Hip

Here we have collated the most common conditions related to the Hip joint. We have also included a few case vignettes to help aid you clinical understanding of these conditions.

After you have worked through these we have included a brief quiz which upon completion will provide you with a nice certificate!

Hip Anatomy

The Hip joint is a capsule joint which comprises of the femoral head and the acetabulum of the pelvis.

Shenton’s line is a very important indication in radiographs of any trauma sustained in the hip.

Scroll through the images above to see a 'disrupted' Shenton's line.

Case 1:

A 77-year-old Lady is walking to the shops to collect her Christmas turkey. After collection she steps out onto the icy pavement slipping with impact to the ground. Her wife phones for an ambulance stating that her leg was externally rotated and shortened.

On admission to the hospital the trauma team give her analgesia and imaging shows that this lady has a complete and fully displaced fracture of the femoral neck. The Surgeon consents the patient for a total hip replacement.

The patient asks why they can’t just repair the bone as it is…

Why do you think the Surgeon has chosen to perform a THR in this case?

During repairing of bone (e.g. hip screw or fixation) there is a risk of non-union due to Avascular Necrosis (incidence of 10-45%).

THR is indicated in older but active patients with complete displaced femoral neck fractures.

Avascular Necrosis

This is the loss of retrograde blood supply from the circumflex arteries to the head of femur. Reduced blood supply reduces the promotion of healing and increases the likelihood of non-union.

The arterial supply of the femoral head comes from a ring anastomosis of the circumflex femoral arteries at the insertion of the hip capsule at the base of the femoral neck. The medial and lateral circumflex femoral arteries are branches of the profunda femoral artery.