The bones of the foot

These are best considered as a functional unit and are therefore dealt with together under 'the arches of the foot' (see page 235).

Iliofemoral (Y-shaped) ligament

Iliofemoral (Y-shaped) ligament

Iliofemoral Ligament Pain

Pubofemoral ligament

Inguinal ligament

External iliac and femora] artery lying on tendon of psoas

Pubofemoral ligament

Inguinal ligament

External iliac and femora] artery lying on tendon of psoas the femoral artery are intimate anterior relations of the joint.

Fig. 167 The anterior aspect of the hip. Note that the psoas tendon and

The hip is the largest joint in the body. To the surgeon, the examiner and, therefore, the student it is also the most important.

It is a perfect example of a ball-and-socket joint. Its articular surfaces are the femoral head and the horse-shoe shaped articular surface of the acetabulum, which is deepened by the fibrocartilaginous labrum acetabulare. The non-articular lower part of the acetabulum, the acetabular notch, is closed off below by the transverse acetabular ligament. From this notch is given off the ligamentum teres, passing to the fovea on the femoral head.

The capsule of the hip is attached proximally to the margins of the acetabulum and to the transverse acetabular ligament. Distally, it is attached along the trochanteric line, the bases of the greater and lesser trochanters and, posteriorly, to the femoral neck about 0.5 in (12 mm) from the trochanteric crest. From this distal attachment, capsular fibres are reflected on to the femoral neck as retinacula and provide one pathway for the blood supply to the femoral head (see 'The femur', page 216; Fig. 160).

Note that acute osteomyelitis of the upper femoral metaphysis will involve the neck which is intracapsular and which will therefore rapidly produce a secondary pyogenic arthritis of the hip joint. Three ligaments reinforce the capsule:

1 the iliofemoral (Y-shaped ligament of Bigelow) — which arises from the anterior inferior iliac spine, bifurcates, and is inserted at each end of the trochanteric line (Fig. 167);

2 the pubofemoral—arising from the iliopubic junction to blend with the medial aspect of the capsule;

3 the ischiofemoral—arising from the ischium to be inserted into the base of the greater trochanter.

Of these, the iliofemoral is by far the strongest and resists hyperextension strains on the hip. In posterior dislocation it usually remains intact.

The synovium of the hip covers the non-articular surfaces of the joint and occasionally bulges out anteriorly to form a bursa beneath the psoas tendon where this crosses the front of the joint.

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