Surglcal AnaLomy Cf Plp !

olnL
uescrlpLlon of [olnLhlp [olnL ls a ball and sockeL Lype of synovlal [olnL ln whlch aceLabulam and head of
femur form Lhe arLlculaLlng surface AceLabulum provldes almosL LoLal coverage Lo Lhe head of
femurLhls along wlLh surroundlng labrum and sLrong supporLlng llgamenLs make Lhe [olnL very sLable
welghL bearlng axls p Lhrough Lhe anLerolaLeral asecL of head of femur
Moveme nLs hlp [olnL undergoes movemenLs ln all Lhe dlrecLlons varlous agonlsL and anLagonlsL
muscles acL Lo carry abL Lhese movemenLs 8ange of moLlon of Lhe [olnL ls as follows

movemenLs Muscles responslble
prlmary

Secondary
normal
rnrange
Maln nerve supply
flexlon llllacus psoas ma[or ecLlnlus
SarLorlus recLus
femorls
0 Lo 120 lemoral nerve
exLenslon CluLeus maxlmus PamsLrlngs 0 Lo 13 SclaLlc nerve
AdducLlon AdducLor longus magnus
brevls
ecLlnlus and
gracalls
0 Lo 30 CbLuraLor nerve
abducLlon CluLeus medlus and
mlnlmus
1lL sarLoLu 0 Lo 33 lnferlor gluL nerve
lnLernal roLaLlon anLerlor flbers of gluLeus
medlus and gluLeus mlnlmus
1ll 0 Lo 30 lnferlor gluLeal
nerve
LxLernal roLaLlon CbLuraLor
lnLernusexLernusLwo
gamelll quadrlceps femorls
lrlformls
gluLeal maxlmus
and SarLorlus
0 Lo 30


CbLuraLor nerve

vasculsr supply hlp [olnL ls supplled by arLerles ascendlng from Lhe neck hence lLr ls very suscepLlble Lo
vascular compromlse lL ls malnly supplled by exLra capsular arLerlal rlng whlch ls derlved from medlal
and laLeral clrcumflex femoral arLery whlch ln Lurn sre furLher derlved from femoral arLery and profuna
femorls arLery
8lomechanlcs of hlp [olnL Lhe abducLor musculaLure forms Lhe lever arm whlch musL neuLerallseLhe
load applled on lever arm exLendlng from cenLreof gravlLy
ln welghL bearlng Lhe pressure forces aare LransmlLLed Lo head and neck of femur aL an angle of q163 Lo
off 170 degree regardless of poslLlon of pelvls
ulrecLlon of physlologlcal force over head ls ln cronal as well as saglLal plane because body's cenLre of
gravlLy ls posLerlor Lo mldllne
ln cronal plane loadlng paLLern on head ls cycllc or sLaLlc canLllever Lype wlLh compresslve force
medlally and Lenslle sLress on laLeral slde

ln saglLal planeforces are lncreased lf loaded hlp ls flexed as ln cllmblng sLalrs forces form polar angle
beLween 13 Lo 23 degrees anLerlor Lo saglLal plan e of prosLhesls Such forces cause reLroverslon or
posLerlor deflecLlon of lemoral sLem
LS1lMA1Lu LCAu Cn lLMC8AL PLAu
uurlng sLance phase 3 Llmes body welghL
Slngle llmb sLance 36 Llmes body welghL
llfLlng/runnlng /[umplng 10 Llmes body welghL

1herefore excess body welghL and lncreased physlcal acLlvlLy add slgnlflcanLly Lo Lhe forces LhaL bend
loosen or fracLure Lhe sLem of componenL
8lCMLCPAnlCS Cl 1P8
Loosenlng and polyeLhylene wear are ma[or cause of Lha fallure and boLh are relaLed Lo blomechanlcs
of hlp
LengLhen9cenLrallzaLlon of head and abducLor lever arm coupled wlLh decread lever arm of body
welghL leads Lo decrease movemenL of abducLor
MeLhods Lo achleve decreased lever arm
ulsLal / laLeral re aLLachmenL of LrochanLer
AlLered offseLs of sLem Lo hand
ConLrolled reammlng of aceLabulum Lo pressere as much sub chondral bone as posslble
1he cenLre of roLaLlon of dependenL on 3 facLors
verLlcal offseL lrom lesser LrochanLer Lo cenLer of head
PorlzonLal offseL lrom cenLre of head Lo a llne Lhrough axls of dlsLal
femur
AnLerlor offseL (verslon) parL of sLem
ldeal placemenL of femoral prosLhesels
CffseLs should be physlologlcal
Llne Lhrough whlch Lhe LrochanLer passes musL pass Lhrough Lhe cenLre of prosLhesls
SLem should be ln valgus or cenLral buL never varus
1013 degree anLeverslon musL be kepL
8endlng movemenL should be as low as posslble
ldeal placemenL of aceLabular cup
3 degree lncllnaLlon
1013 degree anLeverslon
ueepenlng of aceLabulum Lo shorLen Lhe lever arm of body welghL