Hip and knee
Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie in Bailey & Love's Short Practice of Surgery, 2018
The hip is a ball and socket joint formed by the head of the femur and the cup-shaped acetabulum (Latin: little vinegar cup) (Figure35.1). The joint allows a considerable range of movement in different planes, and is still inherently stable because of its bony anatomy and the static and dynamic stabilisers. The static stabilisers are composed of the ligaments (iliofemoral and pubofemoral ligaments anteriorly and the ischiofemoral ligament posteriorly), the joint capsule and the labrum. The muscles running across the joint (short external rotator muscles posteriorly, the iliopsoas anteriorly and the hip abductors laterally) constitute the dynamic stabilisers. The acetabular labrum is a fibrocartilagenous structure that is triangular in cross-section and attaches to the rim of the acetabulum except at its base, where it is replaced by the transverse ligament. It helps in deepening the socket, thereby enhancing stability. It also acts as a fluid seal and thereby helps to improve joint lubrication.The femoral head derives its blood supply mainly from the retinacular branches of the medial circumflex femoral artery and there is a small contribution from the artery of the ligamentum teres.
Paediatrics
David A Lisle in Imaging for Students, 2012
Developmental dysplasia of the hip (DDH) occurs in 1–2 per 1000 births. Females are more commonly affected than males with a ratio of 8:1. Left hip is more commonly involved than the right. Previously known as congenital hip dislocation, the term DDH more accurately reflects the underlying disorder, which is dysplasia of the acetabulum. Dysplasia of the acetabulum may lead to varying degrees of hip joint subluxation, dislocation and dysfunction. Risk factors for the development of DDH include family history, breech presentation, neuromuscular disorders and foot deformities. Early diagnosis is essential to the prevention of long-term complications including worsening dysplasia, abnormal gait and premature osteoarthritis. Conservative measures, such as splinting for a few weeks, are usually successful in all but the most severe cases.
Developmental dysplasia of the hip
Benjamin Joseph, Selvadurai Nayagam, Randall Loder, Ian Torode in Paediatric Orthopaedics, 2016
In the child with hip instability demonstrated by a positive Ortolani or Barlow sign a Pavlik harness is recommended. After one to two weeks in the harness, both clinical examination and ultrasound examination20 are performed to document improvement in both stability and acetabular development. The acetabular development can be quantified by ultrasound (Figure 24.9). On the ultrasound scan two angles are measured (the bony roof angle or a angle and the cartilage roof angle or β angle). An α angle greater than 60° and a β angle less than 55° suggests that the acetabular development is normal. If the reduction is satisfactory the harness is kept in place for six weeks, by which time the hip ought to have become stable and the acetabular development should have been restored to near normal (Figure 24.10).21
The influence of musculoskeletal forces on the growth of the prenatal cortex in the ilium: a finite element study
Published in Computer Methods in Biomechanics and Biomedical Engineering, 2020
Peter J. Watson, Michael J. Fagan, Catherine A. Dobson
Muscle forces were applied as distributed loads over their attachment areas and were defined in according to the muscle representation of the MSM as described above (i.e., broad origins were modelled in more than one section). The hip joint reaction force was distributed uniformly in a radial direction over the nodes of the acetabulum. The area of articulation within the SIJ was extruded medially by a thickness of 1.3 mm (the average thickness of the SIJ cartilage measured at 20 locations through the structure) and meshed with 60,371 10-noded tetrahedral elements, and defined with the material properties of cortical bone. Ten nodes around the circumference of the medial surface of the extruded area were constrained in all DOF to enable the hemi-pelvis to rotate about the extrusion, thus simulating pelvic rotation about the SIJ.
Desmoid fibromatosis presenting as lateral hip pain in an outpatient physical therapy clinic: A case report
Published in Physiotherapy Theory and Practice, 2023
Kelli Wrolstad, John J Mischke, Audrey RC Elias
The location of pain was not typical with that commonly seen in patients with acetabular labral tear since the vast majority of acetabular labrum tears are associated with anterior hip or groin pain (Cheatham, Enseki, and Kolber, 2016; Groh and Herrera, 2009; Reiman and Thorborg, 2014). In fact, Hamula et al. (2020) found only 6.7% of subjects with labral tears had pain isolated to the lateral hip region. Thus, the isolated lateral location of her hip pain that occasionally extended distally to the calf would be uncommon compared to the typical presentation of a labral tear. Labral tears commonly present with mechanical symptoms such as clicking, locking, catching, or giving way (Cheatham, Enseki, and Kolber, 2016; Groh and Herrera, 2009), none of which the patient had experienced. Patients with labral tears also frequently experience pain reproduction during combined passive flexion, adduction, and internal rotation due to increased strain on the labrum (Reiman, Mather, Hash, and Cook, 2014). The patient demonstrated restrictions in those motions, but also total loss of external rotation with a firm end-feel, which is not expected with a labral tear. Thus, the location of pain, limited external rotation, mechanism of injury, as well as the severe nature of her pain was inconsistent with a typical presentation of an acetabular labral lesion.
Physical therapy management of a patient with persistent groin pain after total hip arthroplasty and iliopsoas tenotomy: a case report
Published in Physiotherapy Theory and Practice, 2022
With 310,800 procedures performed in 2010, total hip arthroplasty (THA) is one of the most common orthopedic surgeries in the United States (Wolford, Palso, and Bercovitz, 2015). It is also one of the most successful orthopedic surgeries, resulting in significant pain relief, improved quality of life, and increased mobility in the short and long term (Learmonth, Young, and Rorabeck, 2007). Complications occur in 2%-10% of THA cases, and the most common complication is aseptic loosening (36.5%) (Wetters et al., 2013). The next most common complications are dislocation (17.7%) and infections (15.3%) (Wetters et al., 2013). Iliopsoas impingement, hereafter referred to as hip impingement syndrome, is rare after THA, but it has been reported to occur in 4.4% of patients (Henderson and Lachiewicz, 2012; Lachiewicz and Kauk, 2009). Described etiologies of hip impingement syndrome after THA include an excessive prominence of the acetabular component at the anteroinferior rim, prominent surgical screws, and a prominent femoral collar (Dora, Houweling, Koch, and Sierra, 2007). Common symptoms of hip impingement syndrome include groin pain with active flexion of the hip and stretching of the iliopsoas (Lachiewicz and Kauk, 2009). Diagnosis of hip impingement syndrome typically involves a combination of clinical findings, imaging findings, and response to anesthetic injection (Dora, Houweling, Koch, and Sierra, 2007).
Related Knowledge Centers
- Hyaline Cartilage
- Ischium
- Femoral Head
- Pelvis
- Ilium
- Pubis
- Acetabular Labrum
- Acetabular Notch
- Glenoid Fossa
- Synovial Fluid