The Hip. Joint meeting IBEC & RCSI. Cappagh National Orthopaedic Hospital . Dr. Aamir Shaikh. Clinical Lecturer of Orthopedics RCSI & UCD. 15 th December 2010 . Content:. 1: Anatomy 2: Clinical features. 3: Examination. 4: Pathology. 5: Treatment. Anatomy.
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Joint meeting IBEC & RCSI.
Cappagh National Orthopaedic Hospital.
Dr. Aamir Shaikh.
Clinical Lecturer of Orthopedics RCSI & UCD.
15th December 2010.
Ball and socket joint of synovial joint.
Connects the pelvic girdle to the lower limb
Made up of femoral head and acetabulum
Designed for stability and wide range of movement
Covered with a thin layer of hyaline cartilage
The articular surface of is horse-shoe shaped and is deficient inferiorly- acetabular notch
Has a labrum
is a circular layer of cartilage which surrounds the outer part of the acetabulum making the socket deeper and so helping provide more stability
Acetabular labral tears are a common injury from major or repeated minor trauma
This is a strong ligament which connects the pelvis to the femur
at the front of the joint
It resembles a Y in shape
Stabilises the hip by limiting hyperextension
Gluteus Maximus, Gluteus Minimus and Gluteus Medius
Attach to the Ilium and travel laterally to insert into the greater trochanter of the femur
Medius and Minimus abduct and medially rotate the hip joint, as well as stabilising the pelvis
Gluteus maximus extends and laterally rotates the hip joint
The four Quadricep muscles are Vastus lateralis, medialis, intermedius and Rectus femoris
All attach inferiorly to the tibial tuberosity
Rectus femoris originates at the Anterior Inferior Iliac Spine and acts to flex the hip
The 3 other Quad muscles do not cross the hip joint, and attach around the greater trochanter and just below it.
The is the primary hip flexor muscle which consists of 2 parts
Attaches superiorly to the lower part of the spine and the inside of the ilium
Cross the hip joint and insert to the lesser trochanter of the femur
The hamstrings are three muscles which form the back of the thigh
Attach superiorly to the ischial tuberosity
Cause hip extension
- hamstrings, addcutormagnus, gluteus maximus
- adductor longus, brevis, and magnus, gracilis, pectineus
- gluteus medius, minimus, tensor fascia lata
- obturatorexternus, internus, piriformis, quadratusfemoris, gluteus maximus
- gluteus medius, minimus, tensor fascia lata.
Obturator (L2, 3, 4)
Sciatic (L4,5, S1, 2,)
WHY ARE THESE IMPORTANT???
Referred pain to the knee can hide hip pathology and vis versa
Always opt for conservative measures over surgical ones
Use analgesia and physiotherapy/ OT when and where appropriate
When necessary offer surgical treatment if appropriate
Watch the patient walk into the room and sit down
- walking aid, limp, uncomfortable gait
Inspect hips for scars, swelling, obvious deformity
Assess leg length for any true leg length discrepancy (measure from ASIS medial malleolus) and apparent leg length (umbilicus medial malleolus)
- a difference in true leg length indicates hip disease on the shorter side
- a difference in apparent leg length are due to tilting of the pelvis
Test flexion (135 deg):
flex knee and move it towards the chest without moving the opposite leg
if opposite side moves apply THOMAS TEST (tests for fixed flexion deformity)
-With hip and knee flexed move the foot outward (ext rotation of hip) and inward (int rotation of hip
- stand on the same side of the bed as the leg being tested
- put your hand over the ASIS of the side not being tested to stabilize the pelvis
- with your other hand grasp the heel of the leg being tested and move it outwards as far as possible
- then bring the leg across to the opposite side to test
- ask the patient to roll onto their stomach
- place one hand over the sacroiliac joint while the other elevate each leg
- ask the patient to stand first on one leg then the other
- normally the non weight bearing hip rises or stays level
- with proximal myopathy or hip joint disease the non weight bearing side sags
-power, tone, sensation
Know your nerve supply!!!
extension: L5, S½
abduction: L4/5, S1
A degenerative joint disease that causes stiffness, pain, and reduction in movement
What are the two types?
Primary OA: middle aged/ elderly, aetiology unknown
Secondary OA: anyone with predisposing factors such as SUFE, CDH, DDH, Perthes, or early onset trauma/ fracture to hip joint etc
Affects weight bearing joint.
Prevalence increases with age
Disease accelerated by mechanical instability/ stress on jt/increased stress on jt surface
initial changes in articular cartilage fibrillation of cartilage vertical clefts exposure of subchondral bone
with continuous pressure this leads to sclerosis of subchondral bone (eburnation)
bone degeneration under stress creates cysts
At joint margins new bone forms resulting in spurs/ osteophytes.
Sub periosteal Cyst formation.
Bone on bone surface contact.
Narrowing of jt space
Sclerosis of subcondral bone
Cystic bone changes
Is a chronic systemic disease of unknown aetiology
Characterized by chronic symmetric inflammation of the joints
Variable extra articular manifestation
Genetic prediposition with HLA
Soft tissue swelling
Joint space narrowing
Hands are often affected earliest
infliximab (anti tnf-α)
X3 Poly. With or without 10 deg
Ceramic or metal.
Gentamicin 0.5 gm as Gentamicin sulphate.
Methyl- methacrylate- methyl acrylate co-polymer
2. 18.8 gm of liquid in amber glass ampoule.
Methyl methacrylate (stablised with hydroquinone)
Chlorophyll – copper-complex.