Hip

The hips are some of the most essential structural components of the body. They are also one of the most prone to orthopedic conditions. Because the hips are tasked with supporting the weight of the upper body and powering locomotion, they are susceptible to injury and general degradation.

When the hips become compromised by orthopedic injury or degenerative conditions (like arthritis), chronic pain and immobility may impair the ability to perform even the most basic activities, including standing, walking and running. For the active, adventure-seeking residents and visitors of the Aspen area, far more is at stake. Hiking, running, mountain biking, skiing; all of these beloved activities and many more stand to be lost when a hip becomes damaged.

At OrthoAspen, our team of hip specialists offers patients the elite-level care needed to relieve chronic symptoms and restore active lifestyles. With advanced, comprehensive treatment options, we ensure targeted solutions for the full spectrum of hip issues. At each stage of the patient experience (evaluation, diagnosis, treatment, recovery), our board-certified physicians ensure care is personalized to meet each patient’s particular needs and goals.

Hip treatments at OrthoAspen range from physical therapy regimes and conservative care to state-of-the-art surgical options. While implementing the most advanced techniques, such as arthroscopic and minimally-invasive surgery, our physicians emphasize an integrative, multifaceted approach to hip care at each stage of the treatment process. The ultimate goal of each treatment plan is the long-term management of orthopedic hip symptoms and elimination of their root causes.

As athletes and members of the Aspen community, our hip specialists are dedicated to restoring your ability to participate in the activities you love.

Common Conditions

Overview of the Hip

The hip joint is the largest weight-bearing joint in the human body. It is also referred to as a ball and socket joint and is surrounded by muscles, ligaments and tendons. The thigh bone, or femur, and the pelvis join to form the hip joint.

Any injury or disease of the hip will adversely affect the joint’s range of motion and ability to bear weight.

The hip joint is made up of the following:

• Bones and joints
• Ligaments of the joint capsule
• Muscles and tendons
• Nerves and blood vessels that supply the bones and muscles of the hip

Bones and Joints

The hip joint is the junction where the hip joins the leg to the trunk of the body. It is comprised of two bones: the thigh bone, or femur, and the pelvis which is made up of three bones called ilium, ischium and pubis. The ball of the hip joint is made by the femoral head while the socket is formed by the acetabulum. The acetabulum is a deep, circular socket formed on the outer edge of the pelvis by the union of three bones: ilium, ischium and pubis. The lower part of the ilium is attached by the pubis while the ischium is considerably behind the pubis. The stability of the hip is provided by the joint capsule, or acetabulum, and the muscles and ligaments which surround and support the hip joint.

The head of the femur rotates and glides within the acetabulum. A fibrocartilaginous lining called the labrum is attached to the acetabulum and further increases the depth of the socket.

The femur, or thigh bone, is one of the longest bones in the human body. The upper part of the thigh bone consists of the femoral head, femoral neck, and greater and lesser trochanters. The head of the femur joins the pelvis (acetabulum) to form the hip joint. Next to the femoral neck, there are two protrusions known as greater and lesser trochanters which serve as sites of muscle attachment.

Articular cartilage is the thin, tough, flexible and slippery surface lubricated by synovial fluid that covers the weight-bearing bones of the body. It enables smooth movements of the bones and reduces friction.

Ligaments

Ligaments are fibrous structures that connect bones to other bones. The hip joint is encircled with ligaments to provide stability to the hip by forming a dense and fibrous structure around the joint capsule. The ligaments adjoining the hip joint include:

• Iliofemoral ligament – This is a Y-shaped ligament that connects the pelvis to the femoral head at the front of the joint. It helps in limiting over-extension of the hip.
• Pubofemoral ligament – This is a triangular shaped ligament that extends between the upper portion of the pubis and the iliofemoral ligament. It attaches the pubis to the femoral head.
• Ischiofemoral ligament – This is a group of strong fibers that arise from the ischium behind the acetabulum and merge with the fibers of the joint capsule.
• Ligamentum teres – This is a small ligament that extends from the tip of the femoral head to the acetabulum. Although it has no role in hip movement, it does have a small artery within that supplies blood to a part of the femoral head.
• Acetabular labrum – The labrum is a fibrous cartilage ring which lines the acetabular socket. It deepens the cavity increasing the stability and strength of the hip joint.

Muscles and Tendons

A long tendon called the iliotibial (IT) band runs along the femur from the hip to the knee and serves as an attachment site for several hip muscles including the following:

• Gluteals – These are the muscles that form the buttocks. There are three muscles (gluteus minimus, gluteus maximus and gluteus medius) that attach to the back of the pelvis and insert into the greater trochanter of the femur.
• Adductors – These muscles are in the thigh which help in adduction, the action of pulling the leg back towards the midline.
• Iliopsoas: This muscle is in front of the hip joint and provides flexion. It is a deep muscle that originates from the lower back and pelvis, and extends up to the inside surface of the upper part of the femur.
• Rectus femoris – This is the largest band of muscles located in front of the thigh. They also are hip flexors.
• Hamstring muscles – These begin at the bottom of the pelvis and run down the back of the thigh. Because they cross the back of the hip joint, they help in extension of the hip by pulling it backwards.

Nerves and Arteries

Nerves of the hip transfer signals from the brain to the muscles to aid in hip movement. They also carry the sensory signals such as touch, pain and temperature back to the brain.

The main nerves in the hip region include the femoral nerve in the front of the femur and the sciatic nerve at the back. The hip is also supplied by a smaller nerve known as the obturator nerve.

In addition to these nerves, there are blood vessels that supply blood to the lower limbs. The femoral artery, one of the largest arteries in the body, arises deep in the pelvis and can be felt in front of the upper thigh.