Hip
Hip Anatomy
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 thighbone 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 of the Hip
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 thighbone 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 that surround and support the hip joint.
The head of the femur rotates and glides within the acetabulum. A fibrocartilaginous lining called the labrum is attached to the acetabulum and further increases the depth of the socket.
The femur is one of the longest bones in the human body. The upper part of the thighbone 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 of the Hip Joint
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 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 of the Hip Joint
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:
- Gluteal: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 in the thighs which help in adduction, the action of pulling the leg back towards the midline.
- Iliopsoas:This muscle is 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 are also called 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 backwards.
Nerves and Arteries of the Hip Joint
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 the anatomical parts of the hip work together to enable various movements.Hip movements include flexion, extension, abduction, adduction, circumduction, and hip rotation.
Conditions
Hip Pain
Hip pain, one of the common symptoms that patients complain of, may not always be felt precisely over the hip joint. Pain may be felt in and around the hip joint and the cause for pain is multifactorial. The exact position of your hip pain suggests the probable cause or underlying condition causing pain.
Osteoarthritis of the Hip
Osteoarthritis, also called degenerative joint disease, is the most common form of arthritis. It occurs most often in older people. This disease affects the tissue covering the ends of bones in a joint (cartilage).
Femoroacetabular Impingement
Femoroacetabular impingement (FAI) is a condition where there is too much friction in the hip joint from bony irregularities causing pain and decreased range of hip motion.
The femoral head and acetabulum rub against each other creating damage and pain to the hip joint.
Avascular Necrosis
Avascular necrosis, also called osteonecrosis, is a condition in which bone death occurs because of inadequate blood supply to it. Lack of blood flow may occur when there is a fracture in the bone or a joint dislocation that may damage nearby blood vessels. Hip joint is most commonly affected; however, the knee and shoulder may also be involved.
Hip Fracture
The hip joint is a “ball and socket” joint. The “ball” is the head of the femur, or thighbone, and the “socket” is the cup shaped acetabulum. The joint surface is covered by a smooth articular surface that allows pain free movement in the joint.
Chondral Lesions or Injuries
A chondral injury refers to an injury of the articular cartilage covering the joint.
Chondral injuries can result from various hip conditions such as labral tears, loose bodies, posterior dislocation, slipped capital femoral epiphysis (SCFE), dysplasia, osteonecrosis, and degenerative arthritis.
Hip Instability
The hip plays an important role in supporting the upper body weight while standing, walking and running, and hip stability is crucial for these functions. The femur (thighbone) and acetabulum (hip bone) join to form the hip joint, while the labrum (tissue rim that seals the hip joint) and the ligaments lining the hip capsule maintain the stability of the hip.
Procedures
Total Hip Replacement
The most common symptom of hip arthritis is joint pain and stiffness resulting in limited range of motion. Vigorous activity can increase the pain and stiffness which may cause limping while walking.
Diagnosis is made by evaluating medical history, a physical examination and X-rays.
Minimally Invasive Total Hip Replacement
Multiple studies have multiple different conclusions. Some say that one approach or the other has better outcomes at various early intervals. Some will show increased complications from one compared to the other at various intervals.
Anterior Hip Replacement
Over the past few years, there have been great advances in the treatment options, implants, and minimally invasive techniques. The latest technique in joint replacement such as anterior hip replacement has resulted in a dramatic improvement in outcome.
Revision Hip Replacement
Revision hip replacement is a complex surgical procedure in which all or part of a previously implanted hip-joint is replaced with a new artificial hip-joint. Total hip replacement surgery is an option to relieve severe arthritis pain that limits your daily activities.
Hip Hemiarthroplasty
The hip joint is one of the body's largest weight-bearing joints and is the point where the thighbone (femur) and the pelvis (acetabulum) unite. It is a ball and socket joint in which the head of the femur is the ball and the pelvic acetabulum forms the socket.
Outpatient Hip Replacement
Hip replacement surgery is one of the most common orthopedic surgeries performed. It involves the replacement of the damaged hip bone (ball shaped upper end of the femur) with a ceramic ball attached to a metal stem that is fixed into the femur and placing a new cup with a special liner in the pelvis.
Hip Preservation Surgery
The hip is a ball and socket joint comprising of the femur (thigh bone) and the pelvic bone. The head of the femur (ball) articulates with a cavity (socket) called the acetabulum in the pelvic bone. To facilitate the smooth and frictionless movement of the hip joint, the articulating surfaces of the femur head and acetabulum are covered by spongy articular cartilage.
Hip Arthroscopy
Arthroscopy, also referred to as keyhole or minimally invasive surgery, is a procedure in which an arthroscope is inserted into a joint to check for any damage and repair it simultaneously.
An arthroscope is a small, fiber-optic instrument consisting of a lens, light source, and video camera.
