1. ANATOMY OF THE HIP Presented By: Cassie Litzinger, Julia Meyer,
Sarah Doumit and Susan Reider

2. SURFACE ANATOMY Iliac Crest Supracristal Plane Gluteal Fold
Gluteal Sulcus
Intergluteal Cleft
SURFACE ANATOMY SD

3. SURFACE ANATOMY Anterior Iliac Spine Posterior Iliac Spine
Inguinal Ligament
Anterior view
SURFACE ANATOMY
Posterior View SD

4. Sacrum
Tip of the Greater Trochanter
SURFACE ANATOMY SD

5. LIGAMENTS Iliofemoral Ligament: Pubofemoral Ligament:
Connects ilium to femur
Prevents hyperextension
Internal/External Rotation
Anteriorly & Superiorly
Pubofemoral Ligament:
Connects pubis to femur
Tightens during extension and Abduction
Prevents over-abduction
Inferiorly & Anteriorly
LIGAMENTS CL

6. LIGAMENTS Ischiofemoral Ligament: Connects ischium to femur
Posterior side of hip
joint
Prevents Posterior Displacement (dislocation)
LIGAMENTS CL

7. LIGAMENTS Inguinal Ligament: Arched fibers of the external oblique
Consists of collagen fibers
Inguinal Hernias common here
LIGAMENTS CL

8. LIGAMENTS Transverse Ligament of Acetabulum: Bridges acetabular notch
Formed by acetabular labrum
LIGAMENTS CL

9. LIGAMENTS Sacrotuberous Ligament: Gluteal ligament
Convert sciatic notches into greater and lesser sciatic foramina
LIGAMENTS CL

10. LIGAMENTS Ligament of the Head of the Femur:
Also called ligamentum teres or “round ligament”
Weak ligament
Conducts artery to head
LIGAMENTS CL

11. LIGAMENTS Zona Orbicularis Circular fibers
Forms collar around femoral neck
LIGAMENTS CL

12. BURSAE Trochanteric Bursa: Ischial Bursa: Gluteofemoral Bursa:
Gluteus Maximus – Greater Trochanter
Ischial Bursa:
Prevents friction between ischial tuberosity and gluteus maximus
Gluteofemoral Bursa:
BURSAE CL

13. CARTILAGE Acetabular Labrum:
Hip joint stability/deepens socket
Fibrous cartilage ring
Articular Cartilage of the Head of the Femur
CARTILAGE CL

14. ARTICULAR CAPSULE Synovial Membrane: Fibrous Layer/capsule:
Lines the capsule
Fibrous Layer/capsule:
Attaches on hip bone to bony rim of acetabulum
Deep fibers form orbicular zone
Reinforces hip
ARTICULAR CAPSULE CL

15. BONES OF THE OS COXAE PELVIC GIRDLE Ilium Ischium Pubis “Hip Bone”
“Sit Bone”
Pubis
BONES OF THE OS COXAE JM

16. ILIUM Iliac Crest Iliac Fossa Iliac Spines Anterior Superior
Anterior Inferior
Posterior Superior
Posterior Inferior
ILIUM JM

17. ISCHIUM Ischial Tuberosity Ischial Spine Greater Sciatic Notch
Lesser Sciatic Notch
ISCHIUM JM

18. PUBIS Superior Pubic Ramus Inferior Pubic Ramus Pubic Arch
Obturator Foramen
PUBIS JM

19. Pubic Crest
Pubic Symphysis
Acetabulum
PUBIS JM

20. DIFFERENTIATION JM

21. FEMUR Head Neck Greater Trochanter Lesser Trochanter Linea Aspera
Pectineal Line
Adductor Tubercle
FEMUR JM

22. MUSCLES PECTINEUS O: Superior Ramus of the Pubis
I: Pectineal line inferior to Lesser Trochanter of Femur
A: Flexes, Adducts, and assists with Medial Rotation of the Hip
N: Femoral Nerve and fibers of Obturator Nerve L2-L4
MUSCLES SR

23. MUSCLES GRACILIS O: Body and Inferior Ramus of the Pubis
I: Anterior medial proximal Tibia
A: Adducts and Medially rotates the hip, Flexes the Knee
N: Obturator Nerve L2-L3
MUSCLES SR

24. MUSCLES ADDUCTOR MAGNUS
O: Inferior Ramus of Pubis and Ischium to Ischial Tuberosity
I: Linea Aspera of Femur, medial Supracondylar Line and adductor Tubercle
A: Adducts thigh, Superior horizontal fibers Flex thigh, and posterior portion Extend thigh at Hip joint
N: Obturator and Tibial Nerves L2-L4
MUSCLES SR

25. MUSCLES ADDUCTOR LONGUS ADDUCTOR BREVIS
O: Body of Pubis inferior to Pubic Crest and lateral Pubic Symphysis
I: Middle 1/3 of Linea Aspera of Femur
A: Adducts, Flexes and helps Medially Rotate Hip
N: Obturator Nerve L2-L4
ADDUCTOR BREVIS
O: Anterior surface of the inferior ramus of Pubis
I: Pectineal Line and medial lip of Linea Aspera of Femur
A: Adducts, Flexes and helps medially rotate Hip
MUSCLES SR

26. PECTINEUS
GRACILIS
ADDUCTOR:
MAGNUS
LONGUS
BREVIS
ADDUCTOR MUSCLES SR

27. MUSCLES PSOAS MAJOR: O: Transverse Process L1-L5 I: Lesser Trochanter
A: Hip/Thigh Flexion
N: Lumbar Nerves L1-L3
MUSCLES CL

28. MUSCLES ILIACUS: O: Iliac Crest, Fossa, Anterior sacroiliac ligament
I: Lesser Trochanter
A: Hip Flexion
N: Femoral L2-L3
MUSCLES CL

29. MUSCLES TENSOR FASCIA LATAE:
O: Anterior Superior Iliac Spine/Anterior iliac crest
I: Tibia by way of iliotibial tract
A: Flexes and abducts thigh at hip joint/Helps stabilize and steady hip
N: Superior Gluteal Nerve
**acts in concert with psoas major and illiacus**
MUSCLES CL

30. PSOAS MAJOR
ILIACUS
TENSOR FASCIA LATAE
MUSCLES CL

31. MUSCLES RECTUS FEMORIS O: Anterior Inferior Iliac Spine
I: Patella via quadriceps tendon and tibia tuberosity via patellar ligament
A: knee extension and hip flexion
N: Femoral L2-L4
MUSCLES JM

32. MUSCLES SARTORIUS O: Anterior Superior Iliac Spine
I: Upper medial surface of the body of the Tibia
A: Knee flexion, Hip flexion, abduction and lateral rotation
N: Femoral L2-L3
MUSCLES JM

33. MUSCLES GLUTEUS MAXIMUS
O: Iliac Crest, Sacrum, Coccyx and Aponeurosis of Sacrospinalis
I: Iliotibial Tract of Fascia Lata and lateral part of Linea Aspera under Greater Trochanter of Femur
A: Hip Extension and Lateral Rotation, Upper fibers Abduct
N: Inferior Gluteal Nerve L5-S2
MUSCLES JM

34. MUSCLES GLUTEUS MEDIUS O: Dorsal Ilium inferior to Iliac Crest
I: Greater Trochanter of Femur
A: Hip Abduction and Medial Rotation
N: Superior Gluteal Nerve L4-S1
MUSCLES JM

35. RECTUS FEMORIS
SARTORIUS
GLUTEUS MAXIMUS
GLUTEUS MEDIUS
MUSCLES JM

36. MUSCLES BICEPS FEMORIS
O: (Long Head) Ischial Tuberosity (Short Head) Linea Aspera of Femur
I: Head of the Fibula and Lateral Condyle of Tibia
A: (Long Head) Hip Extension and Knee Flexion (Short Head) Knee Flexion and Lateral Rotation of Hip (and knee while flexed)
N: (Long Head) Tibial Nerve (Short Head) Fibular Nerve L5-S2
MUSCLES SD

37. MUSCLES SEMITENDINOSUS O: Ischial Tuberosity
I: Proximal medial shaft of Tibia at Pes Anserinus Tendon
A: Hip Extension, Knee Flexion and Medial Rotation while flexed
N: Tibial Nerve L5-S2
MUSCLES SD

38. MUSCLES SEMIMEMBRANOSUS O: Ischial Tuberosity
I: Posterior Medial Condyle of Tibia
A: Knee Flexion, Medially Rotates Knee while flexed, and Hip Extension
N: Tibial Nerve L5-S2
MUSCLES SD

39. BICEPS FEMORIS
SEMIMEMBRANOSUS
SEMITENDINOSUS
HAMSTRINGS SD

40. NERVES Femoral Nerve Sciatic Nerve Inferior Gluteal Nerve
Superior Gluteal Nerve
Obturator Nerve
Common Peroneal Nerve
NERVES SR

41. NERVES Common Peroneal Nerve:
branches off of the sciatic nerve around the knee, sometimes can branch before the knee. Approximately mid posterior thigh
NERVES SR

42. ARTERIES Obturator Artery Femoral Artery
Medial Circumflex Femoral Artery
Femoral Artery
Superior Gluteal Artery
Inferior Gluteal Artery
Lateral Circumflex Femoral Artery
Deep (Profunda) Femoral Artery
ARTERIES SR

43. VEINS
Femoral Vein
Profunda Femoral Vein
Great Saphenous Vein SR

44. TOTAL HIP REPLACEMENT Successful surgical intervention
“Hip replacement surgery is a safe and effective procedure that can relieve your pain, increase motion, and help you get back to enjoying normal, everyday activities.” (Foran, 2015)
Successful surgical intervention
300,000+ in US each year
CANDIDATES: 50 – 80 y/o
Arthritis: OA/RA
Fractures
Aging: pain/stiffness/weakness
Process:
Orthopedic Evaluation
Medication»Therapy»Injections»Surgery
TOTAL HIP REPLACEMENT SD

45. TOTAL HIP REPLACEMENT
Healthy Hip
Degenerated Hip SD

46. SURGICAL PROCEDURE: Damaged bone and cartilage is removed and replaced with Prosthetic Components
Femoral Head replaced with metal stem and articulating ball
Acetabulum replaced with metal socket (cemented or screwed)
Cartilage is replaced by a plastic or ceramic “spacer”
TOTAL HIP REPLACEMENT SD

47. TOTAL HIP REPLACEMENT PRECAUTIONS: PPE Weight Bearing Status
Positioning
ROM
Transfers
Home Planning
TOTAL HIP REPLACEMENT SD

48. QUESTIONS? REFERENCES:
Biel, A. (2014). Pelvis and Thigh. In Trail Guide to the Body (5th ed., pp ). Boulder, CO: Books of Discovery.
Blevins, Gary. (2016) Hip (Iliofemoral) Joint Handout. OTA/PTA 106; Regional Human Anatomy and Physiology
Fairchild, S. L. (2013). Principles and Techniques of Patient Care (5th ed.). St. Louis, MO: Elsevier Saunders.
Foran, J. R., MD. (2015, August). Total Hip Replacement. Retrieved November 20, 2016, from
Gylys, B. A., & Wedding, M. E. (2013). Medical, Surgical, and Diagnostic Procedures. In Medical Terminology Systems: A Body Systems Approach (7th ed., p. 333). Philadelphia, PA: F. A. Davis Company.
QUESTIONS?
THANK YOU!