A joint forms where two or more bones meet.

The hip joint is a ball-and-socket type joint and is formed where the thigh bone (femur)
meets the three bones that make up the pelvis: the ilium at the rear, the ischium at the lower front and the pubis above it. The
thighbone has a ball-shaped knob on the end that fits into a socket formed in the hipbone. A smooth cushion of shiny white articular
cartilage about 1/4 inch thick covers the femoral head and the acetabulum. The articular cartilage is kept slippery by fluid made in the
synovial membrane (joint lining). Since the cartilage is smooth and slippery, the bones move against each other easily and without pain.
Large ligaments, tendons, and muscles around the hip joint (called the joint capsule) hold the bones (ball and socket) in place and
keep it from dislocating.

The weight-bearing bones in our body are usually protected with articular cartilage, which is a thin, tough, flexible, slippery surface
which is lubricated by synovial fluid. The synovial fluid is both viscous and sticky lubricant. Synovial fluid and articular cartilage are a
very slippery combination3 times more slippery than skating on ice, 4 to 10 times more slippery than a metal on plastic hip
replacement, and more than 30 times as slippery as metal on metal using the best petroleum-based lubricant. Synovial fluid is what
allows us to flex our joints under great pressure without wear.
The hip joint is one of the largest joints in the body and is a major weight-bearing joint. Weight bearing stresses on the hip during
walking can be 5 times a persons body weight. A healthy hip can support your weight and allow you to move without pain. Changes in
the hip from disease or injury will significantly affect your gait and place abnormal stress on joints above and below the hi p.
It takes great force to seriously damage the hip because of the strong, large muscles of the thighs that support and move the hip.
Osteoarthritis affects many people, and the brittle bones from osteoporosis in the elderly can lead to life threatening fractures.
Anatomic Terms
Anatomical terms allow us to describe the body clearly and precisely using planes, areas and lines. Instead of your doctor saying his
knee hurts she can say his knee hurts in the anterolateral region and another doctor will know exactly what is meant. Below are
some anatomic terms surgeons use as these terms apply to the hip:
Anatomy of the Hip
Like the shoulder, the hip is a ball-and-socket joint, but is much more stable. The stability in the hip begins with a deep socketthe
acetabulum. Additional stability is provided by the strong joint capsule and its surrounding muscles and ligaments. Its the need for
such a high degree of stabilization of the joint that limits movement. If you think of the hip joint in layers, the deepest l ayer is bone, then
ligaments of the joint capsule and the tendons and muscles are on top. Nerves and vessels supply the muscles and bones of the hip.
The hip joint capsule is a dense, fibrous structure which includes the iliofemoral, pubofemoral, and ischiofemoral ligaments. These
ligaments along with the ligamentum teres and the labrum help give stability of the hip.
Bony Structures of the Hip
The adult skeleton is mainly made of bone and a little cartilage in places. Bone and cartilage are both connective tissues, with
specialized cells called chondrocytes embedded in a gel-like matrix of collagen and elastin fibers. Cartilage can be hyaline,
fibrocartilage and elastic and differ based on the proportions of collagen and elastin. Cartilage is a stiff but flexible tissue that is good
with weight bearing which is why it is found in our joints. Cartilage has almost no blood vessels and is very bad at repairing itself. Bone
is full of blood vessels and is very good at self repair. It is the high water content that makes cartilage flexible.
The hip is formed where the thigh bone (femur) meets the three bones that make up the pelvis: the ilium, the pubis (pubic bone) and
the ischium. You can feel the arching bones of the ilium by placing your hands on your waist. The pubis attaches to the lower part of
the ilium and curves forward. The ischium is slightly behind the pubis. The three bones converge to form the acetabulum, a deep
socket on the outer edge of the pelvis.
The shape of the acetabulum is a half of a sphere; the femoral head is about two-thirds of a sphere. Without weight bearing, the
ball-and-socket are not completely congruent. As the joint bears more weight, the contact of the surface areas increases as does joint
stability. The articular cartilage is thicker on the back part of the socket where most of the force is placed on the joint with walking,
running and jumping. When standing, the bodys center of gravity passes through the center of the acetabula. Obviously, injury to the
acetabulum can affect its ability to distribute weight bearing.
The hip joins the leg to the trunk of the body at the hip joint. The hip joint is made up of the ball of the femoral head that fits into the
cup-shaped acetabulum. The large round head of the femur rotates and glides within the acetabulum. The depth of the acetabulum is
further increased by a fibrocartilagenous labrum attached to the acetabulum. The socket of the hip is much deeper than the socket in
the shoulder and encompasses a greater area of the ball.
The femur is the longest bone in the body. The neck of the femur connects the femoral head with the shaft of the femur. The capsular
ligament of the hip joint attaches to the posterior part of the femoral neck. The neck ends at the greater and lesser trochanter
prominences. The greater trochanter serves as the site of attachment for the abductor muscles. The lesser trochanter is the site of the
iliopsosas tendon.
The greater trochanter is a very prominent bump on the femur and easy to feel on the outside of your thigh. It is the widest part of the
lower legs and is where the tendons of several muscles attach including the gluteus, obturator, gemelli and piriformis muscles. The
lesser trochanter serves as the attachment for the iliopsoas and iliacus muscle tendons.
Hip Ligaments
The stability of the hip is increased by the strong ligaments that encircle the hip (the iliofemoral, pubofemoral, and ischiofemoral
ligaments). These ligaments completely encompass the hip joint and form the joint capsule. The iliofemoral ligament is the
strongest ligament in the body. Damage to the ligamentum teres can result in avascular necrosis because of injury to the small artery
within the ligament that supplies most of the blood to the head of the femur. Death of the bone in the femoral head is one cause for hip
replacement.
Muscles of the Hip
The muscles of the thigh and lower back work together to keep the hip stable, aligned and moving. It is the muscles of the hi p that
allow the 4 basic movements of the hip:
flexion bend
extension straighten
abduction take the leg away from the body
adduction bring the leg back toward the body
The hip muscles are divided up into three basic groups based on their location: anterior muscles(front), posterior (back), and medial
(outside). The muscles of the anterior thigh make up the quadriceps group (vastus medialis, intermedius, lateralis and rectus femoris
muscles). The quads make up about 70% of the thighs muscle mass. The purpose of the quads is flexion (bending) of the hip and
extension (straightening) of the knee.
The gluteal, hamstring and piriformis muscles are located in the buttocks. The gluteus maximum is the main hip extensor and helps
keep up the normal tone of the iliotibial band. The gluteus maximus also keeps the head of the femur from sliding forward in the hip
socket; if it cant do this, pain results form the femoral head pressing against the soft tissues in the front of the hip joint. The gluteal and
sartorius muscles also help abduct the hipthat is, move the leg away from the midline of the body (using the spine as a midline
reference point). It is abduction that allows us to walk sideways. When the glutes are weak, it is the hamstrings that pick up the slack.
Hamstrings can be constantly strained injuries can take awhile to heal when the glutes (gluteus maximus and gluteus medius) are
weak.
Adductionbringing the leg back towards the midlineis performed by the hip adductor muscle group (gracilis muscle, pectineus
muscle).
The hip also has the ability to rotate internally (medially)turning the foot in (pigeon-toed) and externally (laterally)turning the foot
out. Medial rotation is needed for squatting. The piriformis muscle assist in lateral rotation of the hip. Lateral rotation i s needed for
crossing the legs.
The hip muscles do not attach right at the hip joint, thereby giving the hip more stability. The gluteus medius muscle connects to the
greater trochanter, a bony prominence on the neck of the femur. The gluteus medius helps keep the pelvis level when you walk.
The facia lata, which is not a muscle but the deep fascia of the thigh, is known as the iliotibial band. The function of this band is to
prevent dislocation of the hip. If this band is too tight, it can cause hip and knee problems.
Blood Vessels and Nerves of the Hip
The nerves in the hip supply the various muscles in the hip. These nerves include the femoral nerve, lateral femoral cutaneous nerve,
and obturator nerve . The obturator nerve is also responsible for sensation over the thigh. The sciatic nerve is the most commonly
recognized nerve in the hip and thigh. The sciatic nerve is largeas big around as your thumband travels beneath the gluteus
maximus down the back of the leg and then branches on down to the foot. Hip dislocation can cause injury to the sciatic nerve. Nerves
carry signals from the brainto the muscles to move the hip and carries signals from the muscles back to the brain about pain, pressure
and temperature.
The blood supply to the hip is primarily from the internal and external iliac, femoral, obturator, and superior and inferior gluteal arteries.
The femoral artery is well-known because of its use incardiac cath; it travels from deep within the hip down the leg to the knee. The
main blood supply for the femoral head comes from vessels that branch off the femoral artery.
Bursae
Bursae are fluid filled sacs lined with a synovial membrane which produce synovial fluid. The synovial fluid is similar in consistency to
raw egg white. Bursae are often found near joints. Their function is to lessen the friction between tendon and bone, ligament and bone,
tendons and ligaments and between muscles. There are as many as 20 bursae around the hip. Inflammation or infection of the bursa
called bursitis.
The greater trochanteric bursa is located between the greater trochanter (the bony prominence on the femur) and the muscles and
tendons that cross over the greater trochanter. This bursa can get irritated if the iliotibial band is too tight. Two other bursa that can get
inflamed are the iliopsoas bursa, located under the iliopsoas muscle and the bursa located over the ischial tuberosity (the bone you sit
on).
Common Problems of the Hip
Aseptic or Avascular necrosis
Congenital Dislocation
Perthes disease
Aplasia of the acetabulum
Coxa valga
Coxa vara
Osteoarthritis
Dislocation (see image above of simple dislocation)
Bursitis
Legg-Perthes disease
Bone tumor
Fracture











In vertebrate anatomy, hip (or "coxa"
[1]
in medical terminology) refers to either an anatomical region or a joint.
The hip region is located lateral to the gluteal region (i.e. the buttock), inferior to the iliac crest, and overlying the greater trochanterof
the femur, or "thigh bone".
[2]
In adults, three of the bones of the pelvis have fused into the hip bone which forms part of the hip region.
The hip joint, scientifically referred to as the acetabulofemoral joint (art. coxae), is the joint between the femur and acetabulum of
the pelvis and its primary function is to support the weight of the body in both static (e.g. standing) and dynamic (e.g. walking or running)
postures. The hip joints are the most important part in retaining balance. The pelvic inclination angle, which is the single most important
element of human body posture, is adjusted at the hips.
[citation needed]

Region[edit]
The five or so tubercles and the lower lateral borders of the sacrum, and the ischial tuberosity ("sitting bone").
[3]

Proximally the femur is largely covered by muscles and, as a consequence, the greater trochanter is often the only palpable bony structure.
Distally on the femur some more palpable bony structures are the condyles.
[4]

Articulation[edit]
The hip joint is a synovial joint formed by the articulation of the rounded head of the femur and the cup-like acetabulum of the pelvis. It
forms the primary connection between the bones of the lower limb and the axial skeleton of the trunk and pelvis. Both joint surfaces are
covered with a strong but lubricated layer called articular hyaline cartilage. The cuplike acetabulum forms at the union of three pelvic bones
the ilium, pubis, and ischium.
[5]
The Y-shaped growth plate that separates them, the triradiate cartilage, is fused definitively at ages 14
16.
[6]
It is a special type of spheroidal or ball and socket joint where the roughly spherical femoral head is largely contained within the
acetabulum and has an average radius of curvature of 2.5 cm.
[7]
The acetabulum grasps almost half the femoral ball, a grip augmented by a
ring-shaped fibrocartilaginous lip, the acetabular labrum, which extends the joint beyond the equator.
[5]
The head of the femur is attached
to the shaft by a thin neck region that is often prone to fracture in the elderly, which is mainly due to the degenerative effects
of osteoporosis.
Transverse and sagittal angles of acetabular inlet plane.
The acetabulum is oriented inferiorly, laterally and anteriorly, while the femoral neck is directed superiorly, medially, and anteriorly.
The hip bone (innominate bone, pelvic bone
[1]
or coxal bone) is a large flat bone, constricted in the center and expanded above and below.
In some vertebrates (including humans before puberty) it is composed of three bones; ilium, ischium, and pubis.
The two hip bones join at the pubic symphysis and together with the sacrum and coccyx, the hip bones comprise the skeletal component of
the pelvis, i.e. the pelvic girdle (made by 2 hip bones) and the pelvic part of the vertebral column (sacrum + coccyx), which surrounds
the pelvic cavity. The hip bone forms the primary connection between the bones of the lower limb and the axial skeleton. They are
connected to the sacrum, which is part of the axial skeleton, at the sacroiliac joint. Each hip bone is connected to the corresponding femur,
which is part of the lower limb, through a large ball and socket joint, the hip joint.
[2]

Structure[edit]
The hip bone is formed by three bones; ilium, ischium, and pubis. At birth, these three component bones are separated by hyaline cartilage.
They join each other in a Y-shaped portion of cartilage in the acetabulum. By the end of puberty the three bones will have grown together.
The fusion is usually complete by the age 25. See Ossification for further details.
The two hip bones join each other at the pubic symphysis. Together with the sacrum and coccyx, the hip bones form the pelvis.
[2]

Ilium[edit]
Main article: Ilium (bone)
Ilium (plural Ilia) is the uppermost and largest bone. It makes up two-fifth of the acetabulum. It is divisible into two parts, the body and
the ala or wing of ilium; the separation is indicated on the top surface by a curved line, the arcuate line, and on the external surface by the
margin of the acetabulum. The body of ilium forms the sacroiliac joint with thesacrum. The edge of the wing of ilium forms the S-shaped iliac
crest which is easily located through the skin. The iliac crest show clear marks of the attachment of the threeabdominal wall muscles.
[2]

Ischium[edit]
Main article: Ischium
The ischium forms the lower and back part of the hip bone and is located below the ilium and behind the pubis. The ischium is the strongest
of the three bones that forms the hip bone. It is divisible into three portions; The body, the superior ramus and the inferior ramus. The body
forms approximately one-third of the acetabulum.
The ischium forms a large swelling, the tuberosity of the ischium, also referred to colloqially as the "sit bone". When sitting, the weight is
frequently placed upon the ischial tuberosity. The gluteus maximus covers it in the upright posture, but leaves it free in the seated
position.
[2]

Pubis[edit]
Main article: Pubis (bone)
The pubic bone or pubis is the ventral and anterior of the three bones forming the hip bone. It is divisible into a body, a superior ramus and
an inferior ramus. The body forms one-fifth of the acetabulum. The body forms the wide, strong, medial and flat portion of the pubic bone
which unite with the other pubic bone in the pubic symphysis.
[2]
The fibrocartilaginous pad which lies between the symphysial surfaces of
the pubic bones, that secures the pubic symphysis, is called the interpubic disc.
The superior pubic ramus is a part of the pubic bone which forms a portion of the obturator foramen. It extends from the body to the
median plane where it articulates with its fellow of the opposite side. It is conveniently described in two portions; a medial flattened part
and a narrow lateral prismoid portion.
The inferior pubic ramus is thin and flat. It passes laterally and downward from the medial end of the superior ramus. it becomes narrower
as it descends and joins with the inferior ramus of the ischium below the obturator foramen.
Development[edit]
The hip bone is ossified from eight centers: three primary one each for the ilium, ischium, and pubis; and five secondary one each for
the iliac crest, the anterior inferior spine (said to occur more frequently in the male than in the female), the tuberosity of the ischium, the
pubic symphysis (more frequent in the female than in the male), and one or more for the Y-shaped piece at the bottom of the acetabulum.
The centers appear in the following order: in the lower part of the ilium, immediately above the greater sciatic notch, about the eighth or
ninth week of fetal life; in the superior ramus of the ischium, about the third month; in the superior ramus of the pubis, between the fourth
and fifth months. At birth, the three primary centers are quite separate, the crest, the bottom of the acetabulum, the ischial tuberosity, and
the inferior rami of the ischium and pubis being still cartilaginous. By the seventh or eighth year, the inferior rami of the pubis and ischium
are almost completely united by bone. About the thirteenth or fourteenth year, the three primary centers have extended their growth into
the bottom of the acetabulum, and are there separated from each other by a Y-shaped portion of cartilage, which now presents traces of
ossification, often by two or more centers. One of these, the os acetabuli, appears about the age of twelve, between the ilium and pubis,
and fuses with them about the age of eighteen; it forms the pubic part of the acetabulum. The ilium and ischium then become joined, and
lastly the pubis and ischium, through the intervention of this Y-shaped portion. At about the age of puberty, ossification takes place in each
of the remaining portions, and they join with the rest of the bone between the twentieth and twenty-fifth years. Separate centers are
frequently found for the pubic tubercle and the ischial spine, and for the crest and angle of the pubis.


The two symmetrical hip bones (also known as the innominate bones, or pelvic bones) are part of the pelvic girdle, the bony structure that
attaches the axial skeleton to the lower limbs (for more information about the anatomy of the pelvic girdle, click here)
The hip bones have three articulations:
Sacroiliac joint articulation with sacrum.
Pubic symphysis articulation with the corresponding hip bone.
Hip joint articulation with the head of femur.
Structure of the Hip Bone
The hip bone is made up of the three parts the ilium, pubis and ischium. Prior to puberty, the triradiate cartilage separates these
constituents. At the age of 15-17, the three parts begin to fuse.
Their fusion forms a cup-shaped socket known as the acetabulum, which becomes complete at 20-25 years of age. The head of
the femur articulates with the acetabulum to form the hip joint.

Structures of the Hip Joint
Articulating Surfaces
The hip joint consists of an articulation between the head of femur and acetabulum of the pelvis.
The acetabulum is a cup-like depression in the lateral side of the pelvis (much like the glenoid fossa of the scapula). The head of femur is
hemispherical, and fits completely into the concavity of the acetabulum.
Both the acetabulum and head of femur are covered in articularcartilage, which is thicker at the places of weight bearing.