Hip Joint Flashcards
Label the anatomy of the hip joint and on XRAY
Lecture slide
Perineal vs peroneal vs pudendal nerve
Peroneal: Fibular
Perineal: in artery and nerve + of the perineum
Pudendal nerve: Nerve to perineum
Hip tilt?
Hip bones articulate with?
Evolved for ?
Pelvis is tilted forward - ASIS and pubic tubercle are in the same plane
Hip bones articulate with the sacrum at sacro-iliac joint
Evolved for both movement and stability, (standing the body weight is transferred through the hips to the femurs and legs).
Hip Joint:
Location
More worn out in what gender?
Joint between femoral head and acetabulum of hip bone
Joint replacement Common in women
Label areas of full hip anatomy
Lecture Slide
Feature about femoral head in Acetabulum
Head is 2/3 size of socket - fully recessed in
What type of joint is hip
And what structures allow this movement
Multi-axial ball and socket type joint
Articulation between the femoral head as the ball and the acetabulum as the socket.
Acetabulum:
- Label areas surrounding it
- what structures from acetabulum?
-Describe location/about each aspect around Acetabulum
- Acetabulum filled with?
formed from ilium, ischium and pubis
The ilium forms the superior part of the acetabulum, the ischium the posterior part and the pubis the anterior part.
Rim of cartilage covers most of articular surface - called Lunate surface
This is surface that is worn out in OA
Acetabular fossa is central area - no bone Acetabular fossa is filled with fat
Blood vessels and ligaments in acetabular fossa
- connects what together?
-Importance of blood vessel
- CHange in childhood vs adulthood
-Label the blood vessel and ligament o diagram
Acetabular fossa has a blood vessel that is inside a ligament
Ligament connects acetabular fossa to the fovea of the femoral head called ligamentum teres
* Vessel is branch of obturator artery
* Important as infant supplying head femur
* Reduced in size greatly in early teens
* In adult it provides very little - zero blood to femoral head
Ligamentum teres and Transverse Acetabular Ligament (TAL)
- describe
-purpose
-clinical importance
Ligamentum teres is a sturdy structure
- prevents hip dislocation
- connects the femoral head to the acetabulum
Transverse Acetabular Ligament (TAL) covering the acetabular notch inferiorly where no cartilage
- lies under the femoral head and connects the two ends of the acetabulum together
Helps suspend femoral head in acetabulum
Important clinically to orient hip replacements
Why is the hip joint so stable
The femoral head forms 2/3 of a sphere
The acetabular labrum (from fibrocartilage lunate cartilage) further increases the articular area by 10%
The femoral head is more than 50% covered by the acetabulum.
Label the areas of the neck of femur
Lecture Slide
Where the neck joins the shaft there are two large bony elevations- the greater and lesser trochanters
The bony ridge running across the femoral neck between the two trochanters is the intertrochanteric line
Direction of femur
Directed superomedially and slightly anteriorly in its articulation with the acetabulum
type of axis of femur
- how many degrees
-purpose of this axis type
Femur has a long axis
Axis of femoral neck is ~125o to long axis
This allows for great mobility at the hip joint Puts a lot of force through the femoral neck
Most of force is on lower half of the neck
On cross section the inferior part is thicker to support the weight transmitted through the head. When repaired metal hardware is often placed in this stronger region
What are the Ligaments (3) of Joint capsule of hip
- describe and locate on diagram
-describe the location of joint capsuale relative to ligaments
- Pubofermoral ligament
- iIiofemoral ligament
- Ischiofemoral ligament
The capsule is attached proximally to the acetabulum and transverse acetabular ligament and distally into the intertrochateric line of the femur
The hip has a very strong thick joint capsule. Unlike the shoulder the hip is designed to bear weight. Needs to be held together tightly or will dislocate
- These Thicker parts of the capsule also form the ligaments of the hip joint which act to pull the femoral head medially into the acetabulum
What is orbicular zone
-Direction of fibres and how does this change during movement
Some fibres circle around the femoral head to form the orbicular zone
Most fibres take a spiral course which tighten as the thigh is extended and unwind as it is flexed (notice how much more flexion is permitted than extension)
Movements of hip joint and assosicated -muscles
-myotomes
-nerves
Flexion:
iliopsas
Rectus femoris
(minor: sartorius)
Myotomes: L2, L3
Femoral nerve
Extension:
Gluteus maximus
Hamstring
Myotomes: L4, L5, S1
Tibial nerve (L4-S1), Inferior gluteal nerve (L5-S2)
Adduction:
Adductor magnus, longus and brevis
Pectinus
Gracilis
Myotomes: L2-L4
Obturator nerve (L2-L4)
Abduction: Gluteus medius
Gluteus minimus
TFL
(minor: piriformis and sartorius)
Myotomes: L5 and S1
Superior gluteal nerve L4-S1
Arterial Supply to the Hip:
Label on diagram
Lecture Slide
What are the arteries supplying the hip joint
Describe anatomical Location
The arteries supplying the hip joint are the Medial and Lateral
Circumflex femoral Arteries, which are branches off the Profunda Femoris Artery
The medial circumflex femoral artery runs posteriorly; the lateral circumflex femoral artery runs anteriorly around the femoral neck to form a lateral anastomosis. Also anastomose with gluteal vessel anastomoses
Arteries of the
Thigh:
Describe from top to bottom
Label diagram
Lecture slide
Femoral artery gives off profundal femoris branch at level of neck of femur.
Profunda femoris a. branches: Medial circumflex femoral a. Lateral circumflex femoral a. Perforating arteries of Profunda femoris a.
Lateral circumflex femoral a. Branch:
Descending branch of Lateral circumflex femoral a.
Label arteries on Xray image
Lecture Slide
Retinaculuar arteries
Where do they run from/run to?
-importance
Off the circumflex arteries comes the
retinacular arteries, pierce the capsule and run in the retinacular folds of the synovial membrane and run up into the femoral head
These retinacular vessels are crucial for vascular supply to the femoral head and neck
Nerve supply to hip is based on what law
-describe
- Nerves of hip joint (5)
Hilton’s Law
The nerves supplying a joint come from any that cross it or any that supply muscles that cross the joint
1.Femoral Nerve (iliacus )
2. Obturator Nerve (medial compartment adductors)
3.Superior Gluteal Nerve (gluteus medius)
4.Nerve to Quadratus Femoris (posteriorly)
5.Sciatic nerve
Neck of femur fracture due to ischemia:
Describe general process
Bone is more sensitive to ischemia than cartilage (nutrients from synovial fluid)
Ischemic bone develops avascular necrosis
cartilage doesn’t die immediately as it gets its nutrition from the synovial fluid, cartilage gets destroyed as bone crumbles.
Destroyed joint is painful
Who is likely to get neck of femur fractures?
High energy in young patients - traumatic event
Low energy falls in older, especially women with osteoporosis
Types of fractures and are they bad or less bad
Bad: Capital, subcapital, transcervical
Less bad:
Intertrochanteric, subtrochanteric
Intertrochanteric fracture repair
-problems with solution
Dynamic hip screw
-> have to be careful not to damage bone more
-> don’t want to damage profunda femoris artery
Clinical Importance:
Neck of Femur fracture
-cause of fracture
-what types of fratures are more likely to affect blood supply?
- Trauma, osteoporosis and tumour can all lead to fractures of the femoral neck
- Depending on the location of the fracture the blood supply to the head of the femur may be disrupted
- A subcapital (under the head) fracture is most likely to disrupt the blood supply to the head, while a more distal intertrochanteric fracture usually leaves the vascular supply intact.
Treatment chocie depends on
head viability.
Posterior dislocation:
Causes
Anatomical position it occurs in
Posterior Dislocation:
Causes:
- Car crashes
- Falls from height
- Sports injuries
The usual position for this to occur is with the hip flexed, adducted and
internally rotated (as when seated in a car)
* The femoral head then moves superiorly, resulting in a short, internally rotated leg.
What determines if a posterior dislocation is a serious injury
- Soft tissue
damage - risk of avascular
necrosis from arterial damage
Anterior dislocaton
Causes:
What makes it a serious injury?
Causes:
- Forceful abduction with external
rotation of the thigh
- Car crashes
- Falls from height
- Sports injuries
Serious Injury!
- Soft tissue
damage
- risk of avascular
necrosis from arterial damage
- When does femoral artery go from anterior to posterior
At the adductor hiatus
What supplies the femoral head
reticular vessels
Hip joint movements
-assosciated muscles and spinal nerves being tested and nerve supply
Flexion:
ilipsoas
Rectus femoris
L2/L3
Femoral Nerve
Extension:
Glute Max
Hamstrings
L4-S1
Tibial nerve (L4-S1)
Inferior gluteal nerve (L5-S2)
Adduction
Adductor magnus, longus and brevus,pectinus, gracilis
L2-L4
Obturator (L2-L4)
Abduction
Glute medius, minimus
TFL
L5, S1
Superior gluteal (L4-S1)
Why are hip fractures repaired instantly with surgery even though this is a long surgey? Especially for edlery
Immediate surgery in elderly can be risky but it avoids extended bed rest
* Deep vein thrombosis and pulmonary embolism
* Pneumonia
* Muscle loss from inactivity
* Bedsores
