HIP JOINT

COMPLEX
Aneena Alex
MPT Ist Year
MTIMS
INTRODUCTION
 The Hip Joint or Coxofemoral Joint, is the articulation
of the acetabulum of the pelvis and the head of the
femur.
 Diarthrodial ball and socket joint

 Three degrees of freedom

1. Flexion/Extension in the Sagittal plane

2. Abduction/Adduction in the Frontal plane
3. Medial/Lateral Rotation in the Transverse plane
 The primary function of the hip joint is to support the
weight of the head, arms and trunk (HAT) both in static
erect posture and in dynamic postures such as
ambulation, running and stair climbing.
 The hip joint is specially designed for weight bearing
and is concerned with mobility and stability.
STRUCTURE OF THE HIP JOINT
PROXIMAL ARTICULAR SURFACE
 The periphery of the acetabulum is covered with hyaline
cartilage. This horseshoe-shaped cartilage articulates
with the head of femur and allows the stress to uniformly
distributed.
 The transverse acetabular ligament connects two ends of
the horseshoe and it creates a fibro-osseous tunnel
through which blood vessels pass into the deepest
acetabulum called acetabular fossa.
 The acetabulum is deepened by the fibrocartilaginous
acetabular labrum, which surrounds the acetabulum.
ACETABULUM
 The acetabulum is approximately laterally inclined 50,
anteriorly rotated (anteversion) 20 and anteriorly tilted
20 in the frontal, transverse and sagittal planes
respectively.
 Acetabular depth can be measured as the center edge
angle of Wiberg.
 Center edge angles are

classified as:
- definite dysplasia less than 16°
- possible dysplasia 16 to 25
- normal greater than 40
 Acetabular dysplasia is an abnormally shallow
acetabulum that results in a lack of femoral head
coverage.
 Coxa profunda and acetabular protrusia is the
acetabulum excessively covers the femoral head.
ACETABULAR LABRUM
 The entire periphery of the acetabulum is rimed by a ring
of wedge-shaped fibrocartilage called the acetabular
labrum.
 It enhances joint stability not only by deepening the
acetabulum but also by acting as a seal to maintain
negative intra-articular pressure.
DISTAL ARTICULAR SURFACE
 The head of the femur rounded by hyaline cartilage and
just inferior to the medial point a small, roughened pit
called the fovea capitis.
 The fovea is not covered with articular cartilage and is
the point at which the ligament of the head of the femur
(ligamentum teres) is attached.
ANGULATIONS OF THE FEMUR
 There are two angulations made by the head and neck of
the femur in relation to the shaft.
1. 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.
2. 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.
ANGLE OF INCLINATION
 The angle of inclination of the femur approximates 125°

 This value can have a 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
 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°.
HIP JOINT CAPSULE
 The articular capsule of the hip joint is an irregular,
dense fibrous structure with longitudinal and oblique
fibers.
 Both joint capsule and ligamentum teres provide stability
of the hip joint during distractive forces.
HIP JOINT LIGAMENTS
 The ligament is a triangular band that attaches to the
peripheral edge of the acetabular notch.
- Ligamentum teres
- Iliofemoral ligament (Y ligament of Bigelow)
- Pubofemoral ligament
- Ishiofemoral ligament
STRUCTURAL ADAPTIONS TO WEIGHT-BEARING
 In standing or upright weight bearing activities, at least half
the weight of the HAT (the gravitational force) passes down
through the pelvis to the femoral head, whereas the ground
reaction force (GRF) travels up the shaft.
 These two forces, nearly parallel and in opposite directions,
create a force couple with a moment arm(MA) equal to the
distance between the superimposed body weight on the
femoral head and the GRF up the shaft.
 These forces create a bending moment (or set of shear
forces) across the femoral neck. The bending stress creates a
tensile force on the superior aspect of the femoral neck and
a compressive stress on the inferior aspect
FUNCTION OF THE HIP JOINT
MOTION OF THE FEMUR ON THE ACETABULUM
 The motions of the hip joint are easiest to visualize as
movement of the convex femoral head within the concavity of
the acetabulum as the femur moves through its three degrees of
freedom.
Range

0-125
0-15

0-45
0-30
0-45

0-35
MOTION OF THE PELVIS ON THE FEMUR
 Whenever the hip joint is weight-bearing, the femur is
relatively fixed and, in fact, motion of the hip joint is
produced by movement of the pelvis on the femur.
ANTERIOR AND POSTERIOR PELVIC TILT
 Anterior and posterior pelvic tilts are motions of the
entire pelvic ring in the sagittal plane around a coronal
axis.
 In the normally aligned pelvis, the anterior superior iliac
spines of the pelvis lie on a horizontal line with the
posterior superior iliac spines on a vertical line with the
symphysis pubis.
 Anterior and posterior tilting of the pelvis on the fixed
femur produce hip flexion and extension, respectively
• Flexion and extension of the hip occurring as tilting of
the pelvis in the sagittal plane.
• In Posterior tilting of the pelvis moves the symphysis pubis
superiorly on the fixed femur. The hip joint extends.
• In Anterior tilting, the anterior superior iliac spines move
inferiorly on the fixed femur. The hip joint flexes.
LATERAL PELVIC TILT
 Lateral pelvic tilt is a frontal plane motion of the entire
pelvis around an anteroposterior axis.
 In the normally aligned pelvis, a line through the anterior
superior iliac spines is horizontal.
 In lateral tilt of the pelvis in unilateral stance, one hip
joint (e.g., the left hip joint) is the pivot point or axis for
motion of the opposite side of the pelvis (e.g., the right
side) as that side of the pelvis elevates (pelvic hike) or
drops (pelvic drop).
 Lateral tilting of the pelvis around the left can occur
either as hip hiking (elevation of the opposite side of the
pelvis) or as pelvic drop (drop of the opposite side of the
pelvis).
 Hiking of the pelvis around the left hip joint results in
left hip abduction.
 Dropping of the pelvis around the left hip joint results in
left hip joint adduction.
FORWARD AND BACKWARD PELVIC ROTATIONS
 Pelvic rotation is motion of the entire pelvic ring in the
transverse plane around a vertical axis and most
commonly and occurs in single-limb support around the
axis of the supporting or weight-bearing hip joint.
 Forward (anterior) rotation of the pelvis occurs in
unilateral stance when the side of the pelvis opposite to
the weight-bearing hip joint moves anteriorly from the
neutral position.
 Backward (posterior) rotation of the pelvis occurs when
the side of the pelvis opposite the weight-bearing hip
moves posteriorly.
 Forward rotation of the pelvis around the right hip joint
results in medial rotation of the right hip joint.
 Backward rotation of the pelvis around the right hip joint
results in lateral rotation of the right hip joint.
COORDINATED MOTIONS OF THE
FEMUR, PELVIS, AND LUMBAR SPINE
PELVIFEMORAL MOTION
 When the femur, pelvis, and spine move in a coordinated
manner to produce a larger ROM than is available to one
segment alone, the hip joint is participating in what will
predominantly be an open-chain motion termed
pelvifemoral motion.
 Pelvifemoral motion has also been referred to as
pelvifemoral rhythm
Open chain response
 The head and trunk will follow the motion of the pelvis.

Closed chain response

 The head will continue to remain relatively upright and
vertical despite the pelvic motions.
HIP JOINT FORCES AND MUSCLE
FUNCTION IN STANCE
BILATERAL STANCE
 In erect bilateral stance, both hips are in neutral or slight
hyperextension, and weight is evenly distributed between
both legs.
 The line of gravity falls just posterior to the axis for
flexion/extension of the hip joint.
 In the frontal plane during bilateral stance, the
superincumbent body weight is transmitted through the
sacroiliac joints and pelvis to the right and left femoral
heads.
 The joint axis of each hip lies at an equal distance from
the line of gravity of HAT
 That is the gravitational moment arms for the right hip
(DR) and the left hip (DL) are equal. Because the body
weight (W) on each femoral head is the same
(WR=WL), the magnitude of the gravitational torques
around each hip must be identical (WRDR = WLDL).
UNILATERAL STANCE
 The left leg has been lifted from the ground and the full
superimposed body weight (HAT) is being supported by
the right hip joint.
 The weight of the non-weight bearing left limb that is
hanging on the left side of the pelvis must be supported
along with the weight of HAT.
 Of the one third of the portion of body weight found in
the lower extremities, the non-weight bearing limb must
account for half of that, or one sixth of the full body
weight.
 The magnitude of body weight (W) compressing the
right hip joint in right unilateral stance, therefore, is
 Right hip joint compression body weight

= [2/3W] + [1/6W]
= 5/6W
COMPENSATORY LATERAL LEAN OF THE
TRUNK
 The compensatory lateral lean of the trunk toward the
painful stance limb will swing the line of gravity closer
to the hip joint, thereby reducing the gravitational
moment arm.
 Because the weight of HATLL must pass through the
weight-bearing hip joint regardless of trunk position,
leaning toward the painful or weak supporting hip does
not increase the joint compression caused by body
weight.
USE OF A CANE IPSILATERALLY
 Pushing downward on a cane held in the hand on the side
of pain or weakness should reduce the superimposed
body weight by the amount of downward thrust.
 That is, some of the weight of HATLL would follow the
arm to the cane, rather than arriving on the sacrum and
the weight-bearing hip joint.
USE OF A CANE CONTRALATERALLY
 A cane in the hand opposite to the hip impairment
presumes that the downward force on the cane acts
through the full distance between the hand and the
weight-bearing (impaired) hip joint.
 The cane assists the abductor muscles in providing a
counter torque to the torque of gravity.
PATHOLOGICAL GAITS
 When a lateral trunk lean is seen during gait and is due
to hip abductor muscle weakness, it is known as a
gluteus medius gait.
 If the same compensation is due to hip joint pain, it is
known as an antalgic gait.
 If lateral lean and pelvic drop occur during walking, the
gait deviation is commonly referred to as a
trendelenburg gait.
HIP JOINT PATHOLOGY
FEMOROACETABULAR IMPINGEMENT
 Femoroacetabular impingement (FAI) is described as the
dysfunctional abutment of the proximal femur and the
acetabulum.
 The result of such impingement causes pain and can lead
to progressive degenerative changes in the hip joint,
specifically the labrum.
 Cam impingement occurs as a result of an abnormal
widening of the femoral neck that leads to the abutment
of the anterior superior labrum and the articular cartilage
of the acetabulum during flexion or abduction of the hip.
 Pincer impingement occurs as a result of an over
coverage of the acetabulum on the femoral head, causing
compression of the superior labrum between the
acetabular rim and the femoral head-neck junction with
flexion or abduction.
LABRAL PATHOLOGY
 The labrum is a legitimate source of pain. The onset of
labral pathology may be caused either by a single
traumatic event or more commonly by the cumulative
effects of micro trauma.
 Traumatic labral injury may be the result of a rapid and
forceful rotation of the hip.
ARTHROSIS
 The degenerative changes may be the result of
inadequate joint forces, rather than excessive forces at
the hip joint.
 When a person is inactive, nourishment to the articular
cartilage is diminished and more vulnerable to injury and
deterioration.
 The evidence suggest that lower activity levels are
associated with hip OA.
FRACTURE
 The vertical weight-bearing forces that pass down
through the superior margin of the acetabulum in both
unilateral and bilateral stance act at some distance from
ground reaction force up the shaft of the femur.
 The result is a bending force across the femoral neck.
Normally the trabecular systems are capable of resisting
the bending forces, but abnormal increases in the
magnitude of the force or weakening of the bone can
lead to bony failure.
 Most hip fractures happen to people older than age 60.
This is primarily because of a higher rate of
osteoporosis. A fall is the most common reason for a hip
fracture among the elderly.
THANKYOU