Hip joint

Question 1

What type of synovial joint is the hip

Answer 1

Ball and socket

Question 2

Where is the articular cartilage thickest

Answer 2

Places of weight bearing

Question 3

What makes up the hip bone

Answer 3

Ilium
Ischium
Pubis

Question 4

What structures strengthen the hip joint

Answer 4

Acetabular labrum,
Joint capsule,
Ligaments,
Muscles

Question 5

What is the Acetabular labrum

Answer 5

Fibrocartilaginous collar attached to margin of acetabulum and increases its depth

Question 6

Where does the joint capsule attach

Answer 6

Intertrochanteric line (anteriorly)

Question 7

What part of femur is extra capsular

Answer 7

Posterior lateral neck of femur

Question 8

What is the intracapsular ligament

Answer 8

Ligament of head of femur

Question 9

Attachments of ligament of head of femur

Answer 9

Acetabular fossa to fovea of femur

Question 10

Which artery does the ligament of head of femur enclose

Answer 10

Branch of obturator artery

Question 11

What are the extra capsular ligaments

Answer 11

Iliofemoral (anterior and superior protection, strongest in body)
Pubofemoral (anterior and inferior protection )
Ischiofemoral (posterior protection, weakest)

Question 12

What’s the advantage of the orientation of the extra capsular ligaments

Answer 12

Spiral orientation so becomes tighter when joint is extended which increases stability and requires less energy to maintain standing position

Question 13

Origin of iliofemoral ligament

Answer 13

Ilium, inferior to ASIS

Question 14

Attachment of iliofemoral ligament

Answer 14

Intertrochanteric line in 2 places (Y shaped)

Question 15

What does iliofemoral ligament prevent

Answer 15

Hyperextension

Question 16

What does pubofemoral ligament prevent

Answer 16

Excessive abduction

Question 17

Attachment of pubofemoral ligament

Answer 17

Iliopubic eminence and obturator membrane

Question 18

What does ischiofemoral ligament limit

Answer 18

Extension at hip

Question 19

Origin of ischiofemoral

Answer 19

Ischium

Question 20

Attachment of ischiofemoral ligament

Answer 20

Greater trochanter

Question 21

What is the strength of muscles and ligaments anteriorly

Answer 21

Ligaments are strongest

Medial flexors are fewer and weaker

Question 22

What is the strength of muscles and ligaments posteriorly

Answer 22

Ligaments weakest

Medial rotators are greater in number and stronger

Question 23

Muscles performing flexion

Answer 23

Iliopsoas,
Rectus femoris,
Sartorius

Question 24

Muscles performing extension

Answer 24

Gluteus maximus,
Semimembranosus,
Semitendinosus,
Long head of biceps femoris

Question 25

What determines degree of hip flexion

Answer 25

Whether knee is flexed - flexed increases range of hip flexion

Question 26

Muscles performing abduction

Answer 26

Gluteus medius and minimus | Deep gluteals

Question 27

Muscles performing adduction

Answer 27

Adductor longus, brevis and Magnus Pectineus Gracilis Obturator externus

Question 28

Muscles performing lateral rotation

Answer 28

Biceps femoris, Gluteus maximus, Deep gluteals

Question 29

Muscles performing medial rotation

Answer 29

Gluteus medius and medialis Semimembranosus Semitendinosus

Question 30

Articulation

Answer 30

Head of femur and acetabulum of pelvis

Question 31

Innervation of HJ

Answer 31

Femoral nerve, Obturator nerve, Superior gluteal nerve, Nerve to quadratus femoris

Question 32

Blood supply to HJ

Answer 32

Majority by medial circumflex femoral artery, Lateral circumflex femoral artery, Obturator artery via ligament of head of femur (not enough to keep hip alive on own)

Question 33

What separates the hip bones before age 15

Answer 33

Tri-radiate cartilage

Question 34

When is fusion of hip bones complete

Answer 34

20-25

Question 35

Where do the hip bones converge

Answer 35

Acetabulum

Question 36

What are the extra capsular ligaments continuous with

Answer 36

Outer surface of joint capsule

Question 37

Where do the medial and lateral circumflex femoral arteries anastomose

Answer 37

Base of femoral neck

Question 38

What does the lateral circumflex femoral artery have to penetrate to reach the hip joint

Answer 38

Iliofemoral ligament | Therefore medial circumflex femoral artery provides most blood supply to HJ

Question 39

What happens in hip replacement surgery

Answer 39

Plastic socket is cemented to hip bone to replace acetabulum Stainless steel femoral stem and head to replace femur

Question 40

When do surgical hip replacement take place

Answer 40

After traumatic injury | Degenerative diseases of joint

Question 41

What are the bursae of hip joint

Answer 41

Trochanteric Iliopsoas Ischiogluteal

Question 42

When do the bursa of hip joint become inflamed

Answer 42

repetitive strain or direct trauma

Question 43

Where is the trochanteric bursa

Answer 43

Between gluteus maximus and greater trochanter

Question 44

When can the trochanteric bursa be inflamed

Answer 44

In arthritis

Question 45

What percentage of people have iliopsoas bursa communicating with HJ

Answer 45

15%

Question 46

Where is the ischiogluteal bursa

Answer 46

Near ischial tuberosity

Question 47

When can the ischiogluteal bursa become inflamed

Answer 47

Sitting down e.g. Horse riding and cycling

Question 48

What are the types of hip dislocation

Answer 48

Acquired | Congenital

Question 49

What percentage of congenital dislocations are bilateral

Answer 49

50%

Question 50

How common are congenital hip dislocations

Answer 50

1.5 per 1000 births | 8x more likely in girls

Question 51

Cause of congenital hip dislocation

Answer 51

During development the femoral head is not placed within the acetabulum

Question 52

Symptoms of congenital hip dislocation

Answer 52

Inability to abduct at hip Affected limb is shorter Positive trendelenburg sign

Question 53

Consequence of congenital hip dislocation

Answer 53

Predisposes patient to arthritis of hip later in life

Question 54

How common are acquired hip dislocations | Why

Answer 54

Uncommon | Joint is very strong and stable

Question 55

Common cause of acquired hip dislocation

Answer 55

Traumatic accidents

Question 56

Types of acquired hip dislocation

Answer 56

Anterior | Posterior

Question 57

How are hip dislocations named

Answer 57

Position of femoral head in relation to acetabulum

Question 58

What happens in posterior acquired hip dislocation

Answer 58

Femoral head tears through inferior and posterior part of joint capsule (weakest part)

Question 59

Appearance of affected limb in posterior hip dislocation | Why does this occur

Answer 59

Shortened - extensors and adductors | Medially rotated - gluteus medius and minimus

Question 60

Risk of posterior hip dislocation

Answer 60

Sciatic nerve can be damaged | Paralysis of hamstrings and muscles distal to knee

Question 61

How do anterior hip dislocations occur

Answer 61

Excessive: extension abduction lateral rotation

Question 62

What often occurs in anterior hip dislocations

Answer 62

Femoral head pulls Acetabular labrum with it (anterior and inferior to acetabulum)

Question 63

Where is margin of acetabulum incomplete | What strengthens this portion

Answer 63

Inferiorly (Acetabular notch) | Strengthened by transverse Acetabular ligament

Question 64

What is a slipped upper femoral epiphysis

Answer 64

Fracture through epiphyseal growth plate

Question 65

What age does a slipped upper femoral epiphysis usually occur

Answer 65

10-16

Question 66

Displacement of fragments in slipped upper femoral epiphysis

Answer 66

Distal femur displaced superiorly and anteriorly in relation to growth plate

Question 67

Location of iliopsoas bursa

Answer 67

Deep to iliopsoas

Question 68

How does iliopsoas bursitis present

Answer 68

Swelling under inguinal ligament