Anatomy of Hip joint
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Anatomy of Hip joint
- 2. MOB TCD Hip Joint Professor Emeritus Moira OâBrien FRCPI, FFSEM, FFSEM (UK), FTCD Trinity College Dublin
- 3. MOB TCD Hip Joint ⢠Synovial ball and socket joint ⢠Multiaxial ⢠Three degrees of freedom ⢠Movement in three planes ⢠Close pack extension and medial rotation ⢠Least pack semiflexion
- 4. MOB TCD Hip Joint ⢠One of most stable joints in the body ⢠Articular surface of hip joint are reciprocally curved ⢠Superior surface of femur and acetabulum sustain greatest pressure
- 5. MOB TCD Acetabulum ⢠⢠⢠⢠⢠Y-shaped epiphyseal cartilage Start to ossify at 12 years Fuse 16-17 years Acetabular notch is inferior Nonarticular fossa, thin related medially to obturator internus ⢠Pad of fat, proprioceptive nerves
- 6. MOB TCD Articular Surface of Hip Joint ⢠Semilunar articular surface covered with hyaline cartilage ⢠Deepened by acetabular labrum ⢠Wedge shaped fibrocartilage
- 7. MOB TCD Articular Surface ⢠⢠⢠⢠⢠Head of femur 2/3rd of sphere Pit for ligamentum teres Covered with articular cartilage Cartilage thicker posterior superior Epiphyseal line for head intracapsular
- 8. MOB TCD Femur ⢠Trabeculae develop along lines of stress ⢠Calcar femorale is the cortical bone on inferior aspect of neck ⢠Neck is cancellous bone
- 9. MOB TCD Capsule of Hip ⢠Proximally attached ⢠Margins of the acetabular fossa ⢠Base of labrum ⢠Distally, anterior to the intertrochanteric line ⢠Inferiorly, femoral neck close to lesser trochanter
- 10. MOB TCD Capsule of Hip ⢠Posterior ⢠Free border, fingerâs breath from trochanteric crest due to insertion of obturator externus ⢠Into trochanteric fossa and ⢠Root greater trochanter
- 11. MOB TCD Capsule of Hip ⢠Strongest superiorly ⢠Anteromedially, deep fibres reflected head of rectus femoris ⢠Iliopsoas is anterior ⢠Lateral deep fibres of gluteus minimus
- 12. MOB TCD Retinacular Fibres ⢠Fibres of capsule reflected along neck to articular margin called retinacular fibres ⢠Blood supply to head run under retinacular fibres
- 13. MOB TCD Ligaments of Hip ⢠⢠⢠⢠⢠⢠⢠Acetabular labrum Transverse ligament Ligament of head Iliofemoral ligament Pubofemoral ligaments Ischiofemoral ligaments Zona orbicularis
- 14. MOB TCD Ligaments of Hip ⢠Transverse ligament is part of the labrum ⢠Ligamentum teres is triangular, its base is attached to transverse ligament, and the apex to the pit on the head of femur ⢠Blood supply to epiphysis from obturator artery ⢠Only supplies a flake of bone in elderly
- 15. MOB TCD Iliofemoral Ligament ⢠Thickening of capsule ⢠Lower half of anterior inferior iliac spine and adjoining acetabulum ⢠Distally ⢠Upper and lower parts of inter trochanteric line
- 16. MOB TCD Iliofemoral Ligament ⢠One of strongest ligaments in body ⢠Tightens in extension ⢠Helps maintain erect posture ⢠Facet on anterior aspect of neck ⢠Prevents hyperextension ⢠Fulcrum reducing hip
- 17. MOB TCD Pubofemoral Ligament ⢠Superior pubic ramus ⢠Inferior part of inter trochanteric line and upturned part ⢠Relatively weak ⢠Prevents abduction ⢠Bursa between it and iliofemoral
- 18. MOB TCD Ischiofemoral Ligament ⢠Ischium to posterior part of joint (weak) ⢠Circular fibres called zona orbicularis ⢠Centre of gravity in front of head ⢠Synovial under obturator externus
- 19. MOB TCD Synovial Membrane ⢠Lines inner portion of capsule and non articular structures ⢠Ligament of head ⢠Fat in acetabular fossa ⢠May communicate with psoas bursa ⢠Bursa under obturator externus
- 20. MOB TCD Bursa Under Gluteus Maximus ⢠Trochanteric bursa ⢠Posterolateral aspect of greater trochanter gluteofemoral ⢠Vastus lateralis ischial bursa ⢠Ischial tuberosity
- 21. MOB TCD Blood Supply to Head of Femur ⢠Child, obturator artery via ligamentum teres supplies epiphysis ⢠Elderly, main supply via retinacular vessels from trochanteric and cruciate anastamoses ⢠Medial and lateral circumflex femoral vessels
- 22. MOB TCD Blood Supply ⢠Superior gluteal supplies the upper part of the acetabulum ⢠Inferior gluteal supplies the inferior and posterior and the capsule ⢠Transverse and ascending branches of lateral circumflex femoral artery ⢠Transverse and ascending branch of medial circumflex femoral ⢠Cruciate and trochanteric anastomosis
- 23. MOB TCD Blood Supply ⢠Fractures of neck may cause avascular necrosis, extra capsular arteries enter the trochanter at the base of neck ⢠Medial and lateral circumflex femoral vessels and superior gluteal
- 24. MOB TCD Nerve Supply ⢠⢠⢠⢠⢠Femoral nerve Obturator nerve Superior gluteal nerve Nerve to quadratus femoris Posterior dislocation may damage sciatic ⢠Pain in hip referred to knee
- 25. MOB TCD Anterior Relations ⢠⢠⢠⢠⢠⢠Rectus femoris Adductor longus Pectineus Psoas and iliacus Femoral sheath Femoral nerve
- 26. MOB TCD Inferior and Posterior Relations ⢠Obturator externus ⢠Passes inferior and then posterior to joint ⢠Superior gluteal nerve ⢠Inferior gluteal nerve ⢠Sciatic nerve ⢠Posterior cutaneous nerve thigh ⢠Nerves to obturator internus and quadratus femoris ⢠Pudendal nerve
- 27. MOB TCD Lateral Relations ⢠Gluteus minimus ⢠Gluteus medius ⢠Superior gluteal vessels and nerves between ⢠Iliotibial tract ⢠Superficial three quarters of gluteus maximus
- 28. MOB TCD Posterior Relations ⢠⢠⢠⢠⢠⢠⢠⢠Piriformis Superior gemellus Obturator internus Inferior gemellus Quadratus femoris Adductor magnus Obturator externus Gluteus maximus
- 29. MOB TCD Movements: Flexion ⢠Limited by anterior abdominal wall ⢠Psoas ⢠Iliacus ⢠Pectineus ⢠Adductor longus and brevis ⢠Rectus femoris
- 30. MOB TCD Movements: Extension ⢠Hamstrings first 10° ⢠Long head of biceps ⢠Semitendinosus ⢠Semimembranosus ⢠123, extended knee ++ ⢠Adductor magnus ⢠Gluteus maximus most efficient when hip is flexed 45°
- 31. MOB TCD Movements: Adduction ⢠⢠⢠⢠⢠Obturator nerve Adductor longus Adductor brevis Adductor magnus Can flex or extend depending on position of hip
- 32. MOB TCD Movements: Abduction ⢠Gluteus medius ⢠Gluteus minimus ⢠Standing on leg, gluteus medius and minimus abduction ⢠By preventing adduction
- 33. MOB TCD Movements: Medial Rotation ⢠Iliopsoas ⢠Adductors ⢠Anterior fibres of gluteus medius
- 34. MOB TCD Movements: Lateral Rotation ⢠⢠⢠⢠⢠⢠Obturator internus Piriformis Superior gemmelus Obturator Internus Inferior gemmelus Quadratus femoris
- 36. MOB TCD Fractured Neck of Femur
- 37. MOB TCD Hip Problems in Children ⢠⢠⢠⢠Apophysitis Avulsion fractures After 13 years 11-40% of all hip and pelvic fractures Boyd et al., 1997 ⢠Anterior superior iliac spine ⢠Anterior inferior iliac spine ⢠Ischial tuberosity commonest
- 39. MOB TCD Pain in a Child ⢠⢠⢠⢠⢠⢠5-10 year old child Aching pain in hip Limp Limitation of movement Pertheâs Osteochondritis of head of femur
- 40. MOB TCD Stability of Hip ⢠One of the most stable joints ⢠Congenital dislocations is common ⢠1.5 per 1000 live births ⢠Female : male = 8:1 ⢠Ultrasound best method of detecting
- 41. MOB TCD Femoral Anteversion ⢠Femoral version is the angular difference between axis of femoral neck and transcondylar axis of the knee ⢠Femoral anteversion ranges from 30 º - 40 º at birth ⢠Decreases progressively 15 º at skeletal maturation ⢠Adults ⢠Anteversion ⢠Average of 8 º in men and 14º in women ⢠Most common cause of in-toeing ⢠If associated with internal tibial torsion, may lead to patellofemoral subluxation due to an increase in the Q-angle
- 42. MOB TCD Tumors and Neoplasms ⢠⢠⢠⢠Young, healthy athletes do get cancer! Fortunately most tumors are benign! Bone pain at night Tumor till proved otherwise RenstrÜm, 2008
- 43. MOB TCD Hip Joint Labral Tear ⢠Chronic ⢠Secondary to acetabular dysplasia ⢠Part of ârim lesionâ complex RenstrĂśm, 2008
- 44. MOB TCD Labrum Tears and Cartilage Loss ⢠Labrum tears and cartilage loss are common in patients with mechanical symptoms in the hip ⢠In young, active patients with a complaint of groin pain ⢠The diagnosis of a labrum tear should be suspected and investigated as radiographs and the history may be nonspecific for this diagnosis Burnett et al., J Bone Joint Surg (Am), 2006
- 45. MOB TCD MR-Arthrography (MRA) ⢠MR arthrogram has an accuracy of 91% for labral tears Chan et al, Arthroscopy 2005 ⢠Sensitivity labral tear ⢠MR 25%, ⢠MRA 92% Toomayan et al., Am J Roentgenol 2006
- 46. MOB TCD Pincer Impingement ⢠The acetabulum covers too much of the ⢠⢠⢠⢠femoral head Secondary to âretroversionâ, of the socket Or a âprofundaâ socket that is too deep Most of the time the cam and pincer forms exist together Female, 30-40 years RenstrĂśm, 2008
- 47. MOB TCD Cam Impingement ⢠⢠Loss of roundness contributes to abnormal contact between the head and socket Male, 20-30 years RenstrÜm, 2008
- 48. MOB TCD Cam Impingement P Renstrom 08
- 49. âBMJ Publishing Group Limited (âBMJ Groupâ) 2012. All rights reserved.â
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