MSK 22 - Hip joint

Question 1

what bones form the acetabulum - what parts do they make up

Answer 1

ilium (superior part)
ischium (posterior part)
pubis (anterior part)

Question 2

what is the lunate surface of the hip joint

Answer 2

the rim of cartilage that covers most of the articular surface

Question 3

what is the surface that gets worn out in OA

Answer 3

lunate surface

Question 4

what is the acetabular fossa and what is different about its structure

Answer 4

central area

doesnt have cartilage over bone

Question 5

what fills the acetabular fossa

Answer 5

fat

Question 6

the acetabular fossa has a blood vessel that is inside a ligament

what is the name of the ligament and blood vessel

Answer 6

ligamentum teres

branch of obturator artery

Question 7

what does the ligamentum teres do

Answer 7

connect acetabular fossa to fovea of femoral head

prevents hip dislocation

Question 8

what does the obturator artery do

Answer 8

in infancy supplies blood to femoral head but overtime as an adult it atrophies and supplies very little blood

Question 9

where is the transverse acetabular ligament located

Answer 9

between the 2 ends of the lunate surface

covers acetabular notch inferiorly where there is no cartilage

Question 10

what does the transverse acetabular ligament do

Answer 10

suspends femoral head in acetabulum

Question 11

what does the acetabular labrum do for the hip joint

Answer 11

increases articular area

Question 12

how is the femoral neck directed

Answer 12

superomedially and slightly anteriorly in its articulation with the acetabulum

Question 13

what is the bony ridge that runs between the 2 trochanters of the femur

Answer 13

intertrochanteric line

Question 14

what does the angle of the femur allow

Answer 14

greater mobility at the hip joint and puts force through the femoral neck

Question 15

where is most of the force on the femoral neck and what is the structural difference here to address this

Answer 15

on lower half of neck

the inferior part of the neck is thicker to support the weight transmitted through the head

Question 16

what is the role of the joint capsule at the hip

Answer 16

hold things together tightly to prevent dislocations

Question 17

where does the joint capsule of the hip joint attach to on the pelvis and femur

Answer 17

proximally attach to acetabulum and transverse acetabular ligament

distally into intertrochanteric line of femur

Question 18

how many parts/ligaments does the joint capsule of the hip have

Answer 18

3

Question 19

what is the orbicular zone of the hip joint capsule created by

Answer 19

created by fibres that circle around the femoral head

Question 20

the fibres of the hip joint take a spiral course what does this mean when you move the thigh in flexion and extension

Answer 20

the fibres are tightened as you extend the thigh and unwind when you flex the thigh

this allows more flexion than extension

Question 21

the thicker parts of the joint capsule of the hip also have what role when regarding the femoral head

Answer 21

pulls femoral head medially into the acetabulum

Question 22

what 3 muscles are responsible for hip flexion

Answer 22

iliopsoas

rectus femoris

sartorius

Question 23

what myotome levels and nerves are involved in hip flexion

Answer 23

L2 and L3

femoral nerve

Question 24

what 2 muscles are responsible for hip extension

Answer 24

gluteus maximus

hamstrings

Question 25

what myotome levels and nerves are involved in hip extension

Answer 25

L4, L5 and S1 tibial nerve L4-S1 and inferior gluteal nerve L5-S2

Question 26

what 5 muscles are responsible for hip adduction

Answer 26

adductor magnus adductor longus adductor brevis pectineus gracilis

Question 27

what myotome levels and nerves are involved in hip adduction

Answer 27

L2-4 obturator nerve

Question 28

what 5 muscles are responsible for hip adduction

Answer 28

gluteaus medius gluteus minimus tensor fascia lata piriformis sartorius

Question 29

what myotome levels and nerves are involved in hip abduction

Answer 29

L5 and S1 superior gluteal nerve L4-S1

Question 30

what are the 2 arteries that supply the hip joint where do they branch off from

Answer 30

medial and lateral circumflex arteries branch off from profunda femoris artery

Question 31

the two circumflex arteries form anastomoses with which arteries

Answer 31

with the superior and inferior gluteal arteries and minor anastomoses with the obturator artery

Question 32

where do the medial and lateral circumflex arteries run relative to the femoral neck

Answer 32

medial artery runs posteriorly around the femoral neck lateral artery runs anteriorly around the femoral neck

Question 33

femoral artery gives off profundal femoris branch at what level

Answer 33

at level of neck of femur

Question 34

the femoral artery extends down which side of the leg and how does it travel down from the thigh to the leg

Answer 34

extends down the medial side of the leg until it joins the adductor hiatus where it then goes posteriorly into the popliteal region

Question 35

what do the perforating arteries of profunda femoris artery supply

Answer 35

muscles of anterior thigh branches of the perforating arteries also supply the posterior part of leg

Question 36

what arteries come off the internal iliac artery

Answer 36

gluteal arteries

Question 37

what vessels come off the circumflex arteries

Answer 37

retinacular arteries

Question 38

how do the retinacular arteries travel

Answer 38

off the circumflex arteries to pierce the capsule and run in the retinacular folds of synovial membrane and up into the femoral head

Question 39

what does the retinacular arteries supply

Answer 39

femoral head and neck

Question 40

what is hiltons law

Answer 40

nerves supplying a joint come from any that cross it or any that supplies muscles that cross the joint

Question 41

which 5 nerves supply the hip joint

Answer 41

femoral nerve obturator nerve superior gluteal nerve nerve to QF sciatic nerve

Question 42

what muscle is supplied by the femoral nerve

Answer 42

iliacus

Question 43

what group of muscles is supplied by the obturator nerve

Answer 43

medial compartment adductors

Question 44

what muscle is supplied by the superior gluteal nerve

Answer 44

gluteus medius

Question 45

what part of the hip joint is supplied by the nerve to QF

Answer 45

the posterior portion

Question 46

is bone more sensitive to ischemia or is cartilage why is this

Answer 46

bone is more sensitive to ischaemia as cartilage does not rely on blood supply and can still get nutrients from the synovial fluid

Question 47

ischaemic bone develops what condition

Answer 47

avascular necrosis

Question 48

what are the 5 types of femur fractures and which are intra/extracapsular

Answer 48

capital (intracapsular) subcapital (intracapsular) transcervical (intracapsular) intertrochanteric (extracapsular) subtrochanteric (extracapsular)

Question 49

which of the 5 femur fractures are most dangerous

Answer 49

the intracapsular fractures capital, subcapital and transcervical

Question 50

why are intracapsular fractures dangerous

Answer 50

they involve the blood supply to femoral head and prevent retinacular artery from getting to the head

Question 51

what is a capital femur fracture

Answer 51

through the femoral head

Question 52

what is a subcapital femur fracture

Answer 52

base of femoral head

Question 53

what is a transcervical femur fracture

Answer 53

across neck of femur

Question 54

what are the risks of a DHS

Answer 54

might put nails and screws too far in the femur and hit the profunda artery

Question 55

most hip dislocations are in which direction

Answer 55

posterior

Question 56

where does the femoral head land in posterior dislocation

Answer 56

superiorly

Question 57

what is the mechanism of a posterior hip dislocation - what position does this normally happen in

Answer 57

flexed hip that is adducted and internally rotated

Question 58

how is the leg oriented after sustaining a posterior hip dislocation

Answer 58

internally rotated

Question 59

what are the associated structures that could be damaged by a hip dislocation

Answer 59

soft tissue an joint capsule risk of avascular necrosis from arterial damage

Question 60

why are hip joint dislocations common after hip joint replacement

Answer 60

youve cut through the fascia lata to get to hip joint so less stable post op

Question 61

what is the mechanism of an anterior hip dislocations

Answer 61

forceful abduction with external rotation of leg

Question 62

where does the femoral head end up in a anterior hip dislocation?

Answer 62

inferior to pelvis