Hip joint

Dr Henry Knipe and UoE Radiology et al.

The hip joint is a synovial joint between the femoral head and the acetabulum of the pelvis. This article considers the hip joint specifically, however it is worth noting that the word hip is often used to refer more generally to the anatomical region around this joint.

The hip joint is a ball and socket joint that represents the articulation of the bones of the lower limb and the axial skeleton (spine and pelvis). The rounded femoral head sits within the cup-shaped acetabulum.

The acetabulum is formed by the three bones of the pelvis (the ischiumilium and pubis). Between them is a Y-shaped cartilaginous growth plate (the triradiate cartilage) which is usually fused by age 14-16. The ball and socket articulation allows for a high degree of mobility. The acetabular labrum increases the depth of the joint 1, thereby increasing the stability of the joint but causes a reduction in the movement at the joint. In comparison to the shoulder joint, it permits less range of movement due to the increased depth and contact area but displays far more stability.

The acetabulum covers nearly half of the femoral head. The actual hyaline articular (lunate surface) covered area is C-shaped and forms an incomplete ring due to the acetabular notch. This notch is traversed by the transverse ligament. The central non-articular part of the acetabulum is filled with the Haversian fat pad. 

The femoral head is attached to the body of the femur via the neck, which holds it at an angle. It is covered with hyaline cartilage except at the convexity of the head where the fovea exists. Through the fovea, the head is attached to ligamentum teres.

The joint is surrounded by a fibrous capsule, which is attached to the margins of the labrum and the transverse ligament on the acetabulum. It extends to the femur to attach anteriorly to the intertrochanteric line but as not as extensive posteriorly, attached halfway to the intertrochanteric crest. There are circular (internal) and longitudinal (external) fibers. The zona orbicularis is a set of internal circular fibers forming a collar around the neck of femur and partly blended with pubofemoral and ischiofemoral ligaments

Retinacular fibers are the reflected part of the capsule traveling back to the head of the femur from its distal attachment to the neck, binding down the nutrient arteries arising from the trochanteric anastomosis.

The synovial membrane is attached to the articular margins and lines the inner capsule. The ligament of the head of the femur and the surrounding fat are enclosed in a reflecting layer of the synovium.

Thickenings of this capsule constitute the ischiofemoraliliofemoral and pubofemoral ligaments:

  • iliofemoral ligament of Bigelow (strongest): inverted V/Y shaped in appearance, it arises from the lower half of the anterior inferior iliac spine and the acetabular rim with diverging limbs attached to the upper and lower ends of the intertrochanteric line
  • pubofemoral ligament: from the iliopubic eminence and the obturator crest to the capsule on the inferior part of the neck of the femur 
  • ischiofemoral ligament (weakest): arises from body of ischium behind and below acetabulum with fibers directed laterally and upwards to attach to posterosuperior part of base of neck, and covers posterior aspect of hip joint

There are a number of different muscles that permit flexion/extension, adduction/abduction, and internal/external rotation of the hip joint. See: Hip muscles.

Subtendinous, iliopectineal and greater trochanteric bursae, and bursae between gluteus maximus and vastus lateralis exist near the joint 1.

The cruciate and trochanteric anastomoses supply the joint in adults 2. A branch from the posterior branch of the obturator artery may also be present in the ligamentum teres.

  • anterior hip joint drains to deep inguinal nodes
  • posterior and medial hip joint drain to internal iliac nodes 4 
  • femoral nerve via nerve to rectus femoris
  • sciatic nerve via nerve to quadratus femoris
  • obturator nerve from its anterior division
  • superior gluteal nerve variably
  • anterior
    • pectinus separates hip joint from femoral vein
    • more laterally, iliopsoas with underling bursa separates hip joint from femoral artery and femoral nerve 
    • straight head of rectus femoris
  • superior:
    • reflected head of rectus femoris medially
    • gluteus minimis laterally
  • posteroinferiorly: obturator externus spirals obliquely to posterior aspect of hip joint accompanied by ascending branch of medial circumflex femoral artery
  • posterior
    • piriformis
    • obturator internus and gemellis muscles contact joint capsule separating it from sciatic nerve
    • quadratus femoris

There may be a perforation through a circular aperture between the pubofemoral ligament and the vertical band of the iliofemoral ligament which allows communication between the hip joint and iliac bursa ref.

Anatomy: Lower limb
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Article information

rID: 28142
Section: Anatomy
Tag: cases, cases
Synonyms or Alternate Spellings:
  • Hip

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