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Here is a short note on the Hip Joint, sourced from Gray's Anatomy for Students and S Das: A Manual on Clinical Surgery.

The Hip Joint

Type and Articulation

The hip joint is a synovial multiaxial ball-and-socket joint formed by the articulation of the spherical head of the femur with the acetabulum of the pelvic bone. It is designed primarily for stability and weight-bearing, trading some mobility for security.
Hip joint articular surfaces and rotation
Articular surfaces of the hip joint (A) and medial/lateral rotation of the femoral neck (B) - Gray's Anatomy for Students

Articular Surfaces

  • Head of the femur - spherical, covered by hyaline cartilage except at the fovea
  • Lunate surface of the acetabulum - covered by hyaline cartilage; broadest superiorly
  • The acetabular labrum (fibrocartilaginous collar) deepens the socket and increases stability; it bridges the acetabular notch inferiorly as the transverse acetabular ligament, converting the notch into a foramen

Ligaments

Three major extracapsular ligaments reinforce the fibrous capsule, all becoming taut in extension:
Hip joint ligaments - iliofemoral, pubofemoral, and ischiofemoral
Fibrous membrane and ligaments of the hip joint - Gray's Anatomy for Students
LigamentPositionAttachments
Iliofemoral (Y-ligament of Bigelow)AnteriorAIIS/acetabular margin → intertrochanteric line
PubofemoralAnteroinferiorIliopubic eminence → fibrous membrane/iliofemoral lig.
IschiofemoralPosteriorIschium (posteroinferior to acetabulum) → greater trochanter
An intracapsular ligament - the ligament of the head of the femur - runs from the fovea to the acetabular fossa. It carries a branch of the obturator artery contributing to blood supply of the femoral head.

Movements

The hip joint permits:
  • Flexion and extension
  • Abduction and adduction
  • Medial and lateral rotation
  • Circumduction
The long neck of the femur and its angulation on the shaft must be considered when assessing rotational movements - muscles move the greater trochanter forward (medial rotation) or backward (lateral rotation) relative to the acetabulum.

Blood Supply

Branches from multiple vessels form a periarticular network:
  • Medial and lateral circumflex femoral arteries
  • Obturator artery (via ligament of head)
  • Superior and inferior gluteal arteries
  • First perforating branch of the deep artery of the thigh

Nerve Supply

Articular branches from:
  • Femoral nerve
  • Obturator nerve
  • Superior gluteal nerve
  • Nerve to quadratus femoris

Clinical Points (from Das: Manual on Clinical Surgery)

  • Pain from hip disease is classically felt anteriorly and often radiates to the knee (shared innervation via femoral, obturator, and sciatic nerves) - a common clinical trap
  • Trendelenburg's test assesses the abductor mechanism; positive when abductors are weak or the fulcrum is lost (dislocation, coxa vara, fracture neck of femur)
  • Age of onset guides diagnosis: congenital dislocation (birth-5 yrs), Perthes' disease (5-10 yrs), slipped epiphysis (10-15 yrs), idiopathic osteoarthritis (>40 yrs)
  • Thomas' test detects fixed flexion deformity, which can be masked by compensatory lumbar lordosis

Sources: Gray's Anatomy for Students; S Das - A Manual on Clinical Surgery, 13th Ed.
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