Hip Joint Professor Emeritus Moira O’Brien FRCPI, FFSEM, FFSEM (UK), FTCD Trinit

Hip Joint Professor Emeritus Moira O’Brien FRCPI, FFSEM, FFSEM (UK), FTCD Trinit www.phwiki.com

Hip Joint Professor Emeritus Moira O’Brien FRCPI, FFSEM, FFSEM (UK), FTCD Trinit

Bender, Amy, Host – Better Arizona has reference to this Academic Journal, PHwiki organized this Journal Hip Joint Professor Emeritus Moira O’Brien FRCPI, FFSEM, FFSEM (UK), FTCD Trinity College Dublin Hip Joint Synovial ball in addition to socket joint Multiaxial Three degrees of freedom Movement in three planes Close pack extension in addition to medial rotation Least pack semiflexion

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One of most stable joints in the body Articular surface of hip joint are reciprocally curved Superior surface of femur in addition to acetabulum sustain greatest pressure Hip Joint 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 Articular Surface of Hip Joint Semilunar articular surface covered with hyaline cartilage Deepened by acetabular labrum Wedge shaped fibrocartilage

Head of femur 2/3rd of sphere Pit as long as ligamentum teres Covered with articular cartilage Cartilage thicker posterior superior Epiphyseal line as long as head intracapsular Articular Surface Femur Trabeculae develop along lines of stress Calcar femorale is the cortical bone on inferior aspect of neck Neck is cancellous bone 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

Posterior Free border, finger’s breath from trochanteric crest due to insertion of obturator externus Into trochanteric fossa in addition to Root greater trochanter Capsule of Hip Strongest superiorly Anteromedially, deep fibres reflected head of rectus femoris Iliopsoas is anterior Lateral deep fibres of gluteus minimus Capsule of Hip Retinacular Fibres Fibres of capsule reflected along neck to articular margin called retinacular fibres Blood supply to head run under retinacular fibres

Ligaments of Hip Acetabular labrum Transverse ligament Ligament of head Iliofemoral ligament Pubofemoral ligaments Ischiofemoral ligaments Zona orbicularis Transverse ligament is part of the labrum Ligamentum teres is triangular, its base is attached to transverse ligament, in addition to 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 Ligaments of Hip Iliofemoral Ligament Thickening of capsule Lower half of anterior inferior iliac spine in addition to adjoining acetabulum Distally Upper in addition to lower parts of inter trochanteric line

One of strongest ligaments in body Tightens in extension Helps maintain erect posture Facet on anterior aspect of neck Prevents hyperextension Fulcrum reducing hip Iliofemoral Ligament Pubofemoral Ligament Superior pubic ramus Inferior part of inter trochanteric line in addition to upturned part Relatively weak Prevents abduction Bursa between it in addition to iliofemoral 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

Synovial Membrane Lines inner portion of capsule in addition to non articular structures Ligament of head Fat in acetabular fossa May communicate with psoas bursa Bursa under obturator externus Bursa Under Gluteus Maximus Trochanteric bursa Posterolateral aspect of greater trochanter gluteofemoral Vastus lateralis ischial bursa Ischial tuberosity Blood Supply to Head of Femur Child, obturator artery via ligamentum teres supplies epiphysis Elderly, main supply via retinacular vessels from trochanteric in addition to cruciate anastamoses Medial in addition to lateral circumflex femoral vessels

Blood Supply Superior gluteal supplies the upper part of the acetabulum Inferior gluteal supplies the inferior in addition to posterior in addition to the capsule Transverse in addition to ascending branches of lateral circumflex femoral artery Transverse in addition to ascending branch of medial circumflex femoral Cruciate in addition to trochanteric anastomosis Fractures of neck may cause avascular necrosis, extra capsular arteries enter the trochanter at the base of neck Medial in addition to lateral circumflex femoral vessels in addition to superior gluteal Blood Supply Femoral nerve Obturator nerve Superior gluteal nerve Nerve to quadratus femoris Posterior dislocation may damage sciatic Pain in hip referred to knee Nerve Supply

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Anterior Relations Rectus femoris Adductor longus Pectineus Psoas in addition to iliacus Femoral sheath Femoral nerve Inferior in addition to Posterior Relations Obturator externus Passes inferior in addition to then posterior to joint Superior gluteal nerve Inferior gluteal nerve Sciatic nerve Posterior cutaneous nerve thigh Nerves to obturator internus in addition to quadratus femoris Pudendal nerve Lateral Relations Gluteus minimus Gluteus medius Superior gluteal vessels in addition to nerves between Iliotibial tract Superficial three quarters of gluteus maximus

Posterior Relations Piri as long as mis Superior gemellus Obturator internus Inferior gemellus Quadratus femoris Adductor magnus Obturator externus Gluteus maximus Movements: Flexion Limited by anterior abdominal wall Psoas Iliacus Pectineus Adductor longus in addition to brevis Rectus femoris 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°

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