Podcast
Questions and Answers
What is the primary function of the iliofemoral ligament during hip movement?
What is the primary function of the iliofemoral ligament during hip movement?
Which statement correctly describes the attachment points of the pubofemoral ligament?
Which statement correctly describes the attachment points of the pubofemoral ligament?
During which hip movement does the ischiofemoral ligament primarily become taut?
During which hip movement does the ischiofemoral ligament primarily become taut?
Which ligaments are involved in limiting hip abduction?
Which ligaments are involved in limiting hip abduction?
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What characteristic describes the overall structure of the iliofemoral ligament?
What characteristic describes the overall structure of the iliofemoral ligament?
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What does coxa vara describe?
What does coxa vara describe?
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Which statement about the angle of torsion of the femur is correct?
Which statement about the angle of torsion of the femur is correct?
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What is the typical angle of femoral anteversion in a healthy infant?
What is the typical angle of femoral anteversion in a healthy infant?
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Excessive anteversion that persists into adulthood can lead to which condition?
Excessive anteversion that persists into adulthood can lead to which condition?
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What gait pattern is associated with excessive anteversion in children?
What gait pattern is associated with excessive anteversion in children?
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What type of joint is the hip joint classified as?
What type of joint is the hip joint classified as?
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What contributes to the in-toeing posturing in ambulatory children with cerebral palsy?
What contributes to the in-toeing posturing in ambulatory children with cerebral palsy?
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Which of the following bones does NOT form part of the pelvic bone structure?
Which of the following bones does NOT form part of the pelvic bone structure?
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What is the primary characteristic of the capsule of the hip joint?
What is the primary characteristic of the capsule of the hip joint?
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How does the pelvis serve in relation to the organs involved with bowel, bladder, and reproductive functions?
How does the pelvis serve in relation to the organs involved with bowel, bladder, and reproductive functions?
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What is one possible intervention for excessive internal rotational posturing in gait?
What is one possible intervention for excessive internal rotational posturing in gait?
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What is the primary function of the acetabulum in the hip joint?
What is the primary function of the acetabulum in the hip joint?
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What significant change occurs to the hip in elderly individuals, making it more susceptible to certain conditions?
What significant change occurs to the hip in elderly individuals, making it more susceptible to certain conditions?
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Which muscle function is NOT directly related to the pelvic bone structure?
Which muscle function is NOT directly related to the pelvic bone structure?
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What is a common functional limitation resulting from pathology or trauma affecting the hips?
What is a common functional limitation resulting from pathology or trauma affecting the hips?
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Which direction is the acetabulum primarily oriented?
Which direction is the acetabulum primarily oriented?
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What is the primary function of the femoral neck?
What is the primary function of the femoral neck?
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How does the angle of inclination of the femur change from birth to adulthood?
How does the angle of inclination of the femur change from birth to adulthood?
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What term describes abnormal growth resulting in a misshapen proximal femur?
What term describes abnormal growth resulting in a misshapen proximal femur?
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Which movements are permitted by the hip joint based on its three degrees of freedom?
Which movements are permitted by the hip joint based on its three degrees of freedom?
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What effect does a larger central edge angle have on the pelvis?
What effect does a larger central edge angle have on the pelvis?
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What occurs to the angle of inclination as children grow between the ages of 2 and 8?
What occurs to the angle of inclination as children grow between the ages of 2 and 8?
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What anatomical feature connects the femoral head to the femoral shaft?
What anatomical feature connects the femoral head to the femoral shaft?
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What is the average central edge angle value?
What is the average central edge angle value?
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Study Notes
Hip Joint Structure
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The hip joint is a synovial ball and socket joint, formed by the femoral head and the acetabulum.
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The hips serve as "base" joints for the lower extremities, as well as the basilar joints for the entire superimposed pelvis and trunk.
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Pathology or trauma impacting the hips can cause various functional limitations, such as difficulty in:
- Walking
- Dressing
- Driving
- Lifting and carrying
- Climbing stairs
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Hip disease and injury are common among the very young and elderly.
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Abnormal hip formation in infants can lead to dislocation.
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The elderly are more prone to degenerative joint disease and hip fracture due to:
- Osteoporosis
- Increased risk of falling
Pelvic Bone
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The pelvic bone is formed by the union of three bones: the ilium, pubis, and ischium.
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The right and left pelvic bones connect anteriorly at the pubic symphysis and posteriorly at the sacrum.
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The pelvic bone has three main functions:
- Serves as a common attachment point for many muscles of the lower extremity and trunk.
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Transmits weight of the upper body and trunk to the:
- ischial tuberosities during sitting
- lower extremities during standing and walking
- Supports organs involved with bowel, bladder, and reproductive functions with the aid of muscles and connective tissues of the pelvic floor.
Acetabulum
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The acetabulum is located just above the obturator foramen and is a large cup-shaped structure.
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It forms the socket of the hip joint and receives the femoral head.
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The acetabulum lies on the lateral aspect of the hip bone and is directed:
- Laterally
- Inferiorly
- Anteriorly
Femur
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The femur is the longest bone in the human body.
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The head of the femur projects medially and slightly anteriorly to articulate with the acetabulum.
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The femoral neck connects the femoral head to the shaft and displaces the proximal shaft of the femur laterally away from the joint, reducing the risk of bony impingement against the pelvis.
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The femoral head is oriented:
- Superiorly
- Medially
- Anteriorly
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The neck of the femur joins the shaft and supports the head.
Proximal Femur Shape
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Factors influencing the shape of the proximal femur during development:
- Differential growth of the bone's ossification centers
- Force of muscle activation
- Weight bearing
- Circulation
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Femoral dysplasia refers to abnormal growth and development resulting in a misshaped proximal femur.
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Trauma and systemic factors can also affect the shape of the proximal femur.
Hip Joint Degrees of Freedom
- The hip joint allows three degrees of freedom:
- Flexion and extension in the sagittal plane
- Abduction and adduction in the frontal plane
- Medial and lateral rotation in the transverse plane
Angles within the Hip Joint
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Central edge angle of the acetabulum:
- Measured between two lines:
- Line connecting the lateral rim of the acetabulum to the center of the femoral head
- Vertical line passing through the center of the femoral head
- Average value is 22-42 degrees.
- Measured between two lines:
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Function of the central edge angle:
- Provide lateral stability of the pelvis
- A larger angle indicates:
- Increased inferior tilting of the acetabulum
- Increased diameter of the pelvis
- Greater coverage of the femoral head
- A smaller angle leads to diminished coverage of the femoral head.
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Angle of inclination of the femur (neck-shaft angle):
- Measured between the anatomical axis of the femoral neck and the anatomical axis of the femoral shaft in the frontal plane.
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Angle of inclination at birth: 165–170 degrees
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Decreases by about 2 degrees per year between 2 and 8 years of age due to:
- Muscle activity
- Loading across femoral neck during walking
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Normal adult value: 125 degrees
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Coxa vara: Angle of inclination less than 125 degrees
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Coxa valga: Angle of inclination greater than 125 degrees
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Abnormal angles:
- Alter articulation between femoral head and acetabulum
- Affect hip biomechanics
- Can lead to dislocation or degenerative joint disease
Angle of Torsion of the Femur
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Angle of torsion:
- Measured between the axis of the femoral neck and the axis of the femoral condyles in the transverse plane.
- Normal value: 15 degrees (10-30 degrees)
- Decreases with age
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Femoral torsion: Relative rotation (twist) between the femoral shaft and neck.
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Normal alignment (viewed from above):
- Femoral neck projects several degrees anterior to a medial-lateral axis through the femoral condyles.
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Excessive anteversion:
- Increased likelihood of hip dislocation
- Articular incongruence
- Increased joint contact stress
- Increased wear on articular cartilage or acetabular labrum
- Can lead to secondary osteoarthritis of the hip
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Excessive anteversion in children:
- May cause in-toeing gait pattern
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Factors contributing to in-toeing:
- Spasticity or tightness of hip internal rotator and adductor muscles
- Excessive pelvic rotation
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Possible treatment for in-toeing: Femoral de-rotational osteotomy
Hip Joint Capsule
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The capsule is strong, dense, and shaped like a cylindrical sleeve.
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Attachments:
- Entire periphery of the acetabulum
- Femoral neck (intracapsular)
- Greater and lesser trochanters (extracapsular)
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Thicker anterosuperiorly where stress occurs.
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Thinner and loosely attached posteroinferiorly.
Hip Joint Ligaments
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The capsule is strengthened by powerful ligaments anteriorly and posteriorly.
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Anterior ligaments:
- Iliofemoral ligament
- Pubofemoral ligament
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Posterior ligament:
- Ischiofemoral ligament
Iliofemoral Ligament
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Shape: Fan-shaped, resembling an inverted letter Y.
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Attachments:
- Proximal: Near the anterior-inferior iliac spine
- Distal: Whole length of the trochanteric line
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Function:
- Limits hyperextension.
- Taut during adduction of superior fibers.
- Taut during lateral rotation.
- Reinforces the front part of the capsule.
Pubofemoral Ligament
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Attachments:
- Along the anterior and inferior rim of the acetabulum
- Adjacent parts of the superior pubic ramus
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Bands of iliofemoral and pubofemoral ligaments form a Z letter on the anterior capsule.
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Function:
- Taut during hip abduction and extension.
- Taut during external rotation, to a lesser degree.
Ischiofemoral Ligament
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Attachments:
- Posterior aspect of the acetabulum
- Near the apex of the greater trochanter
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Function:
- Taut during hip abduction and extension.
- Taut during medial rotation.
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Description
This quiz covers the anatomy and functional aspects of the hip joint and pelvic bone. It discusses the formation, pathology, and common injuries associated with these structures, particularly in different age groups. Understand key terms and implications related to hip disorders.
