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Hip Anatomy

Femoral Shaft anatomy image

Thigh Cross sectional anatomy image

 

Muscles of the Pelvis

  Muscle Innervation Origin Insertion Action Nerve Root
  Flexors          
1 Iliacus femoral iliac fossa lesser trochanter hip flexion L234(P)
2 Psoas femoral transverse processes of L1-L5 lesser trochanter   L234(P)
3 Pectineus femoral pectineal line of pubis pectineal line of femur   L234(P)
4 Rectus Femoris femoral AIIS, acetabular rim Patella-tibial tubercle   L234(P)
5 Sartorius femoral ASIS proximal medial tibia   L234(P)
  Adductors          
1 Post adductor magnus obturator(P) & Sciatic(tibial) infeior pubic ramus/ischial tuberosity lenea aspera.adductor tubercle   L234(A)
2 Adductor brevis obturator(P)  inferior pubic ramus linea aspera/pectineal line   L234(A)
3 Adductor longus obturator(A) anterior pubic ramus linea aspera   L234(A)
4 Gracilis obturator (A) inf symphysis/pubic arch proximal medial tibia   L234(A)
  External Rotators          
1 Gluteus maximus inferior gluteal ilium post to post gluteal line iliotibial band/gluteal sling   L5-S2(P)
2 Piriformis piriformis ant sacrum/sciatic notch proximal great trochanter   S12(P)
3 Obturator externus obturator ischiopubic rami/obturator membrane trochlear fossa   L234(A)
4 Obturator internus obturator internus ischiopubic rami/obturator membrane medial greater trochanter(MGT)   L5-S2(A)
5 Superior gemellus obturator internus Outer ischial spine MGT   L5-S2(A)
6 Inferior gemellus quadratus femoris ischial tuberosity MGT   L4-S1(A)
7 Quadratus femoris quadratus femoris ischial tuberosity quadrate line of femur   L4-S1(A)
  Abductors          
1 Gluteus medius superior gluteal ilium between post and ant gluteal lines greater trochanter   L4-S1(P)
2 Gluteus minimus superior gluteal ilium between ant and inf gluteal lines ant border of greater trochanter   L4-S1(P)
3 Tensor fasciae latae(TFL) superior gluteal anterior iliac crest iliotibial band   L4-S1(P)

 Hip Range of Motion

Motion

Average

Functional

Flexion

115

90 (120 squat)

Extension

30

 

Abduction

50

20

Adduction

30

 

Internal Rotation

45

0

External Rotation

45

20

Sciatic Nerve

  • Origin: lumbosacral plexus: L4-S3
  • Exits pelvis via the greater sciatic notch; appears in the buttock anterior to the piriformis; passes posteriorly over the superior gemellus, obturator internus, inferior gamellus and quadratus femoris; passes deep to the biceps femoris
  • Travels with the PFCN and inferior gluteal artery
  • Branches into the Tibial Nerve and Common Peroneal Nerve.
  • see also Sciatic Nerve Palsy.

Hip Approaches

Anterior [Smith-Petersen]

  • Superficial interval: sartorius (femoral N) and tensor fasica lata (Superior gluteal N). Ascending branch of the lateral femoral circumflex artery crosses within interval and must be ligated.
  • Deep interval: rectus femoris (Femoral N)_ and Gluteus medius (Superior gluteal N)

Anterolateral [Watson-Jones]

  • Interval: tensor fascia lata (Superior gluteal N) and Gluteus medius (Superior gluteal N)

Lateral (Hardinge)

  • Superficial interval: splits gluteus medius (Superior gluteal N)
  • Deep interval: splints vastus lateralis (Femoral N)
  • 2/3 of gluteus medius, glutues minimus and ligament of Bigelow are detached and require reattachment.
  • Hardinge K, JBJS 1982;64Br:17

Posterior [Moore]

  • Splits gluteus maximus (Inferior gluteal N)

Lateral femoral cutaneous nerve

  • Origin: lumbar plexus 
  • Innervates: purely sensory, innverates the anterolateral thigh
  • Location:  runs on the surface of the iliacus muscle and enters the thigh by passing under the inguinal ligament before piercing the fascia lata. Path can be variable.
  • Injury: see Meralgia Paresthetica 355.1

Superior Gluteal Nerve

  • Main branch of the superior gluteal nerve is between 4.5 and 4.9 cm above the level of the superior acetabular rim.
  • Generally safe to dissect up to 4 cm above the acetabulum or 5 cm above the tip of the greater trochanter.