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In vertebrate anatomy, hip (or "coxa"Latin ''coxa'' was used by Celsus in the sense "hip", but by Pliny the Elder in the sense "hip bone" (Diab, p 77) in medical terminology) refers to either an anatomical region or a joint.

The hip region is located Lateral (anatomy), lateral and Anterior (anatomy), anterior to the Buttocks, gluteal region, Inferior (anatomy), inferior to the iliac crest, and overlying the greater trochanter of the femur, or "thigh bone". In adults, three of the bones of the pelvis have fused into the hip bone or acetabulum which forms part of the hip region.

The hip joint, scientifically referred to as the acetabulofemoral joint (''art. coxae''), is the joint between the head of 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 have very important roles in retaining balance, and for maintaining the Pelvic tilt, pelvic inclination angle.

Hip pain, Pain of the hip may be the result of numerous causes, including nervous, osteoarthritic, infectious, traumatic, and genetic.

Structure

Region

The hip joint, also known as a ball and socket joint, is formed by the acetabulum of the pelvis and the femoral head, which is the top portion of the thigh bone (femur). It allows for a wide range of movement and stability in the lower body.

The proximal femur is largely covered by muscles and, as a consequence, the greater trochanter is often the only palpable bony structure in the hip region.''Thieme Atlas of Anatomy'' (2006), p 381

Articulation

The hip joint is a ball and socket synovial joint formed by the articulation of the rounded Femur head, head of the femur and the cup-like acetabulum of the pelvis. The socket of the acetabulum is pointing downwards and anterolaterally. The socket is also turned such that the outer edge of its roof is more lateral than outer edge of the floor. 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 (bone), ilium, Pubis (bone), pubis, and ischium.Faller (2004), pp 174-175 The Y-shaped growth plate that separates them, the triradiate cartilage, is fused definitively at ages 14–16.''Thieme Atlas of Anatomy'' (2006), p 365 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.''Thieme Atlas of Anatomy'' (2006), p 378 The acetabulum grasps almost half the femoral ball, a grip deepened by a ring-shaped fibrocartilaginous lip, the acetabular labrum, which extends the joint beyond the equator. The centre of the acetabulum (fovea) does not articulate to anything. Instead, it is lined with fat pad and attached to Ligament of head of femur, ligamentum teres. The acetabular labrum is horse-shoe shaped. Its inferior notch is bridged by transverse acetabular ligament. The joint space between the femoral head and the superior acetabulum is normally between 2 and 7 mm.

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.

The acetabulum is oriented inferiorly, laterally and anteriorly, while the femoral neck is directed superiorly, medially, and slightly anteriorly.

Articular angles

Acetabular angle (or Sharp's angle) is the angle between the horizontal line passing through the inferior aspects of triradiate cartilages (Hilgenreiner's line) and another line passing through the inferior angle of triradiate cartilage to superior acetabular rim. The angle measures 35 degrees at birth, 25 degrees at one year of age, and less than 10 degrees by 15 years of age. In adults the angle can vary from 33 to 38 degrees.

The sagittal angle of the acetabular inlet is an angle between a line passing from the anterior to the posterior acetabular rim and the sagittal plane. It measures 7° at birth and increases to 17° in adults.

Wiberg's centre-edge angle (CE angle) is an angle between a vertical line and a line from the centre of the femoral head to the most lateral part of the acetabulum,Page 131
in: as seen on an Anterior and posterior, anteroposterior radiograph.

The vertical-centre-anterior margin angle (VCA) is an angle formed from a vertical line (V) and a line from the centre of the femoral head (C) and the anterior (A) edge of the dense shadow of the subchondral bone slightly posterior to the anterior edge of the acetabulum, with the radiograph being taken from the ''false angle'', that is, a lateral view rotated 25 degrees towards becoming frontal.

The articular cartilage angle (AC angle, also called ''acetabular index'' or Hilgenreiner angle) is an angle formed parallel to the weight bearing dome, that is, the acetabular ''wikt:sourcil, sourcil'' or "roof", and the horizontal plane, or a line connecting the corner of the triangular cartilage and the lateral acetabular rim. In normal hips in children aged between 11 and 24 months, it has been estimated to be on average 20°, ranging between 18° to 25°. It becomes progressively lower with age. Suggested cutoff (reference value), cutoff values to classify the angle as abnormally increased include:
:*30° up to 4 months of age.Page 942
in:
:*25° up to 2 years of age.

Femoral neck angle

The angle between the longitudinal axes of the femoral neck and shaft, called the caput-collum-diaphyseal angle or CCD angle, normally measures approximately 150° in newborn and 126° in adults (''coxa norma'').''Thieme Atlas of Anatomy'' (2006), p 367

An abnormally small angle is known as ''coxa vara'' and an abnormally large angle as ''coxa valga''. Because changes in shape of the femur naturally affects the knee, ''coxa valga'' is often combined with ''genu varum'' (bow-leggedness), while ''coxa vara'' leads to ''genu valgum'' (knock-knees).

Changes in the CCD angle is the result of changes in the stress patterns applied to the hip joint. Such changes, caused for example by a dislocation, change the trabecular patterns inside the bones. Two continuous trabecular systems emerging on the auricular surface of the sacroiliac joint meander and criss-cross each other down through the hip bone, the femoral head, neck, and shaft.

* In the hip bone, one system arises on the upper part of the auricular surface to converge onto the posterior surface of the greater sciatic notch, from where its trabeculae are reflected to the inferior part of the acetabulum. The other system emerges on the lower part of the auricular surface, converges at the level of the superior gluteal line, and is reflected laterally onto the upper part of the acetabulum.
* In the femur, the first system lines up with a system arising from the lateral part of the femoral shaft to stretch to the inferior portion of the femoral neck and head. The other system lines up with a system in the femur stretching from the medial part of the femoral shaft to the superior part of the femoral head.Palastanga (2006), p 353

On the lateral side of the hip joint the fascia lata is strengthened to form the iliotibial tract which functions as a tension band and reduces the bending loads on the proximal part of the femur.

Capsule

Proximally, capsule of the hip joint is attached to the edge of the acetabulum, acetabular labrum, and transverse acetabular ligament. Distally, it is attached to the trochanters of the femur and intertrochanteric line anteriorly. Posteriorly, it is attached to a junction between medial two-thirds and lateral one-third of the femoral neck, one finger breath away from the intertrochanteric crest. From its attachment at the femoral neck, the fibres of the capsule reflected backwards towards the acetabulum, carrying retinacula vessels supplying the femoral head. The part of femoral neck outside the capsule is shorter in front than posteriorly.

The strong but loose fibrous capsule of the hip joint permits the hip joint to have the second largest range of movement (second only to the shoulder) and yet support the weight of the body, arms and head.

The capsule has two sets of fibers: longitudinal and circular.

* The circular fibers form a collar around the femoral neck called the zona orbicularis.
* The longitudinal retinacular fibers travel along the neck and carry blood vessels.

Ligaments

The hip joint is reinforced by four ligaments, of which three are extracapsular and one intracapsular.

The extracapsular ligaments are the Iliofemoral ligament, iliofemoral, ischiofemoral ligament, ischiofemoral, and pubofemoral ligaments attached to the bones of the pelvis (the Ilium (bone), ilium, ischium, and pubis (bone), pubis respectively). All three strengthen the capsule and prevent an excessive range of movement in the joint. Of these, the Y-shaped and twisted iliofemoral ligament is the strongest ligament in the human body. It has a tensile strength of 350 kg. Iliofemoral ligament is a thickening of the anterior capsule extending from anterior inferior iliac spine to intertrochanteric line. Ischiofemoral ligament is the thickening of posterior capsule of the hip and pubofemoral ligament is the thickening of the inferior capsule. In the upright position, iliofemoral ligament prevents the trunk from falling backward without the need for muscular activity, thus preventing excessive hyperextension. In the sitting position, it becomes relaxed, thus permitting the pelvis to tilt backward into its sitting position. Ischiofemoral prevents excessive extension and the pubofemoral ligament prevents excess abduction and extension.

The zona orbicularis, which lies like a collar around the most narrow part of the femur neck, femoral neck, is covered by the other ligaments which partly radiate into it. The zona orbicularis acts like a buttonhole on the femoral head and assists in maintaining the contact in the joint.
All three ligaments become taut when the joint is extended - this stabilises the joint, and reduces the energy demand of muscles when standing.

The intracapsular ligament, the Ligament of head of femur, ligamentum teres, is attached to a depression in the acetabulum (the acetabular notch) and a depression on the femoral head (the fovea of the head). It is only stretched when the hip is dislocated, and may then prevent further displacement.
It is not that important as a ligament but can often be vitally important as a conduit of a small artery to the head of the femur, that is, the . This artery is not present in everyone but can become the only blood supply to the bone in the head of the femur when the neck of the femur is fractured or disrupted by injury in childhood.''Thieme Atlas of Anatomy'' (2006), pp 383, 440

Blood supply

The hip joint is supplied with blood from the Medial circumflex femoral artery, medial circumflex femoral and Lateral circumflex femoral artery, lateral circumflex femoral arteries, which are both usually branches of the Profunda femoris artery, deep artery of the thigh (profunda femoris), but there are numerous variations and one or both may also arise directly from the femoral artery. There is also a small contribution from the foveal artery, a small vessel in the ligament of the head of the femur which is a branch of the posterior division of the obturator artery, which becomes important to avoid avascular necrosis of the femur head, head of the femur when the blood supply from the medial and lateral circumflex arteries are disrupted (e.g. through fracture of the neck of the femur along their course).

The hip has two anatomically important Anastomosis, anastomoses, the Cruciate anastomosis, cruciate and the Trochanteric anastomosis, trochanteric anastomoses, the latter of which provides most of the blood to the head of the femur. These anastomoses exist between the femoral artery or profunda femoris and the gluteal vessels.Clemente (2006), p 227

Muscles and movements

The hip muscles act on three mutually perpendicular main axes, all of which pass through the center of the femur head, femoral head, resulting in three Degrees of freedom (mechanics), degrees of freedom and three pair of principal directions: Flexion and Extension (kinesiology), extension around a transverse axis (left-right); lateral rotation and medial rotation around a longitudinal axis (along the thigh); and Abduction (kinesiology), abduction and adduction around a sagittal axis (forward-backward);''Thieme Atlas of Anatomy'' (2006), p 386 and a combination of these movements (i.e. Anatomical terms of motion#Other special motions, circumduction, a compound movement in which the leg describes the surface of an irregular cone).
Some of the hip muscles also act on either the vertebral joints or the knee joint, that with their extensive areas of origin and/or insertion, different part of individual muscles participate in very different movements, and that the range of movement varies with the position of the hip joint.
Additionally, the Gemelli muscles, inferior and Gemelli muscles, Superior gemelli muscles assist the Obturator internus muscle, obturator internus and the three muscles together form the three-headed muscle known as the triceps coxae.

The movements of the hip joint is thus performed by a series of muscles which are here presented in order of importance with the range of motion from the neutral zero-degree position indicated:

* Lateral or external rotation (30° with the hip extended, 50° with the hip flexed): Gluteus maximus muscle, gluteus maximus; Quadratus femoris muscle, quadratus femoris; Obturator internus muscle, obturator internus; dorsal fibers of Gluteus medius muscle, gluteus medius and Gluteus minimus muscle, minimus; iliopsoas (including psoas major muscle, psoas major from the vertebral column); Obturator externus muscle, obturator externus; Adductor magnus muscle, adductor magnus, Adductor longus muscle, longus, Adductor brevis muscle, brevis, and Adductor minimus muscle, minimus; Piriformis muscle, piriformis; and Sartorius muscle, sartorius. The iliofemoral ligament inhibits lateral rotation and extension, this is why the hip can rotate laterally to a greater degree when it is flexed.
* Medial or internal rotation (40°): anterior fibers of Gluteus medius muscle, gluteus medius and Gluteus minimus muscle, minimus; tensor fasciae latae; the part of Adductor magnus muscle, adductor magnus inserted into the adductor tubercle; and, with the leg abducted also the Pectineus muscle, pectineus.
* Extension or retroversion (20°): Gluteus maximus muscle, gluteus maximus (if put out of action, active standing from a sitting position is not possible, but standing and walking on a flat surface is); dorsal fibers of Gluteus medius muscle, gluteus medius and Gluteus minimus muscle, minimus; Adductor magnus muscle, adductor magnus; and Piriformis muscle, piriformis. Additionally, the following thigh muscles extend the hip: Semimembranosus muscle, semimembranosus, Semitendinosus muscle, semitendinosus, and long head of Biceps femoris muscle, biceps femoris. Maximal extension is inhibited by the iliofemoral ligament.
* Flexion or anteversion (140°): the hip flexors: iliopsoas (with psoas major from vertebral column); tensor fasciae latae, Pectineus muscle, pectineus, Adductor longus muscle, adductor longus, Adductor brevis muscle, adductor brevis, and Gracilis muscle, gracilis. Thigh muscles acting as hip flexors: Rectus femoris muscle, rectus femoris and Sartorius muscle, sartorius. Maximal flexion is inhibited by the thigh coming in contact with the chest.
* Abduction (50° with hip extended, 80° with hip flexed): Gluteus medius muscle, gluteus medius; tensor fasciae latae; Gluteus maximus muscle, gluteus maximus with its attachment at the fascia lata; Gluteus minimus muscle, gluteus minimus; Piriformis muscle, piriformis; and Obturator internus muscle, obturator internus. Maximal abduction is inhibited by the neck of the femur coming into contact with the lateral pelvis. When the hips are flexed, this delays the impingement until a greater angle.
* Adduction (30° with hip extended, 20° with hip flexed): Adductor magnus muscle, adductor magnus with Adductor minimus muscle, adductor minimus; Adductor longus muscle, adductor longus, Adductor brevis muscle, adductor brevis, Gluteus maximus muscle, gluteus maximus with its attachment at the gluteal tuberosity; Gracilis muscle, gracilis (extends to the tibia); Pectineus muscle, pectineus, Quadratus femoris muscle, quadratus femoris; and Obturator externus muscle, obturator externus. Of the thigh muscles, Semitendinosus muscle, semitendinosus is especially involved in hip adduction. Maximal adduction is impeded by the thighs coming into contact with one another. This can be avoided by abducting the opposite leg, or having the legs alternately flexed/extended at the hip so they travel in different planes and do not intersect.

Clinical significance

A hip fracture is a bone fracture, break that occurs in the upper part of the femur. Symptoms may include pain around the hip particularly with movement and shortening of the leg. The hip joint can be replaced by a prosthesis in a hip replacement operation due to fractures or illnesses such as osteoarthritis. Hip pain can have multiple sources and can also be associated with lower back pain.

At the Consumer_Electronics_Show#2022, 2022 Consumer Electronics Show, a company named Safeware announced an Airbag, airbag belt that is designed to prevent hip fractures among such uses as the elderly and hospital patients.

Abnormal orientation of the acetabular socket as seen in hip dysplasia can lead to hip subluxation (partial dislocation), degeneration of the acetabular labrum. Excessive coverage of femoral head by the acetabulum can lead to pincer-type femoro-acetabular impingement (FAI).

Sexual dimorphism and cultural significance

In humans, unlike other animals, the hip bones are substantially different in the two sexes. The hips of human females widen during puberty. The femur, femora are also more widely spaced in females, so as to widen the opening in the hip bone and thus facilitate childbirth. Finally, the ilium and its muscle attachment are shaped so as to situate the buttocks away from the birth canal, where contraction of the buttocks could otherwise damage the baby.

The female hips have long been associated with both fertility and general expression of human sexuality, sexuality. Since broad hips facilitate childbirth and also serve as an anatomical cue of sexual maturity, they have been seen as an attractive trait for women for thousands of years. Many of the classical poses women take when sculpted, painted or photographed, such as the ''Grande Odalisque'', serve to emphasize the prominence of their hips. Similarly, fashion, women's fashion through the ages has often drawn attention to the girth of the wearer's hips.

Additional images

File:Slide2DAD.JPG, Hip joint. Lateral view.
File:Slide2DADA.JPG, Hip joint. Lateral view.
File:Slide1BIBI.JPG, Muscles of Thigh. Anterior views.
File:Blausen 0488 HipAnatomy.png, Illustration of Hip (Frontal view).
File:Iliopectineal line, ilioischial line, tear drop, acetabular fossa, and anterior and posterior wall of the acetabulumi.jpg, Projectional radiography, X-ray of the hip, with measurements used in X-ray of hip dysplasia in adults.
Attribution 4.0 International (CC BY 4.0)
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See also

* Belly dancer
* Body shape
* Bump (dance)
* Femoral acetabular impingement
* Hip dysplasia (human)
* Hip examination
* Obstetrical dilemma
* Rump (animal)
* Snapping hip syndrome
* Waist–hip ratio

Notes

References

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External links

Hip Preservation Awareness, information and support for hip impingement, hip dysplasia, and related issues in young adults (12-adult)



High-performance hips

Hip Pain ICD10

{{Authority control

Hip,
Bones of the lower limb
Joints, *Hip