BIOMECHANICS OF HIP JOINT

Prepared by:

Dr. Hazrat Bilal Malakandi, PT

DPT (IPMR, KMU), MSPT (KMU),
CHPE (KMU), CHR (KMU)

Assistant Professor/Physical Therapist

NCS University System, DHS, Peshawar
 Objectives
• Students will be able to
– Describe proximal and distal articular surfaces
– Describe acetabular angulation
– Describe femoral angulation
– Describe hip joint capsule
– Describe the hip joint ligaments
– Describe forces acting at hip joint
– Describe the trabecular system
– Describe ROM of hip joint
– Describe musculature of hip joint
– Describe the motion of pelvis on femur
 INTRODUCTION
• The hip joint, or coxofemoral joint, is the
articulation of the acetabulum of the pelvis and the
head of the femur.

• Diarthrodial ball-and-socket joint

• Three degrees of freedom:

1. flexion/extension in the sagittal plane
2. abduction/adduction in the frontal plane
3. medial/lateral rotation in the transverse plane
• The primary function of the hip joint
• To support the weight of the head, arms, and trunk
(HAT) both in
• Static erect posture
• Dynamic postures such as ambulation, running,
and stair climbing.
 STRUCTURE OF THE HIPJOINT
Proximal Articular Surface
Acetabulum
• The opening of the acetabulum
is approximately
– Laterally inclined 50° (coronal)
– Anteriorly rotated (anteversion)
20° (transverse)
– Anteriorly tilted 20° (sagittal plane)
• The pubis forms one fifth of the
acetabulum, the ischium forms two fifths,
and the ilium forms the remainder.

• Until full ossification of the pelvis occurs

between 20 and 25 years of age, the
separate segments of the acetabulum may
remain visible on radiograph.
• Lunate surface
– Horse Shoe
– Hyaline cartilage
• Acetabular fossa
– Non articular
– Fats
• Acetabular notch
– Blood vessels pass
• Acetabular transverse
ligament
– Spanned the notch
• Ligamentum teres
– Aka Round ligament
– Triangular in shape
– Artery to femoral head
– Attachments
• from both edges of acetabular notch
• Fovea of femoral head
CENTER EDGE ANGLE OF WIBERG

• Acetabular depth
can be measured as
the center edge
angle of Wiberg
• Center edge angles are classified as follows:
– Definite dysplasia less than 16°
– Possible dysplasia 16° to 25° and
– Normal greater than 25°
• Anteversion of the acetabulum exists when
the acetabulum is positioned too far anteriorly in
the transverse plane.

• Retroversion exists when the acetabulum is

positioned too far posteriorly in the transverse
plane
 Transverse angle of the
acetabular inlet
• Aka Sharp's angle
• Angle between a line passing from the
superior to the inferior acetabular rim and
the horizontal plane.
Sharp's angle
 Acetabular labrum
• The entire periphery of the acetabulum is rimmed
by a ring of wedge-shaped fibrocartilage called
the acetabular labrum.
• Functions
– Deepens the socket
– Grasping the head of the femur to maintain contact
with the acetabulum
– It enhances joint stability by acting as a seal to
maintain negative intra-articular pressure
– Also provide proprioceptive feedback
Distal articular surface

• The head of the femur

– fovea or fovea capitis
– ligament of the head of the femur (ligamentum teres)
 ANGULATION OF THE FEMUR
• There are two angulations
• Angle of inclination
• Occurs in the frontal plane
• Angle between an axis through the femoral head and
neck and the longitudinal axis of the femoral shaft

• Angle of torsion
• Occurs in the transverse plane
• Angle between an axis through the femoral head
and neck and an axis through the distal femoral
condyles
 Angle of inclination
• The angle of inclination of the femur is less than
130° in the unimpaired adult.
• With a normal angle of inclination, the greater
trochanter lies at the level of the center of the
femoral head.
• A pathological increase in the medial angulation
between the neck and shaft is called coxa valga.
• A pathological decrease is called coxa vara.
• Both coxa vara and
coxa valga can lead to
– abnormal lower
extremity biomechanics
– altered muscle function
– gait abnormalities.
Correlation between Foot Overpronation
and Angle of Inclination of Hip Joint.

• Result: Result shows a statically significant correlation

between angle of inclination of femur and navicular drop
test of both sides. Increase in foot overpronation is
correlated with increase in angle of inclination.
• Conclusion: Result suggests that coxa valga may be a
positive correlated with foot overpronation.
 The angle of torsion
• Best viewed by looking down the
length of the femur from top to
bottom

• An axis through the femoral

head and neck in the
transverse plane

• Will lie at an angle to an axis

through the femoral condyles
• The angle of torsion
decreases with age.
– In the newborn, 40°,
– In the adult -10° to 20°.

• A pathologic increase in the

angle of torsion is called
anteversion and a
pathologic decrease in the
angle or reversal of torsion
is known as retroversion
 Hip Joint Radiograph

• Shelton line
• Perkin’s line
• Helgenreiner’s line
• Extrusion index
• Femoral head coverage percentage
• acetabular index
• Shelton
line
 ARTICULAR CONGRUENCE
• In the neutral or standing
position, the articular surface
of the femoral head remains
exposed anteriorly and
somewhat superiorly

• Articular contact between the

femur and the acetabulum
can be increased in the
normal non-weight-bearing
hip joint by a combination of
flexion, abduction, and
slight lateral rotation
 HIP JOINT CAPSULE
• Both joint capsule and ligamentum teres
provide stability of the hip joint during
distractive forces
Anterior attachment
Posterior Attachment

Acetabular margin
Neck of the femur

Trochanteric
crest
 HIP JOINT LIGAMENTS
• Iliofemoral ligament (Y ligament of Bigelow)
• Pubofemoral ligament
• Ischiofemoral ligament
 Iliofemoral ligament
• The iliofemoral ligament resembles an
inverted letter Y.

• It often is referred to as the Y ligament of

Bigelow.

• The apex of the ligament is attached to the

anterior inferior iliac spine, and the two
arms of the Y fan out to attach along the
intertrochanteric line of the femur.
 Iliofemoral ligament

• The superior band of the iliofemoral

ligament is the strongest and thickest of
the hip joint ligaments.

• This strong ligament prevents

overextension during standing.
 Pubofemoral ligament

• Anteriorly located

• Arising from the anterior aspect of the

pubic ramus and passing to the anterior
surface of the intertrochanteric fossa.

• This ligament limits extension and

abduction.
 Anterior View
Anterior
Inferior
Iliac line

Iliofemoral
ligament

Pubofemoral
Trochanteric ligament
line
 Ischiofemoral ligament

• The ischiofemoral ligament is the posterior

ligament.

• The ischiofemoral ligament attaches to the

posterior surface of the acetabular rim and the
acetabulum labrum.
 Ischiofemoral
ligament

Posterior view
 Cont …..

• Some of its fibers spiral around the femoral neck

and blend with the fibers of the circumferential
fibers of the capsule.

• Other fibers are arranged horizontally and attach

to the inner surface of the greater trochanter.

• The spiral fibers of the ischiofemoral ligament

are tightened during hyperextension and
therefore limit hyperextension.
• First order lever
– fulcrum (hip joint)
– forces on either side of fulcrum
• i.e, body weight & abductor tension
• To maintain stable hip, torques produced by the body
weight is countered by abductor muscles pull.
• Abductor force X lever arm1 = weight X leverarm2
• Forces acting across hip
joint

 Body weight
 Abductor muscles
force
 Joint reaction force
 JOINT REACTION FORCE
 Defined as force generated within a joint in response
to forces acting on the joint
 In the hip, it is the result of the need to balance the
moment arms of the body weight and abductor
tension
Maintains a level pelvis
HAT and GRF
Trabecular system
 ROM
• Ranges of passive joint motion typical of the hip
joint :-

Flexion 90° with the knee extended and

120° when the knee is flexed
Extension  10° to 20°
Abduction  45° to 50°
Adduction  20° to 30°
Medial and lateral rotations  42° to 50°
 HIP JOINT MUSCULATURE

Flexion :
 Chiefly by psoas major, iliacus
 Assisted by rectus femoris and
sartorius
 Adductor longus assists in
early flexion following full
extension
Extension :
 Gluteus maximus and the hamstrings.

Abduction :
 Gluteus medius and minimus
 Assisted by sartorius, tensor fasciae latae and
piriformis
 Action is limited by adductor longus, pubofemoral
ligament and medial band of iliofemoral ligament
Adduction :
By Pectineus, gracilis, adductor longus, adductor
brevis and adductor fibers of adductor magnus

Lateral rotation :
Piriformis, obturator internus and externus,
superior and inferior gemelli and quadratus femoris
 Assisted by the gluteus maximus
Medial rotation: the anterior fibers of the
gluteus medius and gluteus minimus,
tensor fasciae latae

Piriformis muscle is a lateral rotator at 0° of

hip flexion but a medial rotator at 90° of hip
flexion
 MOTION OF PELVIS ON THE
FEMUR
Anterior and Posterior Pelvic Tilt
 Anterior and posterior pelvic tilts are motions of the entire
pelvic ring in the sagittal plane around a coronal axis.

 In the normally aligned pelvis, the anterior superior iliac

spines (ASISs) of the pelvis lie on a horizontal line with
the posterior superior iliac spines (PSISs) and on a
vertical line with the symphysis pubis

 Anterior and posterior tilting of the pelvis on the fixed

femur produce hip flexion and extension
 Hip joint extension through posterior tilting of the
pelvis
 Hip flexion through anterior tilting of the pelvis
Lateral Pelvic Tilt

 Lateral pelvic tilt is a frontal plane motion of the

entire pelvis around an anteroposterior axis.

 In the normally aligned pelvis, a line through the

anterior superior iliac spines is horizontal.

 In lateral tilt of the pelvis in unilateral stance, one

hip joint (e.g., the left hip joint) is the pivot point
or axis for motion of the opposite side of the
pelvis (e.g., the right side) as that side of the
pelvis elevates (pelvic hike) or drops (pelvic
drop).
Lateral Shift of the
Pelvis

• With pelvic shift, the

pelvis cannot hike; it
can only drop.
 Forward and Backward Pelvic
Rotation
• Forward (anterior) rotation of the pelvis occurs
in unilateral stance when the side of the pelvis
opposite to the weight-bearing hip joint moves
anteriorly from the neutral position.

• Forward rotation of the pelvis produces medial

rotation of the weight-bearing hip joint.
• Backward (posterior) rotation of the pelvis
occurs when the side of the pelvis opposite
the weight-bearing hip moves posteriorly

• Backward rotation of the pelvis produces lateral

rotation of the supporting hip joint.