Hip Joint PPT

CLINICAL ANATOMY AND
EXAMINATION OF HIP
JOINT.
Anuvind N.S. 22
● The hip joint is a ball and socket type of
synovial joint between the head of the
femur and the acetabulum of the hip bone.
● It is the largest ball and socket type of joint
in the body.
● Its main functions are:
(a) to support the body weight during standing
and
(b) to transmit the forces generated by
movements of trunk femur during walking.
Articular Surfaces.
Ligaments.
1.Capsular ligament.
2. Iliofemoral,Pubofemoral and
Ischiofemoral Ligaments.
3. Round Ligament of the head of Femur.
Also called Ligamentum Teres of Head of
femur.
Flat triangular ligament with apex attached to
the fovea of the head, and its base to the
transverse acetabular ligament.
4. Acetabular Labrum.
Fibrocartilaginous rim attached to the acetabular
margin.The labrum not only deepens the
acetabulum (socket) but grasps the head of femur
tightly to hold it in position.
5. Transverse Acetabular Ligament.
● Part of acetabular labrum, which bridges the
acetabular notch; however, it is devoid of
cartilage cells.
● The acetabular notch thus becomes
converted into the foramen which transmits
the acetabular vessels and nerves to the hip
joint.
Stability of Hip Joint.
The stability of the hip joint is provided by the following factors
which help to prevent its dislocation:
1. Depth of the acetabulum and narrowing of its mouth by the
acetabular labrum.
2. Three strong ligaments (iliofemoral, pubofemoral, and
ischiofemoral) strengthening the capsule of the joint.
3. Strength of the surrounding muscles, e.g., gluteus medius,
gluteus minimus, etc.
4. Length and obliquity of the neck of femur.
MOVEMENTS.
The hip joint is a multiaxial joint and permits the
following movements:
● Flexion and extension.
● Abduction and adduction.
● Medial and lateral rotation.
● Circumduction.
Range of movements.
The flexion is 110°–120°. It is limited by contact
of the thigh with the abdomen.
Extension = 15° Abduction = 50°
Medial rotation = 25° Lateral rotation = 60°
• Dislocation of the hip joint:
(a) Congenital dislocation: The congenital
dislocation of the hip joint is more common than
any other joint in the body. It occurs due to two
reasons:
(i) The joint capsule is loose at birth.
(ii) Hypoplasia of the acetabulum and femoral
head.
Clinically, it presents as:
– Inability of the newborn to abduct the thigh.
– Affected limb is shorter in length and externally
rotated.
– Asymmetry of skin folds of the thighs.
– Lurching gait with positive Trendelenburg’s
sign.
(b) Acquired dislocation:
Occur during an automobile accident when the hip joint is
flexed, adducted, and medially rotated from the usual position
of the lower limb when one is riding in a car.
In this position, the joint is unstable because the femoral
head is covered posteriorly by a joint capsule and not by the
bone.
During head on collision, the knee strikes the dashboard and
dislocates the hip joint.
The head of the femur is forced out of the acetabulum by
tearing the capsule posteroinferiorly and lies on the lateral
surface of the ilium. This causes shortening and medial
rotation of the affected limb.
The dislocation of the hip may be posterior (most
common), anterior (less common), or central
(least common). The sciatic nerve is injured in
posterior dislocation.
Perthes’ disease (pseudocoxalgia): It is a clinical
condition characterized by destruction and
flattening of the head of femur with an increased
joint space in the radiograph.
Coxa vara and coxa valga: Normal neck–shaft
angle is about 120° in adults and 160° in children.
If the neck shaft angle of the femur is reduced
(e.g., fracture neck of femur, Perthes disease), it is
called coxa vara.
If the angle is increased (e.g., congenital
dislocation of the hip joint), it is called coxa valga.
Osteoarthritis: It is a disease of the old age. It is
characterized by the growth of osteophytes at the
articular ends which not only limits the movements
but makes them grating and painful.
Fractures of the neck of the femur: It is referred as fractured hip
implying that the hip bone is broken.
Types
The fractures of the neck of femur are of four types (Fig. 26.11):
(a) Subcapital (near the head).
(b) Cervical (in the middle).
(c) Basal (near the trochanters).
(d) Pertrochanteric fracture (just distal to two trochanters).
Diagnosis is generally confirmed by X-ray by
observing following two lines:
Shenton’s line:continuous curved line formed by
the upper border of the obturator foramen and
lower margin of the neck of the femur.
Schoemaker’s line: It is a straight line that
extends from the tip of the greater trochanter to
the anterior superior iliac spine and continues
upward over the anterior abdominal wall to reach
the umbilicus.
EXAMINATION OF HIP
JOINT
History of
● Motor car collision
● Fall from height
● Falling of heavy weight on the back
Gait
● Observe common gait patterns

● Antalgic gait - cannot bear weight on affected side
● Trendelenburg gait - torso shifts to affected side
● Short limb gait - up and down movement of half the body
● Circumduction gait
● In flexion deformity
INSPECTION
(i)Attitude.
An individual lying with externally rotated lower limb
indicates fracture of neck of femur.
Anterior dislocation- externally rotated,slightly
abducted flexed lower limb.
Posterior dislocation- flexed,adducted and internally
rotated lower limb.
(ii) Swelling.
Abnormal swelling and bruising will be evident in
the injured hip.
PALPATION.
(i) Greater Trochanter:
(ii) Head of femur:
(iii) Tenderness
MEASUREMENTS:
Bryant’s Triangle
Nelaton’s line.
Schoemaker’s line
Chiene’s test
Length of the lower limbs
MOVEMENTS
All movements of hip joint to the full extent
exclude possibility of any bony injury.
In posterior dislocation there is complete
limitation of abduction and lateral rotation
whereas slight adduction and internal rotation
may be possible.
X-RAY Examination
Most important investigation which will not only
indicate the type of injury but will also give a clue
to the line of fracture,type of displacement,type of
treatment required and the probable outcome of
the disease.

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CLINICAL ANATOMY AND

● Observe common gait patterns

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