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Phil Austin
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Introduction to Hip Joint
Articulation of the acetabulum of the pelvis and
the head of femur
Flex / ext
Abd / Add
Med / Lat rotation
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Primary Function
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Structure
Full ossification occurs at 20 – 25 years
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Acetabular Fossa – non articular.
Contains fibro-elastic fat covered
with synovial membrane
In Males ≅ 38 °
In Females ≅ 35 °
Men – 18.5 °
Women – 21.5 °
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Acetabular Labrum
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Ligamentum Teres - Main Function – act as a
channel for secondary blood supply from the
obturator artery and nerves.
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Embryonic Development.
Early stages – both ↑ and
↓ extremity buds project
laterally from body (full
abduction).
At 7 / 8 weeks gestation,
adduction of the joints
begin.
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150 ° in infancy.
125 ° in adults.
120 ° in the elderly
Levangie PK, Norkin CC. Joint Structure and Function, a Comprehensive Analysis. 3rd ed 2001
A pathological increase between neck and shaft –
COXA VALGA
Decrease –
COXA VARA
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Angle of Torsion of Femur
Best viewed by looking down the length of the femur.
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Angle of Torsion of Femur
Anteversion
Age (y)
(in degrees) Pathological Retroversion
.
Birth - 1 y 30 - 50
2 30
3-5 25
6 -12 20
12 -15 17
Levangie PK, Norkin CC. Joint Structure and Function, a Comprehensive
16 - 20 11 Analysis. 3rd ed 2001
20 8
Signs & Symptoms
Anteversion Retroversion
www.clinicalsportsmedicine.com/chapters/24b.htm
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Articular Congruence
Considered congruent
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Articular Congruence
Coxa Valga, anteversion or a shallow acetabulum results
with increased :
Less congruence
Levangie PK, Norkin CC. Joint Structure and Function, a Comprehensive Analysis. 3rd ed 2001
Articular Congruence
The Acetabular fossa may set up a partial vacuum – so
atmospheric pressure may contribute to stability.
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Hip Joint Capsule
Strong and Dense
2 sets of fibres
Superficial longitudinal fibres - Retinacular
Deeper circular fibres – Zona Orbicularis (collar like)
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Iliofemoral lig - Referred to as – Y ligament – stronger /
thickest of all hip ligaments.
Bands of ilio pubo / femoral ligs
Posterior portion
Ischio-femoral ligament –
Outer fibres spiral around femoral neck
Deeper fibres arranged horizontally.
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LOG
moon.ouhsc.edu/dthompso/NAMICS/hipbmk.htm
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Gravity’s effect on the hip
moon.ouhsc.edu/dthompso/NAMICS/hipbmk.htm
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Gravity’s effect on the hip
The iliofemoral ligament elongates = very tight spring →
elastic force.
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Weight-Bearing
Trabeculae of bone line up along lines of stress.
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Medial Trabecular System
Oriented along vertical compressive
forces passing through the hip.
Kapandji. I The Physiology of Joints, Vol 2, ed 5, Williams & Wilkins,
Baltimore 1987.
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Wt bearing causes bending forces
along the shaft of the femur =
Compression forces medially
Tensile forces laterally
Greatest prevalence
of degenerative
change??
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2) Superior portion of femoral head
Typical ROM
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Osteokinematics
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Motion of femur at the hip (open Chain)
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Motion of femur at the hip (open Chain)
Hip extension = 10 → 30° but is ↓ when knee flexion prompts
passive flexion 2 joint rectus femoris.
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Motion of Pelvis at Hip (Closed Chain)
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Anterior / Posterior Tilt
Motion of entire pelvis in a sagittal plane around a frontal
axis
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www.pt.ntu.edu.tw/.../KINspine/PelvicGirdle.htm
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Lateral Tilt
A frontal plane motion of whole pelvis around a A/P
axis.
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Levangie PK, Norkin CC. Joint Structure and Function, a Comprehensive Analysis. 3rd ed 2001
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The pelvis & wt have shifted Rt hip
into adduction & left hip into
abduction.
Levangie PK, Norkin CC. Joint Structure and Function, a Comprehensive Analysis. 3rd ed 2001
Pelvic Rotation
Entire pelvis moving in a
transverse plane around a
vertical axis through the middle
of the pelvis in a bilateral
stance
Levangie, Norkin, Joint Structure and Function. 3rd
edit 2001.
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Lumbar-Pelvic Motion
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Femur, pelvis and LS produce a ↑ ROM than in 1 segment alone.
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Closed Chain Function
All the segments between the weight bearing part = 1
closed chain.
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Open chain response to tight hip flexors
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Flexors
Function primarily as mobility muscles in open chain.
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Flexors
Sartorius – flex, abd, and lat rot of the hip + (flex, med rot
of the knee). Most important when knee and hip are
flexed (climbing stairs)
Williams: Gray's Anatomy ed 38, Churchill Livingston 1995
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Hip Joint Musculature
Lateral Rotators
Medial Rotators
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Muscle Function in Stance
Biomechanics
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Bilateral Stance
Erect bilateral stance – both hips are neutral or slight
hyperextension & weight is evenly distributed through
both legs.
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Bilateral Stance
In a frontal plane the superincumbent BW – transmitted
through the SI´s, along the pelvic trabeculae system to Rt
& Lt femoral heads.
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These 2 opposing graviational
moments of equal magnitude
balance each other & the pelvis
maintains equilibrium in a frontal
plane.
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Hip abds – moment arm of 50mm
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Unilateral Stance
Maintenance of single limb support → countertorque
abduction of equivilent force.
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Unilateral Stance
∴ prevention of the pelvis falling → unsupported side
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Unilateral Stance
Wt loss may help reduce joint reaction.
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Compensatory Lateral Lean
Gravitational force can be ↓ by laterally leaning the trunk
over the pelvis toward the side of pain / weakness when
in a unilateral stance.
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Compensatory Lateral Lean
HATLL must pass through regardless ∴ leaning toward
doesn’t increase joint compression.
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HATLL torque adduction =
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Sacral Articulating Surface
Auricular (c) shaped,
Foetal – prepuberty – surfaces are flat and smooth
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Articulating Surface of the Ilia
Also C-shaped
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Iliac Articulations
In Childhood – permits glide in all ranges (synovial joint).
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Symphysis Pubis Articulation
Cartilaginous joint.
The disc has a thin central cleft (in females may extend
along the length.
Kapandji IA. Physiology of joints 3, ed 2 Churchill Livingstone, Edinburgh, 1974
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Symphysis Pubis Articulation
3 Ligaments associated with pubis joint
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Function of Sacral Region
HAT creates a nutation torque on the sacrum.
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Function
SI’s and pubis – linked by closed kinematic chain
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Function
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Pelvic Floor Muscles
Voluntary contraction of levator ani helps constrict openings of
urethra and anus.
In women, these muscles surround the vagina and help support the
uterus.
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