ANATOMY AND

BIOMECHANICS OF HIP
JOINT

MODERATOR : PROF DR N THANAPPAN MS ORTHO

PRESENTOR : DR N. SATHIYA PRAKASH PG
The hip joint, or coxofemoral joint, is the
articulation of the acetabulum of the pelvis and
the head of the femur.

Diarthrodial Multiaxial ball-and-socket joint.

Support the weight of the body both in static

erect posture & in Dynamic postures such as
ambulation, running, and stair climbing.
ACETABULUM
Proximal articular surface of hip Jt.
Having shared (primary center)physis of
Ilium, pubis, ischium merge as Triradiate
cartilage.
Closes at 12 yrs in female, 14 yrs in male.
Around puberty 3 secondary ossification
center appear in hyaline cartilage of
acetabular cavity.
Articulation of Ilium 40%,Ischium 40% & Pubis
20%.
Concavity of acetabulum develops in response
to the presence of spherical head.
Acetabulum is supported by two
columns in the inverted Y shape.
They inturn linked to the sacrum by
sciatic butress.
Acetabulum is deficient inferiorly by acetabular
notch which is bridged with transverse
acetabulur ligament.
Ligamentum teres passess through
acetabular notch which goes to fovea on the
femoral head
Articular cartilage covers the horse-shoe
shaped articular surface of acetabulum
The center is free of cartilage-acetabular
fossa which is filled with fibrofatty tissue.
Acetabular labrum:
fibrocartilage
Deepens the acetabulum
Distributes stresses to the joint during
joint loading
Maintains intra-articular pressure
Laterally inclined 50°;
Anteriorly rotated (anteversion) 15°-20°,
(amount of forward flexion of of the acetabulum
with sagital plane reference);
Inferiorly inclined at 45°;
Acetabular depth can be measured as the center
edge angle of Wiberg.
Anteversion of the acetabulum is positioned too
far anteriorly in the transverse plane.
Retroversion exists when positioned too far
posteriorly in the transverse plane.
 long axis of
acetabulum points
ϒ forwards : 15-200
ante version

ante
ϒ 450 inferior inclination version
C E angle of wiberg
Formed between a vertical line through
the center of the femoral head & a line
connecting the center of the femoral
head & the bony edge of the
acetabulum

Normal > 25*

Possible between 16*-25*
Definite dysplasia <16*
Proximal femur
Femur starts ossify at 7th fetal week. In
early child 1 single proximal
chondroepiphysis exists.
Capital femoral epiphysis begin at 4
months in girl, 5-6 months in boys.
During 1st year medial portion of physis
grows faster than lateral – elongated neck.
Trochanteric apophysis at 4 years.
Fusion of proximal femoral & trochanteric
physis at 14 & 16 years in girls & boys
respectively.
 Strong bones

 Powerful
 muscles
Strongest
 ligaments
Depth of acetabulum , narrowing of
mouth by acetabular labrum

 Length and obliquity of neck of

femur
 MOBILITY is due to the long neck which is
narrower than the diameter of the head
LIGAMENTS –Capsule
Proximally – Rim of acetabulum.
Distally - Neck of femur ;

Anteriorly – firmly to
intertrochanteric line;
Posterior -weakly ½ inch proximal
to crest of IT.
2 fibres
longitudinal –over iliofemoral ligament;
circular -zona orbicularis over
pubofemoral & ischiofemoral ligaments.
Ligaments
Capsular thickenings .
ANTERIOR ::
Iliofemoral ligament – bigelow.
Pubofemoral ligament.

POSTERIOR
ischiofemoral ligament.
ILIOFEMORAL LIGAMENT
Inverted Y shaped, Blends with capsule.
Thickest & strongest.
Prevent hyperextension of body(taut on
extension).
¼ inch thick - rarely ruptures in trauma.
Superior(APEX) – AIIS & acetabular rim.
Inferior(BASE) -intertochanteric line 2
bands obliquely.
Pubofemoral ligament
Triangular.
Base - iliopubic eminence, superior pubic ramus,
obturator crest and obturator membrane.
Apex(distal)-deep to medial iliofemoral ligament.
Ischiofemoral ligament
Weak band blends with posterior
capsule.
Transverse acetabular ligament

Bridges actabular notch.

Completes the rim of acetabulum.
Forming a foramen –vessels & nerves
enter the hip joint.
Ligamentum teres
Flat fan shape.
Ligament of the head of femur {apex-
fovea}.
Base -Flattened bifurcated & attached
to transverse acetabular ligament.
Ensheathed by synovial membrane.
Before epiphyseal fusion the artery to
ligament teres contribute.
Later it obliterates.
Acetabular labrum
The entire periphery of the acetabulum is
rimmed by a ring of wedge-shaped
fibrocartilage called the acetabular labrum.
Deepens the socket, increases the concavity
of the acetabulum, grasping the head of the
femur to maintain contact with the
acetabulum.
It enhances joint stability by acting as a
seal to maintain negative intra-articular
pressure.
Proprioceptive feedback.
Labrum
Firm fibrocartilagenous ring fixed to the
rim of acetabulum .
Deepens cavity.
Synovial membane
Lines the inner surface of the capsule
and non articular structures(Lig teres &
labrum).
Reflected distally upon neck of femur,
raising the synovium as RETINACULA.
These Folds are prominent over
posteriorly and enclose the cervical
arteries.
Vasular supply
Circumflex arteries

Medial & lateral

Gluteal arteries.

superior & inferior

Obturator artery.
OBTURATOR ARTERY
Internal ileac A.

Obturator artery

Acetabular branch supplies Fat in

acetabular fossa.
CIRCUMFLEX ARTERY
FEMORAL ARTERY

PROFUNDA FEMORIS A

CIRCUMFLEX
ASCENDING
TRANSVERSE

TERMINAL
 Less than 4 yrs

metaphyseal artery
Retinacular arteries
 4 to 8 years
single arterial supply by retinacular
 branch
More than 8 yrs
retinacular arteries
 Foveal artery
Adolescent age grp
retinacular arteries
Foveal arteries
Metaphyseal arteries
 Cartilaginous growth plate appear at 4
years of age

 Blocks the metaphyseal arteries to

enter.
 Foveal artery appears at around
8 yrs
 This transition phase is highly
susceptible to avascular collapse of
head due to single artery supply.

 When growth plate fuses the

metaphyseal arteries gain access to
the epiphysis again.
Inferior & medial to hip capsule,
coursing from deep femoral A to
posterior hip Jt is Medial circumflex A.

Placement of Hohmann retractor too

deep leads to tear, control of bleding
may be difficult.
Femoral neurovascular bundle separated
from anterior Hip jt by iliopsoas.
Nerve supply
Nerve to obturator internus.
Anterior division of obturator nerve.
Nerve to rectus femoris –branch of
femoral nerve.
Superior gluteal nerve.
MUSCLES-PSOAS MAJOR
ILIOPSOAS
GLUTEUS MAXIMUS
Large quadrilateral powerful muscle
cover posterior surface of pelvis.
ABBDUCTORS- {G-MAXIMUS}
Gluteus medius
Fan shaped cover lateral surface of
pelvis.
GLUTEUS MEDIUS
Gluteus minimus
Fan shaped covered by gluteus medius.
GLUTEUS MINIMUS
Piriformis
Lies below and parallel to G.medius
PIRIFORMIS
Gamellus
superior
Quadratus femoris
Obturator internus

Obturator externus
Tensor fascia lata
pectineus
Forms floor of femoral triangle
Adductors
Gracilis
Trabecular system

The medial (or

principal
compressive)
trabecular system
The lateral (or
principal tensile)
trabecular system
Accessory (or
secondary)
trabecular systems
zone of weakness
Wards triangle
 ANGULATION OF THE FEMUR
There are two angulations made by the head
and neck of the femur in relation to the shaft
Angle of inclination occurs in the frontal
plane between an axis through the femoral
head and neck and the longitudinal axis of
the femoral shaft
Angle of torsion occurs in the transverse
plane between an axis through the femoral
head and neck and an axis through the distal
femoral condyles
 :
sagittal & coronal
 Neck Shaft
angle
140 deg at birth
120-135 deg in
 adult
Ante version
Anteverted 40 deg at
birth
12-15 deg in adults
ANGLE OF INCLINATION OF FEMUR
The angle of inclination of the femur
approximates 125°
Normal range from 110° to 144° in the
unimpaired adult
With a normal angle of inclination, the greater
trochanter lies at the level of the center
of the femoral head.
A pathological increase in the medial
angulation between the neck and shaft is
called coxa valga
A pathological decrease is called coxa vara
ANGLE OF TORSION OF THE FEMUR
The angle of torsion of the femur
can best be viewed by looking
down the length of the femur
from top to bottom
An axis through the femoral head
and neck in the transverse plane
will lie at an angle to an axis
through the femoral condyles.
Line parallel to the posterior
femoral condyles & a line through
through the head & neck of femur
make an angle of 10 to 20 degree
In the adult, the normal
angle of torsion is
considered to be 10°
to 20°, 15° for males
and 18° for females
Femoral
anteversion is
considered to exist
when angle of
anterior torsion is
greater than 15° to
20°
A reversal of anterior
torsion, known as
femoral
retroversion, occurs
when angles are less
than 15° to 20°
Femoral anteversion is associated with
increased medial rotation ROM and
concurrent decreased lateral rotation so that
the total excursion of hip rotation motion
remains the same.
Anteversion of the femoral head reduces hip
joint stability because the femoral articular
surface is more exposed anteriorly.
The line of the hip abductors may fall more
posterior to the joint, reducing the
moment arm for abduction
When the femoral head is anteverted, pressure
from the anterior capsuloligamentous
structures and the anterior musculature may
push the femoral head back into the
acetabulum, causing the entire femur to
rotate medially
The knee joint axis through the femoral
condyles is now turned medially
Medial rotation of the femoral condyles alters
the plane of knee flexion/extension and results,
initially,in a toe-in gait and a compensatory
lateral tibial torsion develop
An anteverted femur will also affect the
biomechanics of the patellofemoral joint at
the knee and of the subtalar joint in the
foot
 ARTICULAR CONGRUENCE
In the neutral or
standing position, the
articular surface of the
femoral head
remains exposed
anteriorly and
somewhat superiorly.
Articular contact
between the femur and
the acetabulum can be
increased in the
normal non-weight-
bearing hip joint by a
combination of flexion,
abduction, and slight
lateral rotation
¬

Mechanical axis line passes

between center of hip joint
and center of ankle joint.

Anatomic axis
line is between tip
of greater
trochanter to center
of knee joint.

¬ Angle formed between these

two is around 70
BIOMECHANICS – Science that deals with
the study of forces (internal or external )
acting on the living body
 First order lever

fulcrum (hip joint)

forces on either side of
fulcrum i.e, body weight &
abductor tension
 Biomechanics

¬To maintain stable hip, torques produced by the body weight is countered by

abductor muscles pull.

Abductor force X lever arm1 = weight X

leverarm2
Forces acting across
hip joint
Body weight
Abductor
muscles
force
Joint reaction
force
 Joint reaction force

¬defined as force generated within a joint in response to forces acting on the

joint.

¬in the hip, to balance the moment arms of the body weight and abductor

tension.

¬maintains a level pelvis

Newton’s Third Law Of Motion
¬

e
 joints move in such a way that
rotation about one axis is
accompanied by an obligatory rotation
about another axis & these
movements are coupled
Joint congruence – the proper fit of two
articular surfaces, necessary for joint
motion
 Point at which a joint rotates

 Normally lies on a line perpendicular

to the tangent of the joint surface at
all points of contact
 Wts. of the objects act through the
centre of gravity.
 In humans ◊ just anterior to S2
MOMENT(TORQUE)
It is the tendency of a force to rotate a
body around an axis.

moment(torque)=force (perpendicular) *
distance

MOMENT ARM
shortest distance between the IAR & the
point of load application

L.L constitute 2/6 (1/6 + 1/6), and U.L &
trunk constitute 4/6 the total body wt

 Little or no muscular forces required to

maintain equilibrium in 2 leg stance

 Body wt is equally distributed across

both hips
 Each hip carries 1/3rd body weight
ϒ (4/6 = 2/3 = 1/3 + 1/3)
 Rt. LL supports the body wt & also
the Lt LL’s i.e. 5/6th total body wt.
 Effective Centre of gravity shifts
to the non-supporting leg(L) &
produces downward force to tilt
pelvis
 Rt. abductors must exert a
4/6 +1/6
downward counter balancing =5/6
force with right hip joint acting Typical levels for
as a fulcrum. single leg stance
are 3W,
corresponding to
i.e. Body wt acts eccentrically on a level ratio of
2.5.
the hip and tends to tilt the
pelvis in adduction
----- balanced by the abductors
Body weight is considered as the load
applied to a lever arm that extends from
body’s centre of gravity to centre of
femoral head,
The abductor muscles act as a power for
lever arm that extends from hip joint
surface to the attachment of greater
trochanter.
Ratio of lengths between the two lever
arms is 2.5:1. hence the abductor lever
arm should exert a force 2.5 times greater
than the body weight to keep pelvis stable.
 Reducing joint reaction
force (charnley)
Acetabular side
moving acetabular component medial,
inferior, anterior.
Femoral side
by increasing offset of femoral component
long stem prosthesis
lateralisation of greater trochanter
varus neck shaft angulation
 Reducing joint reaction force
Reduced by
Reducing the body
weight- generated
momentum
By reducing body weight
or reducing the body
weight lever arm
Seen in Trelendenburg
gait(leaning towards the
diseased hip)
Reducing the required hip abductor
force
Altering the neck-shaft angle through
varus osteotomy/varus placement of
the femoral stem
Increasing offset or medialization of the
socket
Use of cane in contralateral hand
Carrying load in ipsilateral hand
 CHARNLEY concept
Shorten lever arm of the body weight by
deepening the acetabulum and
To lengthen the lever arm of the abductor
mechanism by reattaching the osteotomized
greater trochanter laterally
Leading to decrease in moment produced by
body weight there by reducing counterbalance
force that the abductor mechanism must exert
TRENDELENBURG SIGN
1 2

normal

affected
Coxa valga

 Increased neck shaft

 angle
GT is at lower
level
 Shortened abductor lever
arm
 Body wt arm remains
same
 Increased joint forces in
hip during one leg
stance
 higher muscle force
required to keep pelvis
horizontal
Resultant force
R is more than
a normal hip
 Decreased neck shaft
 angle
GT is higher than
normal
 Increased abductor lever
arm
 Abductor muscle length is
shortened
 Decreased joint forces
across the hip during one
leg stance
 lesser muscle force is
required to keep pelvis
horizontal
Resultant force
R is less than
a normal hip
 Abductor muscular forces are to be
increased to counteract body wt

 Increased joint forces across the joint

leading to increased degeneration

 Rationale of decreasing body wt in OA –

decrease in body wt force & hence abductor
force required to counter balance

decreasing joint reaction forces across

that hip
 It creates an additional force that keeps the
pelvis level in the face of gravity's tendency
to adduct the hip during unilateral stance.
 decreases the moment arm between the
center of gravity and the femoral head(R)

 The cane's force must substitute for the hip

abductors.
 Long distance from the centre of hip to
contralateral hand offers excellent mechanical
advantage
USE OF CANE / WALKING STICK
 Both decrease the force exerted
by the body wt on the loaded hip

 Cane: transmits part of the

body wt to the ground
thereby decreasing the
muscular force required for
balancing
 Limping shortens the body
lever arm by shifting the
centre of gravity to the
loaded hip
Biomechanics of total hip arthroplasty

Stability and
range of motion
depends on :
1. Head size
2. Head-neck ratio
and
3. Implant design
 Biomechanics of THR

Centralization of femoral head by

deepening of Acetabulum - decreases body
wt lever arm
Increase in neck length and Lateral
reattachment of trochanter -
lengthens abductor lever arm
This decreases abductor force, hence joint
reaction force, & so the wear of the
implants.
If weight arm is equal to the abductor
arm joint reaction force reduces by 30%
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CHARNLEY CONCEPT OF THR
(acetabular centralisation &
trochanteric lateralisation)
Johnston study
conclusions
 The loads on the hip were significantly
reduced
 placing centre of acetabulum as far
medially, inferiorly, anteriorly
 Prosthesis with a short neck and reduced
neck shaft angle(130)
 Lateral transfer of GT has less desirable
effect
 DPS : FOR MORE PPT VISIT
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 DPS : FOR MORE PPT VISIT
https
://www.slideshare.net/dh
Offset Of Femur
And Prosthesis
 Offset - perpendicular line drawn from center of
femur
 head
Short to axis
offset headof head
gives greater strength
 Disadvantages
 Short abductor lever arm
Joint force become more vertical thus increasing the
abductor pull
 Increased offet
 Disadvantages

g
Increased stress on medial neck ,medial femoral a
cement leading to loosening and failure n
d
Lateralization Of
Abductors
 By using a short offset prosthesis ,
lateralization of GT
 To maintain abductor lever arm
To maintain angle of inclination of abductor
muscle pull
 Lateral and distal displacement of 1cm is
enough- Charnley
THANK YOU