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Learning objectives 1. Understand the formation of hip joint 2. The ligaments involved in stability of the joint 3. The joint capsule and its attachment around the joint. 4. To know the muscles acting on the joint and different movements performed 5. The nerve and blood supply of the joint 6. The radiographic appearance and the dissection of the joint Lecture outline The Hip Joint • The hip joint is formed by the articulation of the head of the femur into the acetabulum of the hip. • ball-and-socket joint. • Synovial joint Bones • • • • Ilium Ischium Pubis Femur • The acetabulum is formed by the pubis, ischium and ilium bones Joint Capsule • • • • Strong fibrous sleeve specialized thickening, called ligaments, add stability Anteriorly – proximally to the bone surrounding the acetabulum. – Distally to the trochanteric line Posteriorly – to the margins of the acetabulum and surrounding bone – neck of the femur- not to the trochanteric crest Ligaments Iliofemoral ligament: • Strongest ligament in the human body. • Attaches to the illium between the two heads of the rectus femoris muscle. • Y shaped. One goes to the base of the greater trochanter and the other to the base of the lesser trochanter. • Seeks to resist excessive extension of the hip joint. Ischiofemoral ligament: • • Attaches from the ischial part of the acetabular rim to the femur. Posterior joint capsule is reinforced by this ligament. Pubofemoral ligament: • • • Attaches to the base of the lesser trochanter and the superior ramus of the pubis, just above the obturator foramen. It is inferior to the iliofemoral ligament and reinforces the inferior part of the hip joint capsule. It also blends with the medial parts of the iliofemoral ligament • The round ligament of the head of the femur is attached to the transverse acetabular ligament and extends to the fovea centralis on the head of the femur • A fibrocartilaginous ring called the acetabular labrum deepens the acetabulum and clasps the head of the femur which makes the joint more stable Muscles • External rotators: piriformis, quadratus femoris, Obturator internus • • • • • and externus, gemellus superior and inferior, Flexors: iliopsoas, rectus femoris Adductors: adductor magnus, adductor longus and brevis, pectineus, gracilis Internal rotators: gluteus medius, gluteus minimus, tensor fascia latae Extensors: semitendinosus and semimembranosus, biceps femoris, gluteus maximus Abductors: gluteus medius, gluteus minimus Nerves • • • • • Femoral Obturator Sciatic Nerve to quadratus femoris Direct branches of sacral plexus Blood Supply • • • • Medial Circumflex Lateral Circumflex Obturator Inferior gluteal Movements • Flexion- mainly due to contraction of the iliopsoas muscle, with • • • • • help from the sartorius, rectus femoris, and pectineus Extension- chiefly by the guteus maximus muscles with help by the hamstrings Adduction- by the adductor longus, brevis, magnus and the gracilis Abduction- by the gluteus medius and gluteus minimus Lateral rotation- by the gluteus maximus, quadratus femoris, piriformis, obturator internus and externus, gemelli Medial rotation- by the anterior part of the glueteus minimus and medius and tensor fasciae latae muscles