Anatomy, Pathology & Treatment of the Hip joint

Hip Anatomy

The hip joint is known as a ball and socket joint and forms a connection between the femur (upper leg) and pelvis.

The hip joint is known as a synovial joint meaning that the bones are not in direct contact due to the presence a synovial fluid filled joint capsule and a layer of cartilage. Synovial joints allow greater mobility compared with other joints such as fibrous and cartilaginous joints. Unfortunately, this feature is also the reason why synovial joints are more prone to injury and wear and tear.

The surfaces of the bones within the joint are covered in articular cartilage which is very smooth allowing them to glide past one another with minimal friction during movement.

The hip joint is designed for stability and weight baring. It has a deeper socket compared to the shoulder joint which allows greater stability however this does mean that the range of movement is slightly compromised.

The stability is further improved by the presence of a fibrocartilaginous collar called the labrum which in essence deepens the socket.

Stability also comes from a series of ligaments that surround the joint as well as many muscles that act on the hip joint;

• Flexion – iliopsoas, rectus femoris, sartorius, pectineus
• Extension – gluteus maximus; semimembranosus, semitendinosus and biceps femoris
• Abduction – gluteus medius, gluteus minimus, piriformis and tensor fascia latae
• Adduction – adductors longus, brevis and magnus, pectineus and gracilis
• Lateral rotation – biceps femoris, gluteus maximus and piriformis
• Medial rotation – anterior fibres of gluteus medius and minimus, tensor fascia latae

The reason there are so many muscles that act on the hip joint is due to the fact the joint can move in six different directions plus combinations of these directions. Having a good understanding of these muscles groups is key when rehabilitating issues with the hip joint.

Common pathology of the hip

Osteoarthritis

Osteoarthritis is a general term used to describe any degree of wear and tear within a joint. The cartilage within the joint can become less efficient over time and therefore less able to take stress that is being placed on it.

People often get concerned about a ‘diagnosis of osteoarthritis’ however most adults have some degree of wear and tear in their joints without there being any associated symptoms. In almost all situations physiotherapy will be the first line of treatment in dealing with osteoarthritis of the knee.

In most cases symptoms can be significantly improved by building the strength and stability of the knee through rehabilitation and a referral to an orthopaedic surgeon is not required.  

Fractured neck of femur

This injury usually occurs following a fall onto the hip and is common in the older population due to the fact bone density tends to be lower. It almost always needs surgery to fix where either a hip replacement or screws are used to fix the issue. A period of rehabilitation will follow lead by a physiotherapist.

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Hip bursitis

A bursa is a fluid filled sac that is found in many areas of the body and sits between tendons and bones helping to reduce friction.

The outside of the hip is a common place for the bursa to get irritated and inflamed.

In most cases a course of physiotherapy will solve this issue. If symptoms persist often a corticosteroid injection is administered to reduce the inflammation.  

Labrum tear

The labrum is a fibrocartilaginous collar which provided extra stability to the hip joint by deepening the socket.

It can sometimes tear, usually during sporting events such as football, hockey and hurdling.

Symptoms include groin pain, catching sensation when moving the hip and reduced range of movement.

A physiotherapy assessment is able to detect a likely labrum tear and an MRI scan is often used to confirm the diagnosis.

Depending on the severity of the tear conservative management or surgery is used to manage the issue.

Treatment

The White House Clinic is much more than just a regular physiotherapy clinic. We have the ability to facilitate any intervention that is needed to help manage and rehabilitate any type of knee injury or issue. The information below outlines all of the services available at the clinic.

Physiotherapy assessment and treatment

We have a group of highly experienced physiotherapists who will be able to provide a thorough assessment and diagnosis of your knee issue. Following this they will be able to provide you with the most evidence-based treatment to ensure improvement and hopefully resolution of your symptoms.

In the case where further investigations or treatment is required, they have the knowledge base and contacts to make sure the appropriate onward referrals are made with minimal waiting times.

State-of-the-art gym and rehabilitation facilities

Our clinic is equipped with both a gym and a studio both filled with modern equipment enabling our physiotherapists have the facilities to provide the best rehabilitation available.

Rapid access to investigative and scanning facilities

If you require further investigation such as an x-ray or MRI scan, we have the clinical pathways to refer you quickly. Some hip issues can be assessed with an ultrasound scan which we are able to perform in house with no waiting list.

Corticosteroid injections

In certain situations, an anti-inflammatory, pain relieving injection known as a corticosteroid injection is used in the management of hip issues such as bursitis. We are able to provide these injections on site.

Direct referral links to the top orthopaedic specialists in the area

We have long standing professional relationships with the top orthopaedic specialists in the area so in the scenario where an orthopaedic referral, possibly leading to surgery, is required we are able to refer swiftly and directly.

Pre-operative and Post-operative rehabilitation

We have a vast amount of experience in dealing with patients before and after hip surgery with many of the local hospitals referring a large variety of surgical cases to us.

Prior to surgery it is best practice to optimise the range of movement and strength of the hip joint which will allow for a quicker recovery after surgery

After surgery there is a surgical protocol that is followed. Our physiotherapists will be able to guide you through this protocol to ensure optimal recovery is achieved.

Summary

At the White House Clinic we are able to help you with any form of hip issue at any stage of the process to recovery.

The hip joint can be a source of pain and decreased function for many people however there is almost never a situation where you ‘just have to live with it’.

If you have any questions about your hip or any of the services that we provide then get it contact with us today and we will be happy to help.

Please refer to the ‘Hip and Knee Service’ section on our website for more information regarding the treatments covered in this article.