Hip

HIP Pradeep Chockalingam

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Anatomy 



Acetabulum (Proximal) Femoral head (Distal)

http://www.fpnotebook.com/ORT78.htm www.pdfcoke.com/cpradheep

Joint Type 

Ball and socket joint



Synovial joint

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Blood supply to head & NOF 

Medial and lateral femoral circumflex arteries



Obturator artery



Superior and inferior gluteal arteries



Ascending branch of first perforating branch of profunda femoris

http://www.orthogastonia.com/patient_ed/images/hip/hip_avn/hip_avn_anatomy02.jpg www.pdfcoke.com/cpradheep

Capsule 

Proximal Attached around the brim of the bony acetabulum



Distal  

Anteriorly along the inter trochanteric line Posteriorly ½" above the inter trochanteric crest

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Ligaments 

Iliofemoral ligament reinforcing the anterior surface of the articular capsule of the hip joint



Ischiofemoral ligament reinforcing the posterior surface of the articular capsule of the hip joint



Ligament of the head of the femur attaches to the fovea of the head and to the acetabular fossa www.pdfcoke.com/cpradheep

Ligaments 

Cont.

Transverse acetabular ligament spans the acetabular notch near the rim of the acetabulum



Zona orbicularis circularly oriented ligamentous fibers that reinforce the capsule of the hip joint



Pubofemoral ligament reinforcing the medial surface of the articular capsule of the hip joint www.pdfcoke.com/cpradheep

Muscles Extension  



Gluteus maximus Adductor magnus (ischial part) Hamstrings

Flexion



Iliopsoas Pectineus Sartorius Rectus femoris



Tensor fascia latae

  

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Muscles Adduction     

Adductor longus Adductor brevis Adductor magnus Gracilis Pectineus (to a small degree)

Abduction 

Gluteus medius Gluteus minimus



Tensor fascia latae



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Muscles Lateral Rotation

Medial Rotation





   

  

Obturator externus Obturator internus Superior and inferior gemelli Piriformis Quadratus femoris Gluteus maximus Sartorius Posterior part of gluteus medius

 

Gluteus minimus Anterior part of gluteus medius Pectineus

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Range of Motion 

    

Flexion: 110 to 120 degrees Extension: 10 to 15 degrees Abduction: 30 to 50 degrees Adduction: 30 degrees Lateral rotation: 40 to 60 degrees Medial rotation: 30 to 40 degrees

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Examination of Hip 

Subjective



Objective

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Subjective History taking

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Objective    

Observation Palpation Examination Special tests

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Common problems in adults 

     

#NOF Osteoarthritis Rheumatoid Arthritis Ankylosing spondylitis Paget's Disease Dislocation Infectious joint diseases

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Paediatrics 



Developmental dysplasia of the hip Girls > Boys Perthes disease Boys > Girls

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#NOF Falls (1% of all falls cause #NOF)  90% of hip fractures occur after age 70  Male : Female ratio 1 : 2  Tall, Low BMI (at risk) (Mortality rate Male > Female) 

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http://herkules.oulu.fi/isbn9514270959/html/x286.html www.pdfcoke.com/cpradheep

Trabicullar system of Hip

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Classification of #NOF

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Pauwels Classification

http://www.e-radiography.net/articles/Fractures%20of%20the%20lower%20limb/Fractures%20of%20the%20lower%20limb.htm

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Intracapsular

(Gardens)

http://www.emedicine.com/radio/topic342.htm www.pdfcoke.com/cpradheep

Extracapsular

(Jensen)

Jensen classification of trochanteric fractures

http://herkules.oulu.fi/isbn9514270959/html/x261.html

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Intracapsular Vs Extracapsular 



    

Less common Minimal rotation violence Minimal Nil Difficult Common Rare





More Lateral violence



Fully externally rotated Marked local swelling Easy Does not occur



Common

  

http://www.bonetumour.org/book/Truma/chapter18/ch18_sub2.html www.pdfcoke.com/cpradheep

Management of #NOF  

Conservative Surgical     

THR HHR DHS CHS Girdlestone

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Surgical approach to hip 

Anterior



Lateral



Posterior

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http://www.totaljoints.info/Approaches_TH.jpg www.pdfcoke.com/cpradheep

Anterior  

Internal rotators, Abductors Low risk of hip dislocation, but risk of limp due to division of the abductor muscles attachments. Risk for damage of skin nerves with persisting skin numbness

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Lateral   

TFL, G. Medius, G. Minimus, V. Lateralis Risk to Superior Glutial Nerve Excellent access but healing problems with detached abductor muscles

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Posterior 

 

External rotator, G. Maximus, Fascia lata Risk to Sciatic Nerve Easy access, but greater risk of total hip dislocation

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PT Management    

Early Mobilisation Early Weight Bearing Quadriceps, Abductor Exercises Patient Education

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