Anatomy
Hip Joint
The hip joint is the largest weight-bearing joint in the human body. It is also referred to as a ball and socket joint and is surrounded by muscles, ligaments, and tendons. The thigh bone or femur and the pelvis join to form the hip joint.
Any injury or disease of the hip will adversely affect the joint's range of motion and ability to bear weight.
The hip joint is made up of the following:
- Bones and joints
- Ligaments of the joint capsule
- Muscles and tendons
- Nerves and blood vessels that supply the bones and muscles of the hip
Bones and Joints
The hip joint is the junction where the hip joins the leg to the trunk of the body. It is comprised of two bones: the thigh bone or femur and the pelvis which is made up of three bones called ilium, ischium, and pubis. The ball of the hip joint is made by the femoral head while the socket is formed by the acetabulum. The Acetabulum is a deep, circular socket formed on the outer edge of the pelvis by the union of three bones: ilium, ischium, and pubis. The lower part of the ilium is attached by the pubis while the ischium is considerably behind the pubis. The stability of the hip is provided by the joint capsule or acetabulum and the muscles and ligaments which surround and support the hip joint.
The head of the femur rotates and glides within the acetabulum. A fibrocartilagenous lining called the labrum is attached to the acetabulum and further increases the depth of the socket.
The femur or thigh bone is one of the longest bones in the human body. The upper part of the thigh bone consists of the femoral head, femoral neck, and greater and lesser trochanters. The head of the femur joins the pelvis (acetabulum) to form the hip joint. Next, to the femoral neck, there are two protrusions known as greater and lesser trochanters which serve as sites of muscle attachment.
Articular cartilage is the thin, tough, flexible, and slippery surface lubricated by synovial fluid that covers the weight-bearing bones of the body. It enables smooth movements of the bones and reduces friction.
Ligaments
Ligaments are fibrous structures that connect bones to other bones. The hip joint is encircled with ligaments to provide stability to the hip by forming a dense and fibrous structure around the joint capsule. The ligaments adjoining the hip joint include:
Iliofemoral ligament: This is a Y-shaped ligament that connects the pelvis to the femoral head at the front of the joint. It helps in limiting the over-extension of the hip.
Pubofemoral ligament: This is a triangular shaped ligament that extends between the upper portion of the pubis and the iliofemoral ligament. It attaches the pubis to the femoral head.
Ischiofemoral ligament: This is a group of strong fibers that arise from the ischium behind the acetabulum and merge with the fibers of the joint capsule.
Ligamentum teres: This is a small ligament that extends from the tip of the femoral head to the acetabulum. Although it has no role in hip movement, it does have a small artery within that supplies blood to a part of the femoral head.
Acetabular labrum: The labrum is a fibrous cartilage ring which lines the acetabular socket. It deepens the cavity, increasing the stability and strength of the hip joint.
Muscles and Tendons
A long tendon called the iliotibial band runs along the femur from the hip to the knee and serves as an attachment site for several hip muscles including the following:
Gluteals: These are the muscles that form the buttocks. There are three muscles (gluteus minimus, gluteus maximus, and gluteus medius) that attach to the back of the pelvis and insert into the greater trochanter of the femur.
Adductors: These muscles are located in the thigh which helps in adduction, the action of pulling the leg back towards the midline.
Iliopsoas: This muscle is located in front of the hip joint and provides flexion. It is a deep muscle that originates from the lower back and pelvis and extends up to the inside surface of the upper part of the femur.
Rectus femoris: This is the largest band of muscles located in front of the thigh. They also are hip flexors.
Hamstring muscles: These begin at the bottom of the pelvis and run down the back of the thigh. Because they cross the back of the hip joint, they help in extension of the hip by pulling it backward.
Nerves and Arteries
Nerves of the hip transfer signals from the brain to the muscles to aid in hip movement. They also carry the sensory signals such as touch, pain, and temperature back to the brain.
The main nerves in the hip region include the femoral nerve in the front of the femur and the sciatic nerve at the back. The hip is also supplied by a smaller nerve known as the obturator nerve.
In addition to these nerves, there are blood vessels that supply blood to the lower limbs. The femoral artery, one of the largest arteries in the body, arises deep in the pelvis and can be felt in front of the upper thigh.
Hip Movements
All of the anatomical parts of the hip work together to enable various hip movements. Hip movements include flexion, extension, abduction, adduction, circumduction, and hip rotation.
Hip Conditions
Osteoarthritis of the Hip
Osteoarthritis, also called degenerative joint disease, is the most common form of arthritis. It occurs most often in the elderly. This disease affects the tissue covering the ends of bones in a joint called cartilage.
Inflammatory Arthritis of the Hip
The inflammation of the joints is referred to as arthritis. Inflammation arises when the smooth lining called cartilage at the ends of bones wears away. In some cases, the inflammation is caused when the lining of the joint becomes inflamed as part of an underlying systemic disease.
Hip Bursitis
Hip bursitis is a painful condition caused by the inflammation of a bursa in the hip. Bursae are fluid-filled sacs present in the joints between bone and soft tissue to reduce friction and provide cushioning during movement.
Femoroacetabular Impingement
Femoroacetabular impingement (FAI) is a condition characterized by excessive friction in the hip joint from the presence of bony irregularities. These cause pain and decreased range of hip motion.
Developmental Dysplasia
Developmental dysplasia of the hip (DDH) or hip dysplasia is a condition that is seen in infants and young children because of developmental problems in the hip joint.
Hip Labral Tear
A hip labral tear is an injury to the labrum, the cartilage that surrounds the outside rim of your hip joint socket.
Snapping Hip Syndrome
Snapping hip syndrome is a condition in which you hear or feel a snapping sound in the hip when you swing your legs, run, walk or get up from a chair. The sound can be experienced in the back, front or side of the hip.
Gluteus Medius Tear
A gluteus medius tear is the partial or complete rupture of the gluteus medius muscle due to severe muscle strain. Gluteus medius tears often occur at the tendinous attachment to the greater trochanter of the femur bone.
Gluteus Tendon Tear
The gluteal muscles (situated in the buttocks) are necessary for the stability and movement of the hip joints. The tendons of two gluteal muscles (gluteus medius and gluteal minimus) are attached at the outer hip region and are often called the “rotator cuff of the hip.”
Hip Injury
A hip fracture is a break that occurs near the hip in the upper part of the femur or thighbone. It is most frequently caused after minor trauma in elderly patients, and by a high-energy trauma or serious injury in young people.
Hip Instability
Injury or damage to these structures can lead to a condition called hip instability when the joint becomes unstable.
Hip Dislocation
Hip dislocation occurs when the head of the femur moves out of the socket. The femoral head can dislocate either backward (posterior dislocation) or forward (anterior dislocation).
Hip Fracture
A hip fracture is a break that occurs near the hip in the upper part of the femur or thighbone. The thighbone has two bony processes on the upper part - the greater and lesser trochanters. The lesser trochanter projects from the base of the femoral neck on the back of the thighbone.
Femoral Neck Fracture
Fractures to the femoral neck can completely or partially disconnect the femoral head from the rest of the femur. Femoral neck fractures may be either displaced, where the bone is moved out of its original position, or non-displaced, where there is no instability of the bone.
Femoral Shaft Fracture
A femoral shaft fracture is a crack or break anywhere along the long and straight section of the femur (thighbone) due to high-energy trauma or low-energy trauma in osteoporotic patients.
Stress Fractures of the Hip
Stress fractures of the hip are a break in the upper part of the thigh bone (femur) that fits into the socket of the hip joint. It can occur in any part of the hip, however, it mostly occurs just below the ball of the ball-and-socket hip joint called the femoral neck.
Femur Fracture
The femur or thigh bone is the longest and strongest bone in the body, connecting the hip to the knee. A femur fracture is a break in the femur.
Pediatric Femur Fracture
The femur or thighbone is the largest and strongest bone in the human body. Pediatric thighbone fractures can occur when your child falls hard on the ground and gets hit during sports, automobile accidents and child abuse.
Pelvic Fractures
A pelvic fracture is a condition that occurs due to the breakage of the pelvic bone. It may cause damage to the internal organs, nerves and blood vessels associated with the pelvic region.
Periprosthetic Hip Fractures
Hip replacement is a surgical procedure in which the damaged cartilage and bone are removed from the hip joint and replaced with artificial components.
Subtrochanteric Hip Fracture
A hip fracture is a break that occurs near the hip in the upper part of the femur or thighbone. The thighbone has two bony processes on the upper part - the greater and lesser trochanters.
Hamstring Injuries
The hamstring is a group of three muscles that run along the back of the thigh from the hip to the knee. Hamstring injuries occur when these muscles are strained or pulled.
Hip Tendonitis
Tendons are strong connective tissue structures that connect muscle to bone. Hip tendonitis is a condition associated with degeneration of the hip tendons.
Irritable Hip
Irritable hip, also known as acute transient synovitis, is a common disorder of childhood characterized by hip pain and limping. The term transient means that it does not last long.
Hip Ligament Injuries
Injuries to the hip ligaments are commonly called a hip sprain and can range from minor tears of the ligaments to more serious injuries involving the hip muscles, tendons or bone.
Hip Abductor Tears
Hip abductors are a major group of muscles found in the buttocks. It includes the gluteus maximus, gluteus medius, gluteus minimus, and tensor fascia lata muscles.
Hip Adductor Injuries
A hip adductor injury is also called a groin strain or groin tear and involves any of the adductor muscles. These injuries are common among athletes and those who play hockey, football, soccer, basketball, tennis, baseball, etc.
Hip Flexor Pain
Hip flexor pain is a distressing feeling or discomfort noted in the hip and/or groin region that can make everyday activities, such as going up and down the stairs or lifting your leg to tie a shoe extremely difficult and painful and can severely limit your activity and mobility.
Transient Osteoporosis of the Hip
Transient osteoporosis of the hip is a rare condition that causes temporary bone loss in the upper region of the thighbone (femur). It occurs most often in young or middle-aged men of the age groups 30 to 60, and women in their later stages of pregnancy or early postpartum (following childbirth).
Hip Procedures
Total Hip Replacement
Total hip replacement is a surgical procedure in which the damaged cartilage and bone are removed from the hip joint and replaced with artificial components. The main indication for total hip replacement is arthritis.
Outpatient Hip Replacement
Hip replacement surgery is one of the most common orthopedic surgeries performed. It involves the replacement of the damaged hip bone (ball shaped upper end of the femur) with a ceramic ball attached to a metal stem that is fixed into the femur and placing a new cup with a special liner in the pelvis.
Robotic Total Hip Replacement
Robotic total hip replacement is a minimally invasive procedure where your surgeon is assisted by a robotic system to perform a total hip replacement surgery.
Revision Hip Replacement
During total hip replacement, the damaged cartilage and bone are removed from the hip joint and replaced with artificial components.
Minimally Invasive Total Hip Replacement
Minimally invasive total hip replacement is a surgical procedure performed through one or two small incisions rather than the single long incision of 10–12-inches as in the traditional approach.
Anterior Hip Replacement
Anterior hip replacement surgery is performed under general anesthesia or regional anesthesia. You will lie down on your back, on a special operating table that enables your surgeon to perform the surgery from the front of the hip.
Computer-assisted Hip Replacement
Computer-assisted hip replacement is an image-guided, minimally invasive surgical procedure to replace your diseased or damaged hip with an artificial device using the assistance of computer software.
Computer-Navigated Total Hip Replacement
For a successful total hip replacement, accurate positioning of the implants is crucial to accomplish a good clinical outcome. Computer-navigated total hip replacement is an advanced technology developed to provide more accurate positioning of an implant.
Custom/Patient-Specific Hip Replacement
Custom total hip replacement, also called bespoke hip replacement or patient-specific hip replacement, is a newer, more advanced technology in total hip arthroplasty that uses an individualized hip implant for the replacement of the damaged or injured components of the hip joint.
Posterior Hip Replacement
Posterior hip replacement is a minimally invasive hip surgery performed to replace the hip joint. It is also referred to as muscle sparing surgery because no muscles are cut to access the hip joint, enabling a quicker return to normal activity.
Mini-Posterior Hip Replacement
Mini-posterior hip replacement is a surgical procedure used to replace your damaged hip with synthetic parts inserted through a small incision made at the back of the hip.
Outpatient Anterior Approach Hip Replacement
Outpatient anterior approach hip replacement refers to surgery accessed from in front of the hip in an outpatient setting.
Hip Arthroscopy
Hip arthroscopy, also referred to as keyhole or minimally invasive surgery, is a procedure in which an arthroscope is inserted into your hip joint to check for any damage and repair it simultaneously.
Hip Arthroscopy - Supine Position
Arthroscopy, also referred to as keyhole or minimally invasive surgery, is a procedure in which an arthroscope is inserted into a joint to check for any damage and to repair the problem at the same time.
Robotic Assisted Hip Surgery
Robotic assisted hip surgery is a minimally invasive surgical procedure that involves the use of a specialized robotic system to remove the damaged parts of a hip joint and replace them with an artificial prosthesis or implant.
Hip Labral Repair
Labrum is a ring of strong fibrocartilaginous tissue lining around the socket of the hip joint. Labrum serves many functions where it acts as a shock absorber, lubricates the joint, and distributes the pressure equally.
Hip Fracture Surgery
Surgical correction of a hip fracture is known as hip fracture surgery. Hip fractures involve a break that occurs near the hip in the upper part of the femur or thigh bone.
Hip Cartilage Repair
Hip cartilage repair is the process of restoring damaged cartilage in the hip joint, either surgically or non-surgically.
Hip Distraction
The hip joint is one of the most important and flexible joints in the human body which allows us to walk, run, bend and perform physical activities.
Hip Microfracture
Hip Microfracture is a marrow-stimulating technique that creates a network of small holes in the bone below the hip cartilage (subchondral bone). The goal of the procedure is to increase the blood supply to stimulate cartilage growth.
Surgical Release of Iliopsoas Tendon
Surgical release of the iliopsoas tendon is a procedure that involves the excision or cutting of the iliopsoas tendon in the hip to reduce pain and improve range of motion.
Core Decompression for Avascular Necrosis of the Hip
Avascular necrosis commonly affects the head of the femur. Necrosis leads to tiny cracks in the bone which finally causes the head of the femur to collapse.
Stem Cell Therapy for Hip Injuries
Stem cell therapy is a form of regenerative medicine that utilizes the body’s natural healing mechanism to treat various conditions.
Physical Therapy for Hip
Physical therapy is an exercise program that helps you to improve movement, relieve pain, encourage blood flow for faster healing, and restore your physical function and fitness level.
Sacroiliac Joint Injections
Sacroiliac joints (SI joint) are joints in the lower back region, where the sacrum and ilium bones join. Even though these joints are small and have limited motion, they have an important role in connecting your spine to the pelvic bone and the lower part of your body.
Trochanteric Bursa Injections
A trochanteric bursa injection is a minimally invasive procedure in which medicine is injected directly into the trochanteric bursa in the hip joint using a thin needle and syringe to relieve pain and inflammation.
Ultrasound Guided Hip Injections
An ultrasound scan is an imaging procedure that uses high-frequency sound waves to produce pictures of the inside of the body. Ultrasound-guided hip joint injections are used to diagnose the underlying cause and relieve hip pain.
Others
Activities After Hip Replacement
You will be discharged from the hospital once you have sufficient pain control and are able to perform basic activities on your own, such as getting in and out of bed, going to the bathroom and walking with an assistive device such as crutches or a walker.
Physical Examination of the Hip
The physical examination of the hip by your doctor includes a visual inspection of your hip, palpation of the hip to diagnose tenderness or any abnormality, etc; and testing range of motion of the hip.