for injury
This zone is susceptible to bending forces and
can fracture when forces are excessive or when
tissues are no longer able to resist normal
forces
Functions of Hip Joint:
Arthrokinematics:
• Hip joint involves movement of a convex femoral
head within the concave acetabulum
• Head glides within the acetabulum in a direction
opposite to the motion of distal end of femur
• From a neutral position flexion and extension
occurs as almost pure “spin” of femoral head
around a coronal axis through the head and neck
of femur
• Head spins posteriorly in flexion and anteriorly in
extension
• However, flexion and extension from other
positions must include both “spinning” and
“gliding” of articular surfaces
• Motions of abduction/adduction and medial/
lateral rotation must include both spinning
and gliding of one surface over the other,but
again occur opposite to motion of distal end
of femur when femur is the moving segment
• Whenever hip joint is weight bearing
(femur is relatively fixed) and motion of hip
joint is produced by movement of pelvis on
femur
Osteokinematics:
Motion of femur at hip joint:
• ROM available at hip joint is most commonly
described by movement of femur
• ROM is influenced by whether it is performed
actively or passively and whether passive tension
in two joint muscles is encountered or avoided
• Following are the ranges of passive motion:
Flexion :90° with knee extended and 120°-135°
when knee is flexed & passive tension in
hamstrings is released
Extension :10°-30°, when hip extension is
combined with knee flexion, passive tension in
rectus femoris may limit the movement
 Abduction:45°-50° can be limited by
gracilis muscle
Adduction:20°-30° can be limited by TFL
and associated IT band
Medial rotation: 30-45°(hip in 90° flexion)
Lateral rotation: 45-60°
 Normal gait on level ground requires at
least the following ranges:
• 30° flexion
• 10° hyperextension
• 5° of abduction and adduction
• 5° of medial and lateral rotation
Motion of pelvis at hip joint:
When proximal segment of joint moves on
distal part, the motion is the same as if the
distal segment were the moving part
However, the direction of movement of the
lever reverses
For e.g. elbow flexion can be a movement of
distal forearm upwards or conversely a
rotation of proximal humerus downward
• At the hip joint, this reversal of motion of
lever is complicated by the horizontal
orientation and nonlever shape of pelvis
• Unlike at other joints there is a new set of
terms to identify joint motion when pelvis is
the moving segment
• Terms of pelvic motion are used with weight-
bearing hip motion because these are the
motions that are visible
• These motions are also key to what occurs at
above or below joints of pelvis
Anterior and Posterior Pelvic Tilt:
• Are motions of pelvis in saggital plane
around a coronal axis
• In a normally aligned pelvis the ASIS lie on
a horizontal line with PSIS and on a vertical
line with symphysis pubis
• Anterior and posterior tilting
of the pelvis on a
fixed femur produces
hip flexion & extension
respectively
Posterior tilting:
• Posterior tilting of the pelvis moves
symphysis pubis superiorly and the lumbar
spine flexes slightly, hip joint extends
• Hip extension via posterior tilting brings
symphysis pubis up and posterior part of the
pelvis closer to the femur rather than
moving femur posteriorly
Anterior tilting:
• Anterior tilting of pelvis moves symphysis
pubis inferiorly and lumbar spine is hyper
extended ,hip joint is flexed
• Hip flexion through anterior tilting of the
pelvis brings ASIS anterior and inferiorly,
symphysis pubis moves down and closer to
the femur
• Anterior and posterior tilting can result in
flexion and extension of both hip joints
simultaneously or can occur at a stance hip
joint if the opposite limb is non weight
bearing
Lateral Pelvic tilt:
Occurs in a frontal lane and around A-P axis
In a normally aligned pelvis line passing
through both the ASIS is horizontal
If this line is not horizontal lateral tilt has
occurred
This can occur in unilateral or bilateral stance
• In lateral tilt of pelvis in unilateral stance,
one hip joint is the pivot point or axis of
motion of the opposite side of the pelvis as
it elevates(hiking) or drops(pelvic drops)
Pelvic Rotation:
• Rotation of entire pelvis in a transverse lane
around a vertical axis
• Forward rotation of pelvis occurs when the
side of the pelvis opposite to the supporting
hip joint moves anteriorly.This produces
medial rotation of the supporting hip joint
• Backward rotation of the pelvis occurs
when the side of pelvis opposite the
supporting limb moves posteriorly.This
produces lateral rotation of supporting hip
joint