HIP

Pradeep Chockalingam

www.scribd.com/cpradheep
Anatomy
 Acetabulum
(Proximal)
 Femoral head
(Distal)

http://www.fpnotebook.com/ORT78.htm
www.scribd.com/cpradheep
Joint Type
 Ball and socket joint

 Synovial joint

www.scribd.com/cpradheep
Blood supply to head & NOF
 Medial and lateral femoral
circumflex arteries
 Obturator artery
 Superior and inferior gluteal
arteries
 Ascending branch of first
perforating branch of
profunda femoris

http://www.orthogastonia.com/patient_ed/images/hip/hip_avn/hip_avn_anatomy02.jpg

www.scribd.com/cpradheep
Capsule
 Proximal
Attached around the brim of the bony
acetabulum
 Distal
 Anteriorly along the inter trochanteric line
 Posteriorly ½" above the inter trochanteric crest

www.scribd.com/cpradheep
Ligaments
 Iliofemoral ligament
reinforcing the anterior surface of the articular
capsule of the hip joint
 Ischiofemoral ligament
reinforcing the posterior surface of the articular
capsule of the hip joint
 Ligament of the head of the femur
attaches to the fovea of the head and to the
acetabular fossa
www.scribd.com/cpradheep
Ligaments Cont.

 Transverse acetabular ligament

spans the acetabular notch near the rim of the
acetabulum
 Zona orbicularis
circularly oriented ligamentous fibers that reinforce
the capsule of the hip joint
 Pubofemoral ligament
reinforcing the medial surface of the articular capsule
of the hip joint
www.scribd.com/cpradheep
 Muscles
Extension Flexion
 Gluteus maximus  Iliopsoas
 Adductor magnus  Pectineus
(ischial part)  Sartorius
 Hamstrings  Rectus femoris
 Tensor fascia latae

www.scribd.com/cpradheep
 Muscles
Adduction Abduction
 Adductor longus  Gluteus medius
 Adductor brevis  Gluteus minimus
 Adductor magnus  Tensor fascia latae
 Gracilis
 Pectineus (to a small
degree)

www.scribd.com/cpradheep
 Muscles
Lateral Rotation Medial Rotation
 Obturator externus  Gluteus minimus
 Obturator internus  Anterior part of gluteus
 Superior and inferior gemelli medius
 Piriformis  Pectineus
 Quadratus femoris
 Gluteus maximus
 Sartorius
 Posterior part of gluteus
medius

www.scribd.com/cpradheep
Range of Motion
 Flexion: 110 to 120 degrees
 Extension: 10 to 15 degrees
 Abduction: 30 to 50 degrees
 Adduction: 30 degrees
 Lateral rotation: 40 to 60 degrees
 Medial rotation: 30 to 40 degrees

www.scribd.com/cpradheep
Examination of Hip
 Subjective

 Objective

www.scribd.com/cpradheep
Subjective
History taking

www.scribd.com/cpradheep
Objective
 Observation
 Palpation
 Examination
 Special tests

www.scribd.com/cpradheep
Common problems in adults
 #NOF
 Osteoarthritis
 Rheumatoid Arthritis
 Ankylosing spondylitis
 Paget's Disease
 Dislocation
 Infectious joint diseases

www.scribd.com/cpradheep
Paediatrics
 Developmental dysplasia of the hip
Girls > Boys
 Perthes disease
Boys > Girls

www.scribd.com/cpradheep
#NOF
 Falls (1% of all falls cause #NOF)
 90% of hip fractures occur after age 70

 Male : Female ratio 1 : 2

 Tall, Low BMI (at risk)

(Mortality rate Male > Female)

www.scribd.com/cpradheep
http://herkules.oulu.fi/isbn9514270959/html/x286.html

www.scribd.com/cpradheep
Trabicullar system of Hip

www.scribd.com/cpradheep
Classification of #NOF

http://herkules.oulu.fi/isbn9514270959/html/c247.html

www.scribd.com/cpradheep
 Pauwels Classification

http://www.e-radiography.net/articles/Fractures%20of%20the%20lower%20limb/Fractures%20of%20the%20lower%20limb.htm

www.scribd.com/cpradheep
Intracapsular (Gardens)

http://www.emedicine.com/radio/topic342.htm

www.scribd.com/cpradheep
 Extracapsular (Jensen)

Jensen classification of trochanteric fractures

http://herkules.oulu.fi/isbn9514270959/html/x261.html

www.scribd.com/cpradheep
 Intracapsular Vs Extracapsular
 Less common  More
 Minimal rotation  Lateral violence
violence
 Minimal  Fully externally rotated
 Nil  Marked local swelling
 Difficult  Easy
 Common  Does not occur
 Rare  Common

http://www.bonetumour.org/book/Truma/chapter18/ch18_sub2.html

www.scribd.com/cpradheep
Management of #NOF
 Conservative
 Surgical
 THR
 HHR
 DHS
 CHS
 Girdlestone

www.scribd.com/cpradheep
Surgical approach to hip
 Anterior

 Lateral

 Posterior

www.scribd.com/cpradheep
http://www.totaljoints.info/Approaches_TH.jpg
www.scribd.com/cpradheep
Anterior
 Internal rotators, Abductors
 Low risk of hip dislocation, but risk of
limp due to division of the abductor
muscles attachments. Risk for damage
of skin nerves with persisting skin
numbness

www.scribd.com/cpradheep
Lateral
 TFL, G. Medius, G. Minimus, V. Lateralis
 Risk to Superior Glutial Nerve
 Excellent access but healing problems
with detached abductor muscles

www.scribd.com/cpradheep
Posterior
 External rotator, G. Maximus, Fascia
lata
 Risk to Sciatic Nerve
 Easy access, but greater risk of total hip
dislocation

www.scribd.com/cpradheep
PT Management
 Early Mobilisation
 Early Weight Bearing
 Quadriceps, Abductor Exercises
 Patient Education

www.scribd.com/cpradheep