Updated: 10/6/2021

Hip Anatomy

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  • Overview
    • Ball-and-socket type of diarthrodial joint
    • Stability
      • conferred by bony architechture
      • augmented by acetabular labrum and hip capsule
    • Acetabulum
      • formed from three ossification centers
        • ilium
        • ischium
        • pubis
      • posterosuperior portion has thicker cartilage for weightbearing purposes
  • Osteology
    • Acetabulum
      • anteverted 15 degrees
      • abducted 45 degrees (caudal tilt)
      • divided into four quadrants
        • line drawn from ASIS through center of acetabulum
          • anterior and posterior quadrants
        • line perpendicularly bisecting previous line
          • superior and inferior quadrants
        • posterior-superior
          • contains superior gluteal nerve and vessels and sciatic nerve
          • safest zone for screw placement
        • posterior-inferior
          • contains inferior gluteal nerve and internal pudendal vessels
          • second safest zone for screw placement
        • anterior-inferior
          • contain the obturator vessels
          • unsafe for screws
        • anterior-superior
          • contains external iliac artery and vein
          • unsafe for screws
    • Proximal femur
      • femoral head
        • center of femoral head should be at the level of the tip of the greater trochanter
      • femoral neck
        • anteverted 15 degrees (in relation to femoral condyles)
        • neck shaft angle of 125 degrees
      • greater and lesser trochanters
  • Capsule & Ligaments
    • Hip joint capsule
      • attaches anteriorly to the along the intertrochanteric line
      • extends posteriorly only partially across the femoral neck
        • basicervical and intertrochanteric regions are extracapsular
      • three ligaments
        • iliofemoral ligament (Y ligament of Bigelow)
          • strongest ligament
          • AIIS to intertrochanteric line
          • taut in full hip extension
          • prevents anterior dislocation / hyperextension
        • ischiofemoral
          • reinforces posterior capsule
        • pubofemoral
    • Ligamentum teres
      • cotyloid notch to fovea of femoral head
    • Transverse acetabular ligament
      • the most inferior portion of labrum
      • provides anatomic landmark for reaming
  • Blood Supply
    • Blood supply to femoral head changes with age
      • birth to 4 years of age
        • medial and lateral circumflex and ligamentus teres
      • 4 years of age to adult
        • posterosuperior and posteroinferior retinacular vessels from medial femoral circumflex
        • piriformis start nails
          • damage posterosuperior retinacular vessels
          • can cause AVN of femoral head
      • adult age
        • medial femoral circumflex
        • avoid transection the quadratus during posterior approach and damaging the MFC artery
    • Ligamentum teres
      • arterial branch of the posterior division of the obturator artery to the femoral head
      • not significant in adults
    • Abdominal aorta
      • external iliac artery
        • common femoral artery
          • at risk during screw placement in anterosuperior quadrant during THA
          • profunda femoris
            • lateral femoral circumflex
              • ascending branch at risk during the direct anterior approach
            • medial femoral circumflex
              • major blood supply to femoral head
              • at risk during psoas tenotomy
          • femoral artery perforators
            • supply vastus lateralis
      • internal iliac artery
        • obturator (posterior branch)
          • supplies transverse acetabular ligament
          • at risk with screw placement in anteroinferior acetabulum and acetabular retractors
        • superior gluteal
        • inferior gluteal
          • supplies short external rotators and gluteus maximus
          • runs along the piriformis after it exits the greater sciatic notch
        • internal pudendal
          • re-enters pelvis via lesser sciatic notch
    • Corona Mortis
      • connection between inferior epigastric branch of the external iliac vessels and the obturator vessels
  • Neurologic
    • Lumbosacral plexus
      • T12-S4 nerve roots
      • lies posterior to psoas muscle
    • Sciatic nerve
      • posterior division
        • peroneal
          • lateral in comparison to tibial division
          • most commonly injured neural structure during THA
          • runs deep to long head of biceps femoris
        • superior gluteal
        • inferior gluteal
        • piriformis
        • posterior femoral cutaneous
      • anterior division
        • tibial
        • nerve to quadratus femoris
        • nerve to obturator internus
        • pudendal
        • coccygeus
    • Obturator nerve
    • Femoral nerve
      • between iliacus and iliopsoas
      • branches to muscle, overlying skin, and hip joint
    • Lateral femoral cutanous nerve
      • L2-L3 nerve roots; branch of the lumbar plexus
      • deep to inguinal ligament near ASIS
    • Genitofemoral nerve
      • branch of the lumbar plexus
      • pierces iliopsoas and runs on its anteromedial surface
  • Musculature
    • Hip flexors
      • iliopsoas
      • rectus femoris
      • sartorius
      • pectineus
      • iliacus
    • Hip adductors
      • posterior adductor magnus
      • adductor longus
      • adductor brevis
      • gracilis
    • External rotators
      • gluteus maximus
      • piriformis
      • obturator externus
      • obturator interus
      • superior gemellus
      • inferior gemellus
      • quadratus femoris
    • Hip abductors
      • gluteus medius
      • gluteus minimus
      • tnesor fasciae latae
    • Hip extensors
      • gluteus maximus
      • hamstring tendons
        • semitendinosis
        • semimembranosus
        • long head of the biceps femoris
  • Approaches to the hip
    • Anterior - Smith-Petersen
    • Anterolateral - Watson-Jones
    • Medial
    • Direct lateral - Hardinge
    • Posterior - Southern or Moore
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