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MD1 Endocrine > Joints of the Hip Complex > Flashcards

Joints of the Hip Complex Flashcards

1
Q

What is the hip bone a part of?

A

Pelvis

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2
Q

What are the three parts of the hip bone?

A

Ilium
Ischium
Pubis

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3
Q

What structure do the three parts of the hip bone form?

A

Acetabulum

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4
Q

When does the epiphysis at the acetabulum close?

A

Mid to late teens

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5
Q

What proportion do each of the parts of the hip bone contribute to the acetabulum?

A 
Ilium = 2/5
Ischium = 2/5
Pubis = 1/5
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6
Q

Why is the rim of the acetabulum smooth?

A

Articular surface

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7
Q

What is the articular surface of the acetabulum called?

A

Lunate surface

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8
Q

What covers the lunate surface?

A

Hyaline cartilage

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9
Q

Is the acetabular notch smooth?

A

No

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10
Q

Which part of the acetabulum is weight bearing?

A

Lunate surface

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11
Q

What happens to the cartilage with age?

A

Thins > osteoarthritic changes

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12
Q

What rims the articular surface of the acetabulum?

A

Labrum

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13
Q

What is the labrum made of?

A

Fibrocartilage

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14
Q

What fills the acetabular notch, and the acetabulum medioinferiorly?

A

Transverse acetabular ligament

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15
Q

What does the ligament coming straight out of the acetabulum and transverse acetabular ligament attach to?

A

Head of femur

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16
Q

What fills the non-articular area of the acetabulum?

A

Fat pad

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17
Q

What is the common name for fat pads associated with joints?

A

Aversium fat pad

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18
Q

What is the relevance of the aversium fat pad of the acetabulum having a nerve and blood supply?

A

Can become entrapped

Can cause pain

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19
Q

What is the relationship between the head and neck of the femur?

A

Large hemispherical ball at end of long neck

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20
Q

Where do the muscles attach to the femur?

A

Trochanter

  • Greater
  • Lesser
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21
Q

Why does the femoral neck have thick cortical bone?

A

Large amount of force applied here

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22
Q

What is the ligament of the head of the femur called>

A

Ligamentum terres

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23
Q

Where at the femur does ligamentum terres attach?

A

Depression = fovea capitis

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24
Q

When is the curvature of the neck of the femur disrupted?

A

Fracture of neck of femur

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25
Q

When is the perpendicular angle between the long axis of the femur and a line between the greater trochanter and fovea capitis disrupted?

A

Disruption of head of femur

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26
Q

What is the orientation of the head and neck of the femur?

A

Medially and upwards

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27
Q

In which direction does the head of the femur pass?

A

Slightly anterior

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28
Q

Which part of the head of the femur lies outside and in front of the socket?

A

Anterior part

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29
Q

What protects the part of the head of the femur outside the acetabulum?

A

Psoas bursa

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30
Q

Where is the psoas bursa located?

A

Underneath psoas muscle

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31
Q

What does a waisted neck of the femur allow?

A

Larger range of movement in all planes without making contact with edges of acetabulum

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32
Q

Why is the cartilage thickest where the head of the femur articulates with the roof of the acetabulum?

A

Main weight bearing at head of femur

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33
Q

What does the thick layer of cortical bone at the head of the femur do?

A

Resist shearing forces

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34
Q

What does the medial bundle of trabecular bone do?

A

Resist weight bearing

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35
Q

What does the arcuate bundle of trabecular bone do?

A

Resist shearing force

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36
Q

What does the trabecular bone at the greater trochanter resist?

A

Pull of muscles like gluteus medius and minimus

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37
Q

Where is there a site of weakness in the neck of the femur, where the trabecular bone is not as dense?

A

Inferior aspect

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38
Q

What are some of the epiphyses of the femur?

A 
Greater trochanter
Lesser trochanter
Head of femur
Ischial tuberosity
Inferior iliac spine
Superior iliac spine
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39
Q

What muscle attaches at the ischial tuberosity?

A

Hamstrings

40
Q

What muscle attaches at the anterior superior iliac spine?

A

Rectus femoris

41
Q

How can the epiphyses be pulled away from the bone in childhood?

A

Strong forces applied via attached muscles

42
Q

What is it called when the epiphysis pulls away from the bone?

A

Avulsion fracture

43
Q

What is the orientation of the acetabulum?

A

Faces a little anteriorly from coronal plane

44
Q

What is the relationship between the anterior and posterior rims of the acetabulum in an A-P x-ray?

A

Posterior rim more inferior than anterior rim

45
Q

What is the angle between the head and neck of the femur called?

A

Neck-shaft angle = angle of inclination

46
Q

How does the neck-shaft angle change from childhood?

A

Reduces

47
Q

What are the variations in the neck-shaft angle called?

A

Reduced angle = coxa vara

increased angle = coxa valga

48
Q

What is the angle of torsion between the head of the femur and the coronal plane?

A

12-15 degrees

Can also vary

49
Q

What can be a detrimental consequence of a coxa vara?

A

Increases stress on femoral neck

Extreme forces can cause capital epiphysis to become dislodged > slip inferiorly

50
Q

What is it called when the capital epiphysis is dislodged and slips inferiorly?

A

Slipped capital femoral epiphysis

51
Q

Why is there a natural tendency to tilt backwards at the hip joint?

A

Centre of gravity passes behind joint

52
Q

What resists posterior rotation at the hip joint?

A

Reinforcing ligaments at front of capsule

53
Q

What is the position of greatest stability for the hip joint?

A

Close packed position

  • Extension
  • Abduction
  • Medial rotation
54
Q

What is a loose packed position?

A

Flexion
Adduction
Lateral rotation

55
Q

Where does the capsule attach to the femur?

A

Base of neck

56
Q

What are the three ligaments attaching to the capsule?

A 
Ileofemoral = in front
Pubofemoral = behind
Ischiofemoral = behind
57
Q

To where do the ligaments of the capsule extend?

A

Intertrochanteric line

58
Q

From where does the ileofemoral ligament come?

A

Ilium

59
Q

From where does the pubofemoral ligament come?

A

Pubis

60
Q

From where does the ischiofemoral ligament come?

A

Ischium

61
Q

How much force at the hip joint does the ileofemoral ligament provide?

A

60%

62
Q

What does thee ileofemoral ligament do?

A

Prevents joint from rotating backwards

63
Q

Where do the pubofemoral and ischiofemoral ligaments attach to the femur?

A

Blend with capsule only to greater trochanter

64
Q

Why aren’t the pubofemoral and ischiofemoral ligaments as extensive as the ileofemoral ligament?

A

Allow more movement at joint

65
Q

Why is the hip joint most stable in extension?

A

Primarily because of ileofemoral ligament > spiral and tightens with hip extension

66
Q

What lines the inside of the ligamentous supports of the hip joint?

A

Zona obicularis = ring of fibres

67
Q

What does the labrum of the hip joint do?

A

Bridges acetabular notch
Deepens socket > enhances stability
Increases surface area

68
Q

What does the labrum of the hip joint become continuous with?

A

Transverse ligament

69
Q

Where is the blood supply of the labrum of the hip joint?

A

Towards periphery > can potentially be repaired

70
Q

When is the labrum of the hip joint commonly damaged?

A

Dislocation of hip

71
Q

What is the function of the ligament of the head of the femur?

A

No supporting role
Large number of Golgi tendon organs > proprioception
Directs branch of obdurator artery into joint before epiphysis closes

72
Q

When does the branch of the obdurator artery that travels with the ligament of the head of the femur regress?

A

When epiphysis closes = after puberty

73
Q

What are the movements at the hip joint?

A

Flexion much greater than extension
Abduction greater than adduction
Medial rotation with extension > joint locked
Lateral rotation with flexion

74
Q

What types of rotation occur at the hip joint during locomotion?

A

Medial rotation in early stance phase

Lateral rotation in swing phase

75
Q

How is the hip joint linked with the knee joint?

A

Long powerful muscles including

  • Sartorius
  • Rectus femoris
  • Hamstrings
76
Q

What is the role of the muscles that link the hip and the knee?

A

Synchronisation of hip with knee

Injury to these muscles > loss of synchronicity

77
Q

What are the gluteal muscles?

A

Gluteus maximus
Gluteus medius
Gluteus minimus

78
Q

What does the gluteus maximus muscle do?

A

Terminal extension - important in sprinting

79
Q

What do gluteus medius and minimus do?

A

Abduct hip
When one foot extends in gait, gluteus medius and minimus contract on supported side > strop trunk falling towards unsupported side

80
Q

What happens when gluteus medius and minimus are injured?

A

Trendellenberg gait = classic gait where pelvis falls to unsupported side

81
Q

Where are the outward rotators of the hip?

A

Run along line of femoral neck
Deep to gluteus maximus
From hip bone to region around greater trochanter

82
Q

What do the outward rotators of the hip do?

A

Stabilise head of femur in acetabulum

Act like rotator cuff muscles of arm

83
Q

What is the nerve supply to the hip joint?

A

Articular branches of

  • Femoral nerve
  • Obdurator nerve
  • Gluteal nerve
84
Q

Where is pain from the hip referred to?

A

Medial aspect of thigh via obdurator nerve

85
Q

Where is pain to the hip referred from?

A

Lumbar spine, particularly upper lumbar segments

86
Q

What is the blood supply of the hip joint?

A

Medial and lateral femoral circumflex arteries

Anastomose around neck of femur

87
Q

What is the articular circle formed by the anastomosis around the neck of the femur called?

A

Vascular arteriosus

88
Q

What are the medial and lateral femoral circumflex arteries branches of?

A

Profunda femoris

Variation - might get one/both coming from common femoral artery

89
Q

How does the blood supply extend into the capsule of the hip joint?

A

Retinacular vessels from anastomosis around neck of femur travel longitudinally up head of femur into capsule

90
Q

When are the retinacular vessels susceptible to damage?

A

Fractures of neck of femur

91
Q

What do you do surgically if there is serious injury to the blood vessels of the hip joint?

A

Only option may be to remove head of femur/put in pins to hold head to femoral neck > commonly causes problems distal to attachment of pins though

92
Q

Where is the location of the femoral artery in relation to the hip joint?

A

Between anterior superior iliac crest and pubic tubercle
Bisects inguinal ligamnt
Passes over psoas

93
Q

Where is the sciatic nerve in relation to the hip joint?

A

Behind, just inferior to head of femur

94
Q

When may the sciatic nerve be endangered by the hip joint?

A

Head of femur dislocates posteriorly

95
Q

Why must the head of the femur be re-articulated within hours in a posterior dislocation?

A

Risk of avascular necrosis

96
Q

In whom is congenital dislocation of the hip more common: males or females?

A

Females

97
Q

How can congenital dislocation of the hip occur?

A

Little movement in utero > fixation of joint > flattening of actabulum > developmental dysplasia

MD1 Endocrine (18 decks)

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