BIOMECHANICS OF HIP
JOINT
INTRODUCTIO
N
• Hip joint is an articulation of the acetabulum of the
pelvis and the head of the femur
• Ball-and-socket joint
Ranges of passive joint motion
Flexion 90° with the knee extended and 120° when the
knee is flexed
Hip extension 10° to 20°
Abduction 45° to 50°
Adduction 20° to 30°
Medial and lateral rotations 45-50
STRUCTURE OF THE HIP
JOINT
Acetabulum
The opening of the acetabulum is-
• laterally inclined 40° in the frontal
• anteriorly rotated (anteversion)
20 sagittal planes
ANGULATION OF THE FEMUR
1.Angle of inclination(neck-shaft angle)-
• In the frontal plane
between an axis through the femoral head and neck
and the longitudinal axis of the femoral shaft
• Approximately 160°at birth
Normal range in adult 120° to 135°
A pathological increase in the neck and shaft coxa valga
A pathological decrease coxa vara
2.Angle of torsion
• In the transverse plane
• Between an axis through the
femoral head and neck and an axis
through the distal femoral condyles
• Best be viewed by looking down
the length of the femur from top to
bottom
• The normal angle of torsion
-10° to 20°
• 15° for males and 18° for
females
• Anteversion is -greater
than 15° to 20°
• Retroversion- less than 15°
to 20°
Biomechanics of hip
The forces acting across the hip
joint are :
• Body weight
• Abductor muscle force
• Joint reaction force
Joint reaction force –
• force generated within a joint in
response to forces acting on the
joint
• JRA= bodyweight + abductor
force
Biomechanics of hip
Hip joint is first order lever with
fulcrum as hip joint
Stable hip-
weight x lever arm1 = Abductor force x
lever arm2
Unilateral stance
• When the left leg has been
lifted from the ground Weight
bearing Rt hip joint weight of
the non-weightbearing left
limb(1/6) + weight of HAT(2/3)
weight supported by rt hip joint
=[2/3 x W] + [1/6 x W]= 5/6 x W
This torque is balanced by
abductor arm torque by significant
increase in the abductor force
Compensatory Lateral Lean of
the Trunk Limping
• The effective loading is decreased by
moving the centre of gravity of body
close to the centre of femoral head
• Reduces the gravitational moment
arm, gravitational torque and Joint
Reaction force
Cane
Use of cane in opposite hand .
There reduction of the total body weight as some the weight is transmitted
though cane .
Use of a Cane Contralaterally
Cane assists the abductor
muscles in providing counter
torque
Trendelenberg gait
• In normal 2 legged stance , body centre of gravity is
placed anterior to the centre of 2nd sacral vertebra
• On weight bearing on the affected side , weak abductors
fail to raise the pelvis on the opposite side
• Centre of gravity fails to shift toward the weight bearing
leg
• Trendelenberg gait bilaterally –waddling gait (duck
walking)
Causes of positive Trendelenberg Sign
COXA VALGA
Femoral head points
more superiorly
decreased amount of
coverage superiorly.
decreases the
stability of the hip
Valgus angulation
• Increases joint
reaction force
• Decreases shear
• Neutral or valgus
angulation better
for THA
COXA VARA
Varus angulation
• Decreases joint reaction force
• Increases shear across the neck increase
the predisposition for femoral neck fracture,
slipped capital femoral epiphysis
• Leads to shortening of the lower extremity
• Alters muscle tension resting length of the
abductors
• May cause a persistent limp
Diagram of hip –M moment , R joint reaction force , w
work
Body weight(W) x body wt lever arm(B) =
Abductor force(M) x abductor lever arm (A)
An increase in the ratio of A/B decreases R
Medialization of the acetabulum ,
long neck prosthesis or
lateralization of the greater trochater
R and abductor moment are reduced
by shifting body weight over the hipreduces body weight
lever arm
• Trendelenberg gait gait(leaning towards the diseased hip)
A cane in the contralateral hand produces an additional
moment .
• This can reduce R upto 60%
Total hip arthroplasty
CHARNLEY concept
Shorten lever arm of the body weight by
deepening the acetabulum
Lengthen the lever arm of the abductor
mechanism by reattaching the osteotomized
greater trochanter laterally
Leads to decrease in moment produced by
body weight there by reducing counterbalance
force by the abductors
To preserve sub chondral bone in the pelvis
deepening done in the acetabulum only as
much as necessary to obtain bony coverage for
the cup.
And most total hip procedures are now done
without osteotomy of the greater trochanter
The abductor lever arm is altered only relative
to the offset of the head to the stem.
The forces on the joint act
in the coronal plane & the
sagittal plane
Body’s center of gravity is
posterior to the axis of
the joint
in the midline anterior
to the 2nd sacral
vertebral body producing
torsion of the stem
Reducing the joint reaction force in
total hip arthroplasty
Acetabular side
Moving acetabular component medial, inferior and
anterior
Femoral side
Increasing the offset of femoral component
Lateralizing greater trochanter by increasing offset
neck / prosthesis
Varus neck shaft angulation :increases shear across
joint
References
Campbell operative orthopaedics 13th edition
Appley’s system of orthopedics 10 edition
Miller’s reviw of orthopedics 7th edition
Basic Orthopaedic sciences
Thank you
