Transcript 20-hip joint

HIP JOINT
Prof.
Saeed Makarem
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ARTICULAR SURFACES
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Prof. Saeed Makarem
The head of the femur
articulates with the
acetabulum .
The wide superior part
of the articular
surface is the weight
bearing area.
So, it is the ilium that
bears the weight.
The rim of the
acetabulum is
defective inferiorly at
the acetabular notch,
which is bridged by
the transverse
acetabular ligament.
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ARTICULAR SURFACES
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Prof. Saeed Makarem
The head of the femur is
covered with hyaline
cartilage, except over
the fovea or pit, to which
the ligament of the head
of the femur is attached.
More than half of the
femoral head is
contained within the
acetabulum.
The articular or lunate
surface of the
acetabulum is
horseshoe-shaped.
The acetabulum has a
centrally located
nonarticular acetabular
fossa, which is occupied
by a fat that is covered
with synovial
membrane.
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ACETABULAR LABRUM
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Type of joint: Synovial ball and socket
The depth of the
acetabulum is
increased by the
fibrocartilaginous rim
(acetabular labrum) .It
is attached to the rim of
the acetabulum and to
the transverse
acetabular ligament.
The labrum deepens
the socket for the
femoral head and its
free edge clasps the
head beyond its widest
diameter.
This helps to hold it
firmly in the
acetabulum (i.e.,
preventing its
dislocation).
Prof. Saeed Makarem
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FIBROUS CAPSULE
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Prof. Saeed Makarem
It is strong and dense.
Proximally, it is
attached to the edge of
the acetabulum,
outside the acetabular
labrum, and to the
transverse acetabular
ligament.
Distally, it is attached
to the neck of the
femur as follows:
 anteriorly to the
intertrochanteric
line and
 posteriorly to the
neck proximal to
the
intertrochanteric
crest.
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SYNOVIAL MEMBRANE
Prof. Saeed Makarem
Lines the fibrous capsule
 It covers the portion of
the neck of the femur
that lies within the joint
capsule.
 It surrounds the
ligament of head of the
femur and covers the
pad of fat of acetabular
fossa.
 A pouch of synovial
membrane frequently
protrudes through a gap
in the anterior wall of the
capsule, between the
pubofemoral and
iliofemoral ligaments,
and forms the psoas
bursa beneath the psoas
tendon.
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Ligaments
Iliofemoral:
• anterior
• Triangular Y- shaped
• It’s apex attached to the ilium (AIIS).
• It’s base forms 2 bands which attached to the upper & lower parts of the
intertrochanteric line
• Function: It prevents hyperextension of the joint.
ISCHIOFEMORAL LIGAMENT
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Prof. Saeed Makarem
It is spiral in shape.
It arises from the
ischial portion of
the acetabular rim
and spirals inferolaterally to the neck
of the femur,
It reinforces the
capsule of the hip
joint posteriorly and
limits extension of
the hip.
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PUBOFEMORAL LIGAMENT
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Prof. Saeed Makarem
Triangular in
shape.
It s base is
attached to
superior pubic
ramus.
Its apex is
attached to
intertrochanteric
line.
It limits
abduction and
extension of the
hip joint
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TRANSVERSE ACETABULAR LIGAMENT
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Prof. Saeed Makarem
The transverse
acetabular
ligament bridges
the acetabular
notch.
The ligament
converts the notch
into a tunnel
through which the
blood vessels and
nerves enter the
joint.
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LIGAMENT OF THE
HEAD OF THE FEMUR
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Prof. Saeed Makarem
Intracapsular ligament, about
3.5 cm long,
It is flat and triangular in shape.
It's wide end is attached to the
margins of the acetabular notch
and to the transverse
acetabular ligament, and its
narrow end is attached to the
femoral fovea.
It contains a small artery to the
head of the femur, which is a
branch of the obturator artery.
It is surrounded by a sleeve of
synovial membrane.
This ligament is stretched when
the flexed thigh is adducted or
laterally rotated.
It is weak and appears to be of
little importance in support of
the hip joint.
NERVE SUPPLY
The articular nerves are
derived from:
1. • The femoral nerve
via the nerve to the
rectus femoris .
2. • The obturator
nerve via its anterior
division;
3. • The sciatic nerve
via the nerve to the
quadratus femoris .
4. • The superior
gluteal nerve.
Prof. Saeed Makarem
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BLOOD SUPPLY
The articular arteries
are branches of
 Medial and lateral
circumflex femoral
arteries,
 Posterior division
of the obturator
artery (the artery
to the head of the
femur),
 Deep division of
the superior
gluteal artery, and
 The inferior
gluteal artery.
Prof. Saeed Makarem
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IMPORTANT RELATIONS
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Prof. Saeed Makarem
Anteriorly:
 Iliopsoas,
 Pectineus,
 Rectus femoris.
 Iliopsoas and pectineus
separate the femoral
vessels and nerve from
the joint.
Posteriorly:
 Obturator internus,
 Gemelli,
 Quadratus femoris
 These muscles separate
the joint from the sciatic
nerve.
Superiorly:
 Piriformis.
 gluteus minimus.
Inferiorly:
 Obturator externus
Trendelenburg’s Sign
Standing on one foot
needs:
1- Intact gluteus
medius & minimus.
2- Intact superior
gluteal nerve.
3- Intact neck of femur
4- Normal angle of
neck of the femur.
5- Head of femur must
be located within the
acetabulum.
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Pelvis sinks downward on the
opposite (unsupported side)
 Shenton’s
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Line
The superior margin of
obturator foramen forms
a smooth continuous
curve with the inferior
margin of the neck of
femur.
Prof. Saeed Makarem
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Flexion is performed by the:
 iliopsoas,
 rectus femoris,
 sartorius, and also by the
 adductor muscles.
Extension (a backward movement of
the flexed thigh) is performed by the:
 gluteus maximus and the
 hamstring muscles.
Abduction is performed by the:
 gluteus medius and minimus
 assisted by the sartorius, tensor
fasciae lata, and piriformis.
Adduction is performed by the:
 adductor longus and brevis and the
 adductor fibers of the adductor
magnus.
 These muscles are assisted by the
pectineus and the gracilis.
MOVEMENTS
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Lateral rotation is performed by the:
 piriformis,
 obturator internus and externus,
 superior and inferior gemelli, and
 quadratus femoris,
 assisted by the gluteus maximus.
Medial rotation is performed by the
 anterior fibers of gluteus medius
and gluteus minimus and the
 tensor fasciae latae.
Circumduction is a combination of the
above movements.
It should be remembered that the
extensor group of muscles is more
powerful than the flexor group, and
that the lateral rotators are more
powerful than the medial rotators.
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MOVEMENTS
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Prof. Saeed Makarem
The hip joint has a wide range of movement, but less than the shoulder .
Some of the movement has been sacrificed in order to provide stability.
The strength of the joint depends largely on the shape of the bones and on the very
strong ligaments.
When the knee is flexed, flexion is limited by the anterior surface of the thigh coming
into contact with the anterior abdominal wall.
When the knee is extended, flexion is limited by the tension of the hamstring
muscles.
Extension, which is the movement of the flexed thigh backward to the anatomical
position, is limited by the tension of the 3 extra-capsular ligament ( Iliofemoral,
pubofemoral, and ischiofemoral )
Abduction is limited by the tension of the pubofemoral ligament, and
adduction is limited by contact with the opposite limb and by the tension in the
ligament of the head of the femur.
Lateral rotation is limited by the tension in the iliofemoral and pubofemoral
ligaments, and
medial rotation is limited by the ischiofemoral ligament.
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