Joints of the Hip Complex Flashcards
1
Q
What is the hip bone a part of?
A
Pelvis
2
Q
What are the three parts of the hip bone?
A
Ilium
Ischium
Pubis
3
Q
What structure do the three parts of the hip bone form?
A
Acetabulum
4
Q
When does the epiphysis at the acetabulum close?
A
Mid to late teens
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
6
Q
Why is the rim of the acetabulum smooth?
A
Articular surface
7
Q
What is the articular surface of the acetabulum called?
A
Lunate surface
8
Q
What covers the lunate surface?
A
Hyaline cartilage
9
Q
Is the acetabular notch smooth?
A
No
10
Q
Which part of the acetabulum is weight bearing?
A
Lunate surface
11
Q
What happens to the cartilage with age?
A
Thins > osteoarthritic changes
12
Q
What rims the articular surface of the acetabulum?
A
Labrum
13
Q
What is the labrum made of?
A
Fibrocartilage
14
Q
What fills the acetabular notch, and the acetabulum medioinferiorly?
A
Transverse acetabular ligament
15
Q
What does the ligament coming straight out of the acetabulum and transverse acetabular ligament attach to?
A
Head of femur
16
Q
What fills the non-articular area of the acetabulum?
A
Fat pad
17
Q
What is the common name for fat pads associated with joints?
A
Aversium fat pad
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
19
Q
What is the relationship between the head and neck of the femur?
A
Large hemispherical ball at end of long neck
20
Q
Where do the muscles attach to the femur?
A
Trochanter
- Greater
- Lesser
21
Q
Why does the femoral neck have thick cortical bone?
A
Large amount of force applied here
22
Q
What is the ligament of the head of the femur called>
A
Ligamentum terres
23
Q
Where at the femur does ligamentum terres attach?
A
Depression = fovea capitis
24
Q
When is the curvature of the neck of the femur disrupted?
A
Fracture of neck of femur
25
When is the perpendicular angle between the long axis of the femur and a line between the greater trochanter and fovea capitis disrupted?
Disruption of head of femur
26
What is the orientation of the head and neck of the femur?
Medially and upwards
27
In which direction does the head of the femur pass?
Slightly anterior
28
Which part of the head of the femur lies outside and in front of the socket?
Anterior part
29
What protects the part of the head of the femur outside the acetabulum?
Psoas bursa
30
Where is the psoas bursa located?
Underneath psoas muscle
31
What does a waisted neck of the femur allow?
Larger range of movement in all planes without making contact with edges of acetabulum
32
Why is the cartilage thickest where the head of the femur articulates with the roof of the acetabulum?
Main weight bearing at head of femur
33
What does the thick layer of cortical bone at the head of the femur do?
Resist shearing forces
34
What does the medial bundle of trabecular bone do?
Resist weight bearing
35
What does the arcuate bundle of trabecular bone do?
Resist shearing force
36
What does the trabecular bone at the greater trochanter resist?
Pull of muscles like gluteus medius and minimus
37
Where is there a site of weakness in the neck of the femur, where the trabecular bone is not as dense?
Inferior aspect
38
What are some of the epiphyses of the femur?
```
Greater trochanter
Lesser trochanter
Head of femur
Ischial tuberosity
Inferior iliac spine
Superior iliac spine
```
39
What muscle attaches at the ischial tuberosity?
Hamstrings
40
What muscle attaches at the anterior superior iliac spine?
Rectus femoris
41
How can the epiphyses be pulled away from the bone in childhood?
Strong forces applied via attached muscles
42
What is it called when the epiphysis pulls away from the bone?
Avulsion fracture
43
What is the orientation of the acetabulum?
Faces a little anteriorly from coronal plane
44
What is the relationship between the anterior and posterior rims of the acetabulum in an A-P x-ray?
Posterior rim more inferior than anterior rim
45
What is the angle between the head and neck of the femur called?
Neck-shaft angle = angle of inclination
46
How does the neck-shaft angle change from childhood?
Reduces
47
What are the variations in the neck-shaft angle called?
Reduced angle = coxa vara
| increased angle = coxa valga
48
What is the angle of torsion between the head of the femur and the coronal plane?
12-15 degrees
| Can also vary
49
What can be a detrimental consequence of a coxa vara?
Increases stress on femoral neck
| Extreme forces can cause capital epiphysis to become dislodged > slip inferiorly
50
What is it called when the capital epiphysis is dislodged and slips inferiorly?
Slipped capital femoral epiphysis
51
Why is there a natural tendency to tilt backwards at the hip joint?
Centre of gravity passes behind joint
52
What resists posterior rotation at the hip joint?
Reinforcing ligaments at front of capsule
53
What is the position of greatest stability for the hip joint?
Close packed position
- Extension
- Abduction
- Medial rotation
54
What is a loose packed position?
Flexion
Adduction
Lateral rotation
55
Where does the capsule attach to the femur?
Base of neck
56
What are the three ligaments attaching to the capsule?
```
Ileofemoral = in front
Pubofemoral = behind
Ischiofemoral = behind
```
57
To where do the ligaments of the capsule extend?
Intertrochanteric line
58
From where does the ileofemoral ligament come?
Ilium
59
From where does the pubofemoral ligament come?
Pubis
60
From where does the ischiofemoral ligament come?
Ischium
61
How much force at the hip joint does the ileofemoral ligament provide?
60%
62
What does thee ileofemoral ligament do?
Prevents joint from rotating backwards
63
Where do the pubofemoral and ischiofemoral ligaments attach to the femur?
Blend with capsule only to greater trochanter
64
Why aren't the pubofemoral and ischiofemoral ligaments as extensive as the ileofemoral ligament?
Allow more movement at joint
65
Why is the hip joint most stable in extension?
Primarily because of ileofemoral ligament > spiral and tightens with hip extension
66
What lines the inside of the ligamentous supports of the hip joint?
Zona obicularis = ring of fibres
67
What does the labrum of the hip joint do?
Bridges acetabular notch
Deepens socket > enhances stability
Increases surface area
68
What does the labrum of the hip joint become continuous with?
Transverse ligament
69
Where is the blood supply of the labrum of the hip joint?
Towards periphery > can potentially be repaired
70
When is the labrum of the hip joint commonly damaged?
Dislocation of hip
71
What is the function of the ligament of the head of the femur?
No supporting role
Large number of Golgi tendon organs > proprioception
Directs branch of obdurator artery into joint before epiphysis closes
72
When does the branch of the obdurator artery that travels with the ligament of the head of the femur regress?
When epiphysis closes = after puberty
73
What are the movements at the hip joint?
Flexion much greater than extension
Abduction greater than adduction
Medial rotation with extension > joint locked
Lateral rotation with flexion
74
What types of rotation occur at the hip joint during locomotion?
Medial rotation in early stance phase
| Lateral rotation in swing phase
75
How is the hip joint linked with the knee joint?
Long powerful muscles including
- Sartorius
- Rectus femoris
- Hamstrings
76
What is the role of the muscles that link the hip and the knee?
Synchronisation of hip with knee
| Injury to these muscles > loss of synchronicity
77
What are the gluteal muscles?
Gluteus maximus
Gluteus medius
Gluteus minimus
78
What does the gluteus maximus muscle do?
Terminal extension - important in sprinting
79
What do gluteus medius and minimus do?
Abduct hip
When one foot extends in gait, gluteus medius and minimus contract on supported side > strop trunk falling towards unsupported side
80
What happens when gluteus medius and minimus are injured?
Trendellenberg gait = classic gait where pelvis falls to unsupported side
81
Where are the outward rotators of the hip?
Run along line of femoral neck
Deep to gluteus maximus
From hip bone to region around greater trochanter
82
What do the outward rotators of the hip do?
Stabilise head of femur in acetabulum
| Act like rotator cuff muscles of arm
83
What is the nerve supply to the hip joint?
Articular branches of
- Femoral nerve
- Obdurator nerve
- Gluteal nerve
84
Where is pain from the hip referred to?
Medial aspect of thigh via obdurator nerve
85
Where is pain to the hip referred from?
Lumbar spine, particularly upper lumbar segments
86
What is the blood supply of the hip joint?
Medial and lateral femoral circumflex arteries
| Anastomose around neck of femur
87
What is the articular circle formed by the anastomosis around the neck of the femur called?
Vascular arteriosus
88
What are the medial and lateral femoral circumflex arteries branches of?
Profunda femoris
| Variation - might get one/both coming from common femoral artery
89
How does the blood supply extend into the capsule of the hip joint?
Retinacular vessels from anastomosis around neck of femur travel longitudinally up head of femur into capsule
90
When are the retinacular vessels susceptible to damage?
Fractures of neck of femur
91
What do you do surgically if there is serious injury to the blood vessels of the hip joint?
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
Where is the location of the femoral artery in relation to the hip joint?
Between anterior superior iliac crest and pubic tubercle
Bisects inguinal ligamnt
Passes over psoas
93
Where is the sciatic nerve in relation to the hip joint?
Behind, just inferior to head of femur
94
When may the sciatic nerve be endangered by the hip joint?
Head of femur dislocates posteriorly
95
Why must the head of the femur be re-articulated within hours in a posterior dislocation?
Risk of avascular necrosis
96
In whom is congenital dislocation of the hip more common: males or females?
Females
97
How can congenital dislocation of the hip occur?
Little movement in utero > fixation of joint > flattening of actabulum > developmental dysplasia
