Hips

Question 1

Describe the key features of the osteology of the hip

Answer 1

Ilium, ischium pubis

Acetabular fossa and notch surrounded by lunate surface where all 3 sections of the pelvis meet

Lunate surface, only part that articulates with the head of the femur

Acetabulum lined with articular cartilage and synovial fluid

Acetabular fossa filled with fat, blood vessels and lymphatics

Question 2

Describe the key features of the femur

Answer 2

Head with fovea, neck

Greater trochanter lateral to trochanters fossa

Intertrochanteric line and crest between greater and lesser trochanter

Shaft

Pectineal line, medial border of linea aspera
Gluteal tuberosity, lateral border of linea aspera

Quadrate tubercle, attachment for quadratus femoris above lesser trochanter
Gluteal tuberosity, attachment for gluteus maximus

Question 3

Describe the 2 axis of the femur

What are the 2 important angles of the femur

Answer 3

Anatomical axis, straight down the middle of the femur
Mechanical axis, from head to patella

Angle of anteversion, 12-15, allows for lat/med rotation
Angle of inclination

160 at birth (coxa valga)
125 in adults (124 in females, 126 in males)
90 in elderly (coxa vara)

Question 4

What are the problems with coxa vara

Answer 4

V unstable, can’t support body weight, fractures likely

Question 5

What are the problems associated with an excessive angle of anteversion
How is it resolved

Answer 5

Any higher than 12-15 =>
Lat rotation = harder
Med rotation = easier

Can’t sit cross legged, requires lateral rotation
Need to internally rotate hip to be able to laterally rotate

Question 6

Describe the key structures in the hip joint

Answer 6

Acetabulum labrum, cartilage ring that deepens and stabilises cavity

Lunate surface, only part that articulates with the head

Acetabular fossa, free of articulation

Transverse acetabular ligament, supports head

Acetabular foramen, vessels and nerves enter joint here

Question 7

Describe the key structures in the synovial joint of the hip

Answer 7

Head of femur, section closer to greater trochanters covered in synovial sleeve

Round ligament (contains foveolar artery, branch of obturator) attaches to fovea, surrounded by synovial sleeve

Branch of obturator artery passes through acetabular notch to supply femur head

Synovial membrane surrounds lunate surface

Question 8

What are the 3 capsular ligaments that surround the hip joint
What do they all do

Answer 8

Iliofemoral
Pubofemoral
Ischiofemoral

Have a spiral orientation, taut when joint extended

Question 9

Describe the characteristics of the iliofemoral ligament and its attachments
What is its function

Answer 9

AIIS and intertrochanteric line

Strongest ligament, prevents hyperextension

Y shaped, wraps partially over pubofemoral

Mainly anterior, slightly posterior

Question 10

Describe the attachments of the pubofemoral ligament

What is its function

Answer 10

Attaches to sup pubic rami and intertrochanteric line

Prevent excessive abduction and extension

Anterior

Question 11

Describe the attachments of the ischiofemoral ligament

What is its function

Answer 11

Attaches to ischium and greater trochanter

Prevents hyperextension, stabilises head

Posterior

Question 12

Describe how the function of the muscles around the hip changes as you go around the joint

Answer 12

Anterior => flexor
Posterior => extensor

Superior => abductors, some medial rotation
Inferoanterior => adductors
Inferoposterior => lateral rotation

Question 13

What movements can the gluteus maximus, medius and minimus do

Answer 13

Maximus

• Extensor
• Lat rot

Medius and minimus
-Abductor and med rot

Question 14

What movements can the iliopsoas and medial thigh comp muscles do

Answer 14

Iliopsoas
-Flexion

Med thigh comp

• Flexion
• Adduction

Question 15

What movements can the hamstrings do

Answer 15

Hamstrings

-Extensor

Question 16

What is the max angle possible in hip flexion

What is it limited by

Answer 16

Flexed knee
90-115

Straight knee
60

Hamstrings and trunk

Question 17

What is the max angle possible in hip extension

What is it limited by

Answer 17

Extension
15-30

Iliofemoral, pubofemoral ligament, v tight

Question 18

What is the max angle possible in hip abduction

What is it limited by

Answer 18

Abduction
50-60

Pubofemoral ligament, greater trochanter

Question 19

What is the max angle possible in hip adduction

What is it limited by

Answer 19

Flexed hip
15-45

Other leg

Question 20

What is the max angle possible in hip medial rotation

What is it limited by

Answer 20

Med rot
30-45

Ischiofemoral ligament

Question 21

What is the max angle possible in hip lateral rotation

What is it limited by

Answer 21

Lat rot
45-60

Pubofemoral ligament

Question 22

Describe the blood supply of the hip joint

Answer 22

Femoral => profunda femoris => lateral, medial circumflex

Lateral circumflex comes anteriorly but goes post
=> retinacular arteries

Medial circumflex wraps around and goes posteriorly => retinacular arteries

Medial circumflex supplies most of hip joint

Question 23

Fractures of the hip joint
What are the 3 types
When are they most likely to occur

Answer 23

Intertrochanteric
Subtrochanteric
Transcervical

Osteoporosis (reduced bone density)

Question 24

Describe the features of an intertrochanteric fracture

Answer 24

Between the 2 trochanters

-Retinacular arteries unaffected

Question 25

Describe the features of a transcervial fracture

Answer 25

At the neck of the femur

• Retinacular arteries affected
• Head only gets a small insufficient supply from round ligament => avascular necrosis of the head

Question 26

Describe the features of a subtrochanteric fracture

Answer 26

Shaft breaks

-Retinacular arteries unaffected