CHAPTER 11 Structure and Function of the Hip Complex


Ala of sacrum


Anterior superior iliac spine


Anterior inferior


iliac spine Acetabulum


Superior pubic ramus


Ischium Ischial tuberosity A


Obturator foramen


Pubic symphysis


Sacrum Posterior


Median sacral crest


Posterior superior iliac spine


Posterior inferior


iliac spine


Figure 11.2 Components of the pelvis. (A) Anterior view. (B) Posterior view. (From Roy S, Wolf SL, Scalzitti DA. The Rehabilitation Specialist’s Handbook, 4th ed. Philadelphia, PA: F. A. Davis Company, 2013, with permission.)


anterior surface of the ilium is a smooth, concave surface called the iliac fossa. Each of these bony landmarks is an attachment site for major muscles and ligaments of the hip and is discussed further later in the chapter.


Ischium


The ischium sits inferior to the ilium and forms the pos- terior lower portion of the innominate bone. The ischial spine projects from the posterior ischium and is supe- rior to the lesser sciatic notch. The sacrotuberous and sacrospinous ligaments form the lesser sciatic foramen in the lesser sciatic notch. The ischial tuberosity projects posteriorly and inferiorly from the acetabulum. These tuberosities support the weight of the upper body in a sitting position. The ischial ramus extends between the ischial tuberosity and the anterior inferior pubic ramus.


Pubis


The upper border of the body of the pubis is the pubic crest, and the superior pubic ramus extends from the acetabulum anteriorly to connect with the body. The inferior pubic ramus extends from the body of the pubis to the ischium. The pubic tubercles are attachment sites for the inguinal ligament. Figure 11.4 illustrates the bony aspects of the pelvis and the associated ligaments.


Acetabulum


All three bones of the pelvis form the deep socket of the hip joint called the acetabulum. Interior to the acetabu- lum is the obturator foramen. The ilium and ischium make up about three quarters of the acetabulum, and the pubis forms the remaining one quarter of the socket. The convergence of these three bones forms the surface that accepts forces transmitted through the lower extremity.


Femur


The femur is the longest and strongest bone in the human body. Its shaft is slightly convex on its anterior surface. The femoral head projects medially and slightly anteriorly to articulate with the acetabulum and form the hip joint, also known as the coxofemoral joint. The femoral neck extends laterally as it connects the head to the shaft, displacing it away from the pelvis. The shaft then inclines medially to place the knees and feet nearer to the body.


Sacral foramina B Coccyx Ischial tuberosity


The two pubic bones form the pubic symphysis joint, a synarthrosis joint whose surfaces are lined with hyaline cartilage. The joint contains a fi brocartilaginous interpu- bic disc that functions as a shock absorber during walking and facilitates delivery during childbirth.


Pubic tubercle Pubis Os coxae Anterior Sacroiliac joint Sacrum Ilium Iliac tuberosity


Iliac fossa Iliac crest


231


Iliac crest


Greater sciatic foramen


Greater sciatic notch


Ischial spine Acetabular


margin


Obturator foramen


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