Hip
Anatomy of Hip
Hip Joint
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 thigh bone 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
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 thigh bone 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 which surround and support the hip joint.
The head of the femur rotates and glides within the acetabulum. A fibrocartilagenous lining called the labrum is attached to the acetabulum and further increases the depth of the socket.
The femur or thigh bone is one of the longest bones in the human body. The upper part of the thigh bone 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
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 the 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
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:
- Gluteals: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 located in the thigh which helps in adduction, the action of pulling the leg back towards the midline.
- Iliopsoas: This muscle is located 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 also are 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 backward.
Nerves and Arteries
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 of the anatomical parts of the hip work together to enable various hip movements. Hip movements include flexion, extension, abduction, adduction, circumduction, and hip rotation.
Conditions
Hip Adductor Injuries
Hip adductors are the group of muscles on the inner side of your thigh that enable adduction or the ability to bring the thighs together.
A hip adductor injury is also called a groin strain or groin tear and involves any of the adductor muscles. These injuries are common among athletes and those who play hockey, football, soccer, basketball, tennis, baseball, etc.
Stress Fractures of the Hip
Stress fractures of the hip are a break in the upper part of the thigh bone (femur) that fits into the socket of the hip joint. It can occur in any part of the hip, however, it mostly occurs just below the ball of the ball-and-socket hip joint called the femoral neck.
Stress fractures of the hip are more common in distance runners (high-mileage runners), ballet dancers or high impact athletes of any age.
Avulsion Fractures of the Pelvis
Avulsion fractures of the pelvis is an injury that occurs when a tendon or ligament pulls off a piece of bone from the hip. This results in a part of the pelvic (hip) bone breaking away from the main part of the bone.
Hip Injury
The hip joint is one of the most important and flexible joints in the human body which allows us to walk, run, bend and perform physical activities. It is a ball (femoral head) and socket joint formed between the hip bone and femur (thighbone). It is surrounded by strong muscles and tough ligaments that prevent its dislocation.
Gluteus Tendon Tear
The gluteal muscles (situated in the buttocks) are necessary for the stability and movement of the hip joints. The tendons of two gluteal muscles (gluteus medius and gluteal minimus) are attached at the outer hip region and are often called the “rotator cuff of the hip.” These tendons may be subject to injury or tearing due to various reasons.
Snapping Hip Syndrome
The hip is an important joint that helps us walk, run and jump. The ball-and-socket joint of the hip is formed by the round end of the femur (thighbone) and the cup-shaped socket of the acetabulum (part of the pelvis). Stability of the hip joint is achieved by the labrum (a strong fibrous cartilage that covers the acetabulum and seals it), ligaments (tissues connecting bone to bone) and tendons (tissues connecting muscle to bone) that encase the hip and support the hip movements.
Hip Bursitis
Hip bursitis is a painful condition caused by the inflammation of a bursa in the hip. Bursae are fluid-filled sacs present in the joints between bone and soft tissue to reduce friction and provide cushioning during movement.
Femoroacetabular Impingement
Femoroacetabular impingement (FAI) is a condition characterized by excessive friction in the hip joint from the presence of bony irregularities. These cause pain and decreased range of hip motion.
The femoral head and acetabulum rub against each other, causing damage and pain to the hip joint. The damage can occur to the articular cartilage (the smooth white surface of the ball or socket) or the labral tissue (the lining of the edge of the socket).
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.
Hip Dislocation
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 is surrounded by muscles, ligaments, and tendons that support and hold the bones of the joint in place. Hip dislocation occurs when the head of the femur moves out of the socket.
Hip Labral Tear
The hip joint is a ball and socket joint in which the head of the femur is the ball and the acetabulum forms the socket. The labrum helps to deepen the socket and provide stability to the joint. It also acts as a cushion and enables smooth movement of the joint.
Hip Instability
The hip plays an important role in supporting your upper body weight while standing, walking and running, and hip stability is crucial for these functions. The femur (thighbone) and acetabulum (socket-shaped region of the pelvis) join to form the hip joint, while the labrum (rim of tissue that seals the hip joint) and the ligaments lining the hip capsule maintain the stability of the hip.
Hip Groin Disorders
Hip and groin disorders are more common in athletes. They are caused by rapid acceleration and deceleration motion.
The rehabilitation time for hip and groin injuries is longer than most other injuries, therefore, early and accurate diagnosis is essential. The management of hip and groin injuries is complex due to the presence of multiple anatomic structures in that region.
Subtrochanteric Hip Fracture
A hip fracture is a break that occurs near the hip in the upper part of the femur or thighbone. The thighbone has two bony processes on the upper part - the greater and lesser trochanters. The lesser trochanter projects from the base of the femoral neck on the back of the thighbone. Hip fractures can occur either due to a break in the femoral neck, in the area between the greater and lesser trochanter or below the lesser trochanter.
Hip Abductor Tears
Hip abductors are a major group of muscles found in the buttocks. It includes the gluteus maximus, gluteus medius, gluteus minimus, and tensor fascia lata muscles.
Hip Synovitis
Hip synovitis, also called transient hip synovitis or toxic synovitis, is a condition characterized by inflammation of the synovial tissues that surround the hip joint. It is the most common cause for sudden hip pain that occurs in young children between the age of 2 and 9. It affects boys more commonly than girls and is most of the time limited to only one side of the hip.
Developmental Dysplasia
Developmental dysplasia of the hip (DDH) or hip dysplasia is a condition that is seen in infants and young children because of developmental problems in the hip joint. The femur (thighbone) partially or completely slips out of the hip socket leading to dislocation at the hip joint. It is most common in the first-born baby with a family history of the disorder.
Irritable Hip
Irritable hip, also known as acute transient synovitis, is a common disorder of childhood characterized by hip pain and limping. The term transient means that it does not last long. It usually occurs before puberty and affects only one hip. Boys aged between 4 to 10 years are most often affected.
Hip Tendonitis
Tendons are strong connective tissue structures that connect muscle to bone. Hip tendonitis is a condition associated with degeneration of the hip tendons. This condition is mainly caused due to strain on the tendons which may occur due to overuse or biomechanical problems.
Hip Pointer
The hip joint consists of the femur (thighbone) and pelvic bone, which is made up of the fusion of three bones – the ischium, pubis, and ilium. The femur has two boney prominences close to the hip joint – the greater and lesser trochanters. Hip pointer is an injury or bruise to the iliac crest (curved upper border of the ilium) or greater trochanter, or the surrounding muscles or tissues.
Transient Osteoporosis of the Hip
Transient osteoporosis of the hip is a rare condition that causes temporary bone loss in the upper region of the thighbone (femur). It occurs most often in young or middle-aged men of the age groups 30 to 60, and women in their later stages of pregnancy or early postpartum (following childbirth). It is characterized by abrupt onset of pain that increases with activity.
Osteoarthritis of the Hip
Osteoarthritis, also called degenerative joint disease, is the most common form of arthritis. It occurs most often in the elderly. This disease affects the tissue covering the ends of bones in a joint called cartilage. In osteoarthritis, the cartilage becomes damaged and worn out, causing pain, swelling, stiffness and restricted movement in the affected joint.
Inflammatory Arthritis of the Hip
The inflammation of the joints is referred to as arthritis. Inflammation arises when the smooth lining called cartilage at the ends of bones wears away. In some cases, the inflammation is caused when the lining of the joint becomes inflamed as part of an underlying systemic disease. These conditions are referred to as inflammatory arthritis.
Groin Injuries in Athletes
Groin injuries are injuries sustained by athletes during sports activity. Groin injuries comprise about 2 to 5 percent of all sports injuries. The most common kind of groin injury is a groin strain or a pulled groin muscle. Typical groin injuries vary based on athlete’s gender, age, and sports, with most common groin injuries occurring in certain sports such as football with a prevalence rate as high as 12-16%.
Hamstring Injuries
The hamstring is a group of three muscles that run along the back of the thigh from the hip to the knee. Hamstring injuries occur when these muscles are strained or pulled. They are common in dancers and athletes of all sorts including runners and those who play football, soccer, basketball, tennis, etc.
Procedures
Anterior Jiffy Hip
Total joint replacement surgery is one of the most advanced and successful procedures to treat severe hip and knee pain due to arthritis. Arthritis is a condition in which the articular cartilage that covers the joint surface is damaged or worn out causing pain and inflammation.
Anterior Hip Replacement
Total joint replacement surgery is one of the most advanced and successful procedures to treat severe hip and knee pain due to arthritis. Arthritis is a condition in which the articular cartilage that covers the joint surface is damaged or worn out causing pain and inflammation.
Minimally Invasive Total Hip Replacement
The hip joint is one of the body's largest weight-bearing joints and is the point where the thighbone (femur) and pelvis (acetabulum) join. It is a ball-and-socket joint in which the head of the femur forms the ball and the pelvic acetabulum forms the socket. The joint surface is covered by a smooth articular cartilage that cushions and enables smooth movement of the joint.
Total Hip Replacement
Total hip replacement is a surgical procedure in which the damaged cartilage and bone is removed from the hip joint and replaced with artificial components.
Surgery may be recommended if conservative treatment options such as anti-inflammatory medications and physical therapy do not relieve your symptoms.
Mini-Posterior Hip Replacement
Mini-posterior hip replacement is a surgical procedure used to replace your damaged hip with synthetic parts inserted through a small incision made at the back of the hip.
The surgery involves the replacement of portions of the pelvis and femur (thighbone) without disturbing the vital abductor muscles that are critical to hip stability and gait.
Posterior Hip Replacement
Posterior hip replacement is a minimally invasive hip surgery performed to replace the hip joint. It is also referred to as muscle sparing surgery because no muscles are cut to access the hip joint, enabling a quicker return to normal activity.
The posterior approach is traditionally the most common approach used to perform a total hip replacement.In a posterior hip replacement, the surgeon makes the hip incision at the back of the hip close to the buttocks.The incision is placed so the abductor muscles, the major walking muscles, are not cut.
Robotic Total Hip Replacement
Total hip replacement is a surgical technique where the severely damaged cartilage and bone of the hip joint are removed and substituted with an artificial prosthesis which is bio-compatible and functions like a normal hip. It is one of the most common joint replacement procedures, subsequent to knee replacements. The main aim of this surgery is to restore function to the joint and relieve pain.
Computer-assisted Hip Replacement
Computer-assisted hip replacement is an image-guided, minimally invasive surgical procedure to replace your diseased or damaged hip with an artificial device using the assistance of computer software. The system creates and displays images and provides information that aids your surgeon at various stages of the procedure to improve accuracy and results.
Revision Hip Replacement
During total hip replacement, the damaged cartilage and bone are removed from the hip joint and replaced with artificial components. At times, hip replacement implants can wear out for various reasons and may need to be replaced with the help of a surgical procedure known as revision hip replacement surgery.
Correction of a Painful Hip Replacement
A hip replacement is a surgical procedure where an injured or damaged hip joint is replaced with an artificial hip joint known as a prosthesis.
Reoperation of a total hip replacement to resolve a painful hip condition arising out of a damaged or worn out prosthesis (artificial hip joint) is known as correction of a painful hip replacement. During this corrective surgery, a partial or complete exchange of the prostheses that were implanted during the original surgery is done.
Correction of a Failed Hip Replacement
A hip replacement is a surgical procedure where an injured or damaged hip joint is replaced with an artificial hip joint known as a prosthesis.
Reoperation of a total hip replacement to resolve a painful hip condition arising out of a damaged or worn out prosthesis (artificial hip joint) is known as correction of a failed hip replacement. During this corrective surgery, a partial or complete exchange of the prostheses that were implanted during the original surgery is done.
Hip Trauma Reconstruction
Hip trauma is an injury in the hip due to the impact caused by incidents such as a car accident or a hard fall. The injury can be a bone break or dislocation or both.
Hip Reconstruction
Hip reconstruction is a surgery to repair or replace a damaged hip joint that causes pain and limits your movement.
The hip is a ball-and-socket joint; the ball is formed by the head of the humerus (thighbone) and the socket by the pelvic bones. The joint is covered by ligaments that form a capsule around it. Tendons attached to muscles in the pelvis, thighs, and buttocks help move the hip joint.
Hip Fracture ORIF
A hip fracture is a break that occurs near the hip in the upper part of the femur or thighbone. The thighbone has two bony processes on the upper part - the greater and lesser trochanters. The lesser trochanter projects from the base of the femoral neck on the back of the thighbone. Hip fractures can occur either due to a break in the femoral neck, in the area between the greater and lesser trochanter or below the lesser trochanter.
Hip Fracture Surgery
Surgical correction of a hip fracture is known as hip fracture surgery.
Hip fractures involve a break that occurs near the hip in the upper part of the femur or thigh bone. The thigh bone has two bony processes on the upper part - the greater and lesser trochanters. The lesser trochanter projects from the base of the femoral neck on the back of the thigh bone. Hip fractures can occur either due to a break in the femoral neck, in the area between the greater and lesser trochanter or below the lesser trochanter.
Gluteus Medius Tear
The gluteus medius is one of the major muscles of the hip; essential for the movement of the lower body and keeping the pelvis level during ambulation. The gluteus medius muscle arises from the top of the pelvic bone and attaches to the outer side of the thighbone or femur at the greater trochanter by the gluteus medius tendon. The muscle functions as a hip abductor, controlling side-to-side movement of the hip and providing stabilization to the joint.
Physical Therapy for Hip
Physical therapy is an exercise program that helps you to improve movement, relieve pain, encourage blood flow for faster healing, and restore your physical function and fitness level. The main aim of physical therapy is to make your daily activities, such as walking, getting in and out of bed and climbing stairs, easier.
Others
Activities After Hip Replacement
Hip replacement is a surgery performed to replace parts of a diseased hip joint with a prosthesis. The goal of hip replacement is to eliminate pain and enable you to return to your normal activities. You can help in the recovery and improve the outcomes of the procedure by following certain precautions and changing the way you carry out your daily activities.
Physical Examination of the Hip
The hip joint is a ball and socket joint. The ball is the head of the femur (thighbone) that fits in the acetabulum (the hip socket). Tendons, muscles, and ligaments hold the joint in place. Articular cartilage covers the acetabulum and the femoral head. The synovial membrane of the hip joint secretes the synovial fluid which lubricates the joint enabling smooth movement.
