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Hip Anatomy

Hip Joint

The hip joint is the largest weight-bearing joint in the human body. It is also referred to as a ball and socket joint and is surrounded by muscles, ligaments, and tendons. The thigh bone or femur and the pelvis join to form the hip joint.

Any injury or disease of the hip will adversely affect the joint's range of motion and ability to bear weight.

The hip joint is made up of the following:

  • Bones and joints
  • Ligaments of the joint capsule
  • Muscles and tendons
  • Nerves and blood vessels that supply the bones and muscles of the hip

Bones and Joints

The hip joint is the junction where the hip joins the leg to the trunk of the body. It is comprised of two bones: the thigh bone or femur and the pelvis which is made up of three bones called ilium, ischium, and pubis.  The ball of the hip joint is made by the femoral head while the socket is formed by the acetabulum. The Acetabulum is a deep, circular socket formed on the outer edge of the pelvis by the union of three bones: ilium, ischium, and pubis. The lower part of the ilium is attached by the pubis while the ischium is considerably behind the pubis. The stability of the hip is provided by the joint capsule or acetabulum and the muscles and ligaments which surround and support the hip joint.

The head of the femur rotates and glides within the acetabulum. A fibrocartilagenous lining called the labrum is attached to the acetabulum and further increases the depth of the socket.

The femur or thigh bone is one of the longest bones in the human body. The upper part of the thigh bone consists of the femoral head, femoral neck, and greater and lesser trochanters. The head of the femur joins the pelvis (acetabulum) to form the hip joint. Next, to the femoral neck, there are two protrusions known as greater and lesser trochanters which serve as sites of muscle attachment.

Articular cartilage is the thin, tough, flexible, and slippery surface lubricated by synovial fluid that covers the weight-bearing bones of the body. It enables smooth movements of the bones and reduces friction.

Ligaments

Ligaments are fibrous structures that connect bones to other bones.  The hip joint is encircled with ligaments to provide stability to the hip by forming a dense and fibrous structure around the joint capsule. The ligaments adjoining the hip joint include:

  • Iliofemoral ligament: This is a Y-shaped ligament that connects the pelvis to the femoral head at the front of the joint. It helps in limiting the over-extension of the hip.
  • Pubofemoral ligament: This is a triangular shaped ligament that extends between the upper portion of the pubis and the iliofemoral ligament. It attaches the pubis to the femoral head.
  • Ischiofemoral ligament: This is a group of strong fibers that arise from the ischium behind the acetabulum and merge with the fibers of the joint capsule.
  • Ligamentum teres: This is a small ligament that extends from the tip of the femoral head to the acetabulum. Although it has no role in hip movement, it does have a small artery within that supplies blood to a part of the femoral head.
  • Acetabular labrum: The labrum is a fibrous cartilage ring which lines the acetabular socket. It deepens the cavity, increasing the stability and strength of the hip joint.

Muscles and Tendons

A long tendon called the iliotibial band runs along the femur from the hip to the knee and serves as an attachment site for several hip muscles including the following:

  • Gluteals: These are the muscles that form the buttocks. There are three muscles (gluteus minimus, gluteus maximus, and gluteus medius) that attach to the back of the pelvis and insert into the greater trochanter of the femur.
  • Adductors: These muscles are located in the thigh which helps in adduction, the action of pulling the leg back towards the midline.
  • Iliopsoas:  This muscle is located in front of the hip joint and provides flexion. It is a deep muscle that originates from the lower back and pelvis and extends up to the inside surface of the upper part of the femur.
  • Rectus femoris: This is the largest band of muscles located in front of the thigh. They also are hip flexors.
  • Hamstring muscles: These begin at the bottom of the pelvis and run down the back of the thigh. Because they cross the back of the hip joint, they help in extension of the hip by pulling it backward.

Nerves and Arteries

Nerves of the hip transfer signals from the brain to the muscles to aid in hip movement. They also carry the sensory signals such as touch, pain, and temperature back to the brain.

The main nerves in the hip region include the femoral nerve in the front of the femur and the sciatic nerve at the back.  The hip is also supplied by a smaller nerve known as the obturator nerve.

In addition to these nerves, there are blood vessels that supply blood to the lower limbs. The femoral artery, one of the largest arteries in the body, arises deep in the pelvis and can be felt in front of the upper thigh.

Hip Movements

All of the anatomical parts of the hip work together to enable various hip movements.  Hip movements include flexion, extension, abduction, adduction, circumduction, and hip rotation.

Hip Conditions

Hip Fracture

Hip Fracture

A hip fracture is a break that occurs near the hip in the upper part of the femur or thighbone. The thighbone has two bony processes on the upper part - the greater and lesser trochanters. The lesser trochanter projects from the base of the femoral neck on the back of the thighbone.

Osteoarthritis of the Hip

Osteoarthritis of the Hip

Osteoarthritis, also called degenerative joint disease, is the most common form of arthritis. It occurs most often in the elderly. This disease affects the tissue covering the ends of bones in a joint called cartilage. In osteoarthritis, the cartilage becomes damaged and worn out, causing pain, swelling, stiffness and restricted movement in the affected joint.

Inflammatory Arthritis of the Hip

Inflammatory Arthritis of the Hip

The inflammation of the joints is referred to as arthritis. Inflammation arises when the smooth lining called cartilage at the ends of bones wears away. In some cases, the inflammation is caused when the lining of the joint becomes inflamed as part of an underlying systemic disease.

Femur Fracture

Femur Fracture

The femur or thigh bone is the longest and strongest bone in the body, connecting the hip to the knee. A femur fracture is a break in the femur. The distal femur is the lower part of the thigh bone which flares out like an upside-down funnel and its lower end is covered by a smooth, slippery articular cartilage that protects and cushions the bone during movement.

Pelvic Fractures

Pelvic Fractures

A pelvic fracture is a condition that occurs due to the breakage of the pelvic bone. It may cause damage to the internal organs, nerves and blood vessels associated with the pelvic region.

Femoral Shaft Fracture

Femoral Shaft Fracture

A femoral shaft fracture is a crack or break anywhere along the long and straight section of the femur (thighbone) due to high-energy trauma or low-energy trauma in osteoporotic patients. The femur is the strongest and longest bone in the body. It connects with the pelvis at the top to form the hip joint and the tibia and fibula at the bottom to form the knee joint.

Avulsion Fractures of the Pelvis

Avulsion Fractures of the Pelvis

Avulsion fractures of the pelvis is an injury that occurs when a tendon or ligament pulls off a piece of bone from the hip. This results in a part of the pelvic (hip) bone breaking away from the main part of the bone.

Periprosthetic Hip Fractures

Periprosthetic Hip Fractures

Hip replacement is a surgical procedure in which the damaged cartilage and bone are removed from the hip joint and replaced with artificial components. Any resulting fractures or breaks in the bone around the implant are called periprosthetic hip fractures. They usually occur around the stem of the implant and sometimes to the socket (acetabulum).

Femoral Neck Fracture

Femoral Neck Fracture

Fractures to the femoral neck can completely or partially disconnect the femoral head from the rest of the femur. Femoral neck fractures may be either displaced, where the bone is moved out of its original position, or non-displaced, where there is no instability of the bone. These fractures may disrupt the blood supply to the fractured portion of the bone.

Subtrochanteric Hip Fracture

Subtrochanteric Hip Fracture

A hip fracture is a break that occurs near the hip in the upper part of the femur or thighbone. The thighbone has two bony processes on the upper part - the greater and lesser trochanters. The lesser trochanter projects from the base of the femoral neck on the back of the thighbone. Hip fractures can occur either due to a break in the femoral neck, in the area between the greater and lesser trochanter or below the lesser trochanter.

Hip Bursitis

Hip Bursitis

Hip bursitis is a painful condition caused by the inflammation of a bursa in the hip. Bursae are fluid-filled sacs present in the joints between bone and soft tissue to reduce friction and provide cushioning during movement.

Hip Procedures

Total Hip Replacement

Total Hip Replacement

Total hip replacement is a surgical procedure in which the damaged cartilage and bone are removed from the hip joint and replaced with artificial components. The main indication for total hip replacement is arthritis.

Minimally Invasive Total Hip Replacement

Minimally Invasive Total Hip Replacement

Minimally invasive total hip replacement is a surgical procedure performed through one or two small incisions rather than the single long incision of 10–12-inches as in the traditional approach.

Posterior Hip Replacement

Posterior Hip Replacement

Posterior hip replacement is a minimally invasive hip surgery performed to replace the hip joint. It is also referred to as muscle sparing surgery because no muscles are cut to access the hip joint, enabling a quicker return to normal activity.

Anterior Hip Replacement

Anterior Hip Replacement

Direct anterior hip replacement is a minimally invasive hip surgery to replace the hip joint without cutting through any muscles or tendons as against traditional hip replacement that involves cutting major muscles to access the hip joint.

Outpatient Hip Replacement

Outpatient Hip Replacement

Outpatient hip surgeries are mainly targeted at treating the joints damaged by arthritis and injuries. Chronic joint pain due to erosion of cartilage, damage due to accidents and autoimmune diseases, or bone death leading to the destruction of cartilage are also treated with the help of this surgery.

Custom/Patient-Specific Hip Replacement

Custom/Patient-Specific Hip Replacement

Custom total hip replacement, also called bespoke hip replacement or patient-specific hip replacement, is a newer, more advanced technology in total hip arthroplasty that uses an individualized hip implant for the replacement of the damaged or injured components of the hip joint. The hip implant is an artificial device used to restore the natural anatomy of the hip joint and improve or restore range of motion.

Hip Fracture ORIF

Hip Fracture ORIF

A hip fracture is a break that occurs near the hip in the upper part of the femur or thighbone. The thighbone has two bony processes on the upper part - the greater and lesser trochanters. The lesser trochanter projects from the base of the femoral neck on the back of the thighbone. Hip fractures can occur either due to a break in the femoral neck, in the area between the greater and lesser trochanter or below the lesser trochanter.

Hip Hemiarthroplasty

Hip Hemiarthroplasty

Hip hemiarthroplasty is a surgical technique employed to treat hip fractures. In this procedure, only one half (ball section) of the hip joint is substituted by a metal prosthesis.

Hip Trauma Reconstruction

Hip Trauma Reconstruction

Hip trauma is an injury in the hip due to the impact caused by incidents such as a car accident or a hard fall. The injury can be a bone break or dislocation or both.

Hip Reconstruction

Hip Reconstruction

Hip reconstruction is a surgery to repair or replace a damaged hip joint that causes pain and limits your movement.

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