Skip to main content
SpringerLink
Log in

Anatomy of the Hip Joint

  • Chapter
  • First Online:
Fractures of the Hip

Part of the book series: Fracture Management Joint by Joint ((FMJJ))

Abstract

The normal hip is often described as a synovial ball and socket joint but this hardly does it justice. The hip represents a remarkable coexistence of stability married to versatility in motion. Furthermore this biomechanical phenomenon is built to sustain the demands of a lifetime and today such demands are ever increasing. In broad terms the bony anatomy with concave socket articulating with the femoral head creates an incredibly stable joint challenged only in the most part by high-energy trauma. Its complex intra-articular structures and lubrication system create a mobile and durable couple, the secrets of which have not yet fully been elucidated. The intricate arterial anastomoses supplying the joint have only been revealed in recent years. The application of this anatomical knowledge has permitted surgeons to not only understand hip pathology but also to intervene safely with procedures such as surgical hip dislocations. In this chapter we will explore both acetabulum and proximal femur from their development to final morphology. We shall delve into what is known about the labrum and other articular structures. Finally we shall scrutinize the complex blood supply to the hip for this is paramount to the prognosis of non-arthroplasty treatment of intra-articular hip fractures and preventing complications.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
eBook
USD 16.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 16.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 109.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Ray B, D’Souza AS, Kumar B, et al. Variations in the course and microanatomical study of the lateral femoral cutaneous nerve and its clinical importance. Clin Anat. 2010;23:978–84. https://doi.org/10.1002/ca.21043.

    Article  PubMed  Google Scholar 

  2. Gray H, Lewis WH. Anatomy of the human body. Philadelphia: Lea & Febiger; 1918. https://doi.org/10.5962/bhl.title.20311.

    Book  Google Scholar 

  3. Govsa F, Ozer MA, Ozgur Z. Morphologic features of the acetabulum. Arch Orthop Trauma Surg. 2005;125:453–61. https://doi.org/10.1007/s00402-005-0020-6.

    Article  PubMed  Google Scholar 

  4. Kalberer F, Sierra RJ, Madan SS, et al. Ischial spine projection into the pelvis. Clin Orthop Relat Res. 2008;466:677–83. https://doi.org/10.1007/s11999-007-0058-6.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Watanabe RS. Embryology of the human hip. Clin Orthop Relat Res. 1974;98:8–26. https://doi.org/10.1097/00003086-197401000-00003.

    Article  Google Scholar 

  6. Strayer LM. Embryology of the human hip joint. Clin Orthop Relat Res. 1971;74:221–40. https://doi.org/10.1097/00003086-197101000-00029.

    Article  PubMed  Google Scholar 

  7. Cashin M, Uhthoff H, O’Neill M, Beaule PE. Embryology of the acetabular labral-chondral complex. J Bone Joint Surg Br Vol. 2008;90-B:1019–24. https://doi.org/10.1302/0301-620x.90b8.20161.

    Article  Google Scholar 

  8. Liporace FA, Ong B, Mohaideen A, et al. Development and injury of the triradiate cartilage with its effects on acetabular development. J Trauma. 2003;54:1245–9. https://doi.org/10.1097/01.ta.0000029212.19179.4a.

    Article  PubMed  Google Scholar 

  9. Siebenrock KA, Wahab KHA, Werlen S, et al. Abnormal extension of the femoral head epiphysis as a cause of cam impingement. Clin Orthop Relat Res. 2004;418:54–60. https://doi.org/10.1097/00003086-200401000-00010.

    Article  Google Scholar 

  10. Köhnlein W, Ganz R, Impellizzeri FM, Leunig M. Acetabular morphology: implications for joint-preserving surgery. Clin Orthop Relat Res. 2009;467:682–91. https://doi.org/10.1007/s11999-008-0682-9.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Philippon MJ, Michalski MP, Campbell KJ, et al. An anatomical study of the acetabulum with clinical applications to hip arthroscopy. J Bone Joint Surg Am. 2014;96:1673–82. https://doi.org/10.2106/JBJS.M.01502.

    Article  PubMed  Google Scholar 

  12. Maruyama M, Feinberg JR, Capello WN, Antonio JAD. Morphologic features of the acetabulum and femur. Clin Orthop Relat Res. 2001;393:52–65. https://doi.org/10.1097/00003086-200112000-00006.

    Article  Google Scholar 

  13. Vailas JC, Hurwitz S, Wiesel SW. Posterior acetabular fracture-dislocations. J Trauma. 1989;29:1494–6. https://doi.org/10.1097/00005373-198911000-00007.

    Article  CAS  PubMed  Google Scholar 

  14. Letournel E, Judet R. Fractures of the acetabulum. Berlin: Springer; 1993. https://doi.org/10.1007/978-3-642-75435-7.

    Book  Google Scholar 

  15. Greenwald AS, O’Connor JJ. The transmission of load through the human hip joint. J Biomech. 1971;4:507–28. https://doi.org/10.1016/0021-9290(71)90041-8.

    Article  CAS  PubMed  Google Scholar 

  16. Lazennec JY, Laudet CG, Guérin-Surville H, et al. Dynamic anatomy of the acetabulum: an experimental approach and surgical implications. Surg Radiol Anat. 1997;19:23–30. https://doi.org/10.1007/s00276-997-0023-9.

    Article  CAS  PubMed  Google Scholar 

  17. Daniel M, IgliC A, Kralj-IgliC V. The shape of acetabular cartilage optimizes hip contact stress distribution. J Anat. 2005;207:85–91. https://doi.org/10.1111/j.1469-7580.2005.00425.x.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Beck M, Leunig M, Ellis T, et al. The acetabular blood supply: implications for periacetabular osteotomies. Surg Radiol Anat. 2003;25:361–7. https://doi.org/10.1007/s00276-003-0149-3.

    Article  CAS  PubMed  Google Scholar 

  19. Bardakos NV, Villar RN. The ligamentum teres of the adult hip. J Bone Joint Surg Br Vol. 2009;91-B:8–15. https://doi.org/10.1302/0301-620x.91b1.21421.

    Article  Google Scholar 

  20. Leunig M, Beck M, Stauffer E, et al. Free nerve endings in the ligamentum capitis femoris. Acta Orthop Scand. 2000;71:452–4. https://doi.org/10.1080/000164700317381117.

    Article  CAS  PubMed  Google Scholar 

  21. Tannast M, Murphy SB, Langlotz F, et al. Estimation of pelvic tilt on anteroposterior X-rays—a comparison of six parameters. Skelet Radiol. 2005;35:149–55. https://doi.org/10.1007/s00256-005-0050-8.

    Article  Google Scholar 

  22. Zilber S, Lazennec JY, Gorin M, Saillant G. Variations of caudal, central, and cranial acetabular anteversion according to the tilt of the pelvis. Surg Radiol Anat. 2004;26:462–5. https://doi.org/10.1007/s00276-004-0254-y.

    Article  CAS  PubMed  Google Scholar 

  23. Jain AK, Maheshwari AV, Nath S, et al. Anteversion of the femoral neck in Indian dry femora. J Orthop Sci. 2003;8:334–40. https://doi.org/10.1007/s10776-003-0648-5.

    Article  CAS  PubMed  Google Scholar 

  24. Nakahara I, Takao M, Sakai T, et al. Gender differences in 3D morphology and bony impingement of human hips. J Orthop Res. 2010;29:333–9. https://doi.org/10.1002/jor.21265.

    Article  PubMed  Google Scholar 

  25. Terjesen T, Benum P, Anda S, Svenningsen S. Increased femoral anteversion and osteoarthritis of the hip joint. Acta Orthop Scand. 1982;53:571–5. https://doi.org/10.3109/17453678208992260.

    Article  CAS  PubMed  Google Scholar 

  26. Tönnis D, Heinecke A. Diminished femoral antetorsion syndrome: a cause of pain and osteoarthritis. J Pediatr Orthop. 1991;11:419–31. https://doi.org/10.1097/01241398-199107000-00001.

    Article  PubMed  Google Scholar 

  27. Reikerås O, Høiseth A. Femoral neck angles in osteoarthritis of the hip. Acta Orthop Scand. 1982;53:781–4. https://doi.org/10.3109/17453678208992292.

    Article  PubMed  Google Scholar 

  28. Herzberg W, Meitz R, Halata Z. Antetorsion of the femur neck. A variable of the trochanter minor? Unfallchirurg. 1991;94:168–71.

    CAS  PubMed  Google Scholar 

  29. Meyer DC, Beck M, Ellis T, et al. Comparison of six radiographic projections to assess femoral head/neck asphericity. Clin Orthop Relat Res. 2006;445:181–5. https://doi.org/10.1097/01.blo.0000201168.72388.24.

    Article  PubMed  Google Scholar 

  30. Toogood PA, Skalak A, Cooperman DR. Proximal femoral anatomy in the normal human population. Clin Orthop Relat Res. 2008;467:876–85. https://doi.org/10.1007/s11999-008-0473-3.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Nötzli HP, Wyss TF, Stoecklin CH, et al. The contour of the femoral head-neck junction as a predictor for the risk of anterior impingement. J Bone Joint Surg. 2002;84:556–60. https://doi.org/10.1302/0301-620x.84b4.12014.

    Article  Google Scholar 

  32. Bealule P, Zaragoza E, Motamedi K, et al. Three-dimensional computed tomography of the hip in the assessment of femoroacetabular impingement. J Orthop Res. 2005;23:1286–92. https://doi.org/10.1016/j.orthres.2005.03.011.

    Article  Google Scholar 

  33. Neumann M, Cui Q, Siebenrock KA, Beck M. Impingement-free hip motion: the “normal” angle alpha after osteochondroplasty. Clin Orthop Relat Res. 2008;467:699–703. https://doi.org/10.1007/s11999-008-0616-6.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Keene GS, Villar RN. Arthroscopic anatomy of the hip: an in vivo study. Arthroscopy. 1994;10:392–9. https://doi.org/10.1016/s0749-8063(05)80189-6.

    Article  CAS  PubMed  Google Scholar 

  35. Byrd JWT. Portal anatomy. In: Operative hip arthroscopy. New York: Springer; 2005. p. 110–6. https://doi.org/10.1007/0-387-27047-7_7.

    Chapter  Google Scholar 

  36. Seldes RM, Tan V, Hunt J, et al. Anatomy, histologic features, and vascularity of the adult acetabular labrum. Clin Orthop Relat Res. 2001;382:232–40. https://doi.org/10.1097/00003086-200101000-00031.

    Article  Google Scholar 

  37. Petersen W, Petersen F, Tillmann B. Structure and vascularization of the acetabular labrum with regard to the pathogenesis and healing of labral lesions. Arch Orthop Trauma Surg. 2003;123:283–8. https://doi.org/10.1007/s00402-003-0527-7.

    Article  PubMed  Google Scholar 

  38. McCarthy J, Noble P, Aluisio FV, et al. Anatomy, pathologic features, and treatment of acetabular labral tears. Clin Orthop Relat Res. 2003;406:38–47. https://doi.org/10.1097/00003086-200301000-00008.

    Article  Google Scholar 

  39. Safran MR. The acetabular labrum: anatomic and functional characteristics and rationale for surgical intervention. J Am Acad Orthop Surg. 2010;18:338–45. https://doi.org/10.5435/00124635-201006000-00006.

    Article  PubMed  Google Scholar 

  40. Ferguson SJ, Bryant JT, Ganz R, Ito K. An in vitro investigation of the acetabular labral seal in hip joint mechanics. J Biomech. 2003;36:171–8. https://doi.org/10.1016/s0021-9290(02)00365-2.

    Article  CAS  PubMed  Google Scholar 

  41. Kim YT, Azuma H. The nerve endings of the acetabular labrum. Clin Orthop Relat Res. 1995;320:176–81. https://doi.org/10.1097/00003086-199511000-00029.

    Article  Google Scholar 

  42. Kalhor M. Capsular and pericapsular contributions to acetabular and femoral head perfusion. J Bone Joint Surg Am. 2009;91:409. https://doi.org/10.2106/jbjs.g.01679.

    Article  PubMed  Google Scholar 

  43. Gautier E, Ganz K, Krügel N, et al. Anatomy of the medial femoral circumflex artery and its surgical implications. J Bone Joint Surg. 2000;82:679–83. https://doi.org/10.1302/0301-620x.82b5.10426.

    Article  CAS  Google Scholar 

  44. Lauritzen J. The arterial supply to the femoral head in children. Acta Orthop Scand. 1974;45:724–36. https://doi.org/10.3109/17453677408989681.

    Article  CAS  PubMed  Google Scholar 

  45. Trueta J. Vascular pattern of the femoral head during growth. In: Studies of the development and decay of the human frame. Philadelphia: JB Lippincott; 1968. p. 135–42. https://doi.org/10.1016/b978-1-4831-6802-9.50024-9.

    Chapter  Google Scholar 

  46. Grose AW, Gardner MJ, Sussmann PS, et al. The surgical anatomy of the blood supply to the femoral head: description of the anastomosis between the medial femoral circumflex and inferior gluteal arteries at the hip. J Bone Joint Surg Br Vol. 2008;90-B:1298–303. https://doi.org/10.1302/0301-620x.90b10.20983.

    Article  Google Scholar 

  47. Letournel E, Judet R. Surgical anatomy. In: Fractures of the acetabulum. Berlin: Springer; 1981. p. 1–6. https://doi.org/10.1007/978-3-662-02325-9_1.

    Chapter  Google Scholar 

  48. Freeman MAR. Some anatomical and mechanical considerations relevant to the surface replacement of the femoral head. Clin Orthop Relat Res. 1978;134:19–24. https://doi.org/10.1097/00003086-197807000-00004.

    Article  Google Scholar 

  49. Hulth A. Circulatory disturbances in osteoarthritis of the hip: a venographic study. Acta Orthop Scand. 1958;28:81–9. https://doi.org/10.3109/17453675808988610.

    Article  CAS  PubMed  Google Scholar 

  50. Ganz R, Gill TJ, Gautier E, et al. Surgical dislocation of the adult hip. J Bone Joint Surg. 2001;83:1119–24. https://doi.org/10.1302/0301-620x.83b8.11964.

    Article  CAS  Google Scholar 

  51. Nötzli HP, Siebenrock KA, Hempfing A, et al. Perfusion of the femoral head during surgical dislocation of the hip: monitoring by laser doppler flowmetry. J Bone Joint Surg. 2002;84:300–4. https://doi.org/10.1302/0301-620x.84b2.12146.

    Article  Google Scholar 

  52. Ellis TJ, Beck M. Trochanteric osteotomy for acetabular fractures and proximal femur fractures. Orthop Clin N Am. 2004;35:457–61. https://doi.org/10.1016/j.ocl.2004.05.002.

    Article  Google Scholar 

  53. Tannast M, Kruger A, Mack PW, et al. Surgical dislocation of the hip for the fixation of acetabular fractures. J Bone Joint Surg Br Vol. 2010;92-B:842–52. https://doi.org/10.1302/0301-620x.92b6.22994.

    Article  Google Scholar 

  54. Leunig M, Slongo T, Kleinschmidt M, Ganz R. Subkapitale Korrekturosteotomie bei der Epiphyseolysis capitis femoris mittels chirurgischer Hüftluxation. Oper Orthop Traumatol. 2007;19:389–410. https://doi.org/10.1007/s00064-007-1213-7.

    Article  PubMed  Google Scholar 

  55. Orler R, Hersche O, Helfet DL, et al. Avascular necrosis of the femoral head as a serious complication following femoral nailing in children and adolescents. Unfallchirurg. 1998;101:495–9. https://doi.org/10.1007/s001130050301.

    Article  CAS  PubMed  Google Scholar 

  56. Buford D, Christensen K, Weatherall P. Intramedullary nailing of femoral fractures in adolescents. Clin Orthop Relat Res. 1998;350:85–9. https://doi.org/10.1097/00003086-199805000-00012.

    Article  Google Scholar 

  57. Gardner E. The innervation of the hip joint. Anat Rec. 1948;101:353–71. https://doi.org/10.1002/ar.1091010309.

    Article  CAS  PubMed  Google Scholar 

  58. Dee R. Structure and function of hip joint innervation. Ann R Coll Surg Engl. 1969;45:357–74.

    CAS  PubMed  PubMed Central  Google Scholar 

  59. Saxler G, Löer F, Skumavc M, et al. Localization of SP- and CGRP-immunopositive nerve fibers in the hip joint of patients with painful osteoarthritis and of patients with painless failed total hip arthroplasties. Eur J Pain. 2007;11:67–74. https://doi.org/10.1016/j.ejpain.2005.12.011.

    Article  PubMed  Google Scholar 

  60. Sarban S, Baba F, Kocabey Y, et al. Free nerve endings and morphological features of the ligamentum capitis femoris in developmental dysplasia of the hip. J Pediatr Orthop B. 2007;16:351–6. https://doi.org/10.1097/01.bpb.0000243830.99681.3e.

    Article  PubMed  Google Scholar 

  61. Gerhardt M, Johnson K, Atkinson R, et al. Characterisation and classification of the neural anatomy in the human hip joint. Hip Int. 2018;22:75–81. https://doi.org/10.5301/HIP.2012.9042.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Trauma and Orthopaedics, MidCentral District Health Board, Palmerston North Hospital and Massey University, Palmerston North, Manawatu, New Zealand

    Michael Wyatt

  2. Jacksonville Orthopaedic Institute, Jacksonville, FL, USA

    Carl Freeman

  3. Clinic for Orthopaedic and Trauma Surgery, Luzerner Kantonsspital, Luzern, Switzerland

    Martin Beck

Authors
  1. Michael Wyatt
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Carl Freeman
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Martin Beck
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Michael Wyatt .

Editor information

Editors and Affiliations

  1. Department of Orthopaedic Surgery, Kantonsspital Aarau, Aarau, Switzerland

    Lorenz Büchler

  2. Trauma Center Hirslanden, Clinic Hirslanden, Zürich, Switzerland

    Marius J.B. Keel

Rights and permissions

Reprints and permissions

Copyright information

© 2019 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Wyatt, M., Freeman, C., Beck, M. (2019). Anatomy of the Hip Joint. In: Büchler, L., Keel, M. (eds) Fractures of the Hip. Fracture Management Joint by Joint. Springer, Cham. https://doi.org/10.1007/978-3-030-18838-2_1

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-18838-2_1

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-18837-5

  • Online ISBN: 978-3-030-18838-2

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation