The middle third of the shaft of the femur is triangular in shape with smooth lateral and medial margins between anterior, lateral (posterolateral), and medial (posteromedial) surfaces. The posterior margin is broad and forms a prominent raised crest (the linea aspera).
The linea aspera is a major site of muscle attachment in the thigh. In the proximal third of the femur, the medial and lateral margins of the linea aspera diverge and continue superiorly as the pectineal line and gluteal tuberosity, respectively (Fig. 6.27):
The pectineal line curves anteriorly under the lesser trochanter and joins the intertrochanteric line.
The gluteal tuberosity is a broad linear roughening that curves laterally to the base of the greater trochanter.
The gluteus maximus muscle is attached to the gluteal tuberosity.
The triangular area enclosed by the pectineal line, the gluteal tuberosity, and the intertrochanteric crest is the posterior surface of the proximal end of the femur.
The hip joint is a synovial articulation between the head of the femur and the acetabulum of the pelvic bone (Fig. 6.30A). The joint is a multiaxial ball and socket joint designed for stability and weight-bearing at the expense of mobility. Movements at the joint include flexion, extension, abduction, adduction, medial and lateral rotation, and circumduction.
When considering the effects of muscle action on the hip joint, the long neck of the femur and the angulation of the neck on the shaft of the femur must be borne in mind. For example, medial and lateral rotation of the femur involves muscles that move the greater trochanter forward and backward, respectively, relative to the acetabulum (Fig. 6.30B).
The articular surfaces of the hip joint are: the spherical head of the femur, and the lunate surface of the acetabulum of the pelvic bone.
The acetabulum almost entirely encompasses the hemispherical head of the femur and contributes substantially to joint stability. The nonarticular acetabular fossa contains loose connective tissue. The lunate surface is covered by hyaline cartilage and is broadest superiorly.
Except for the fovea, the head of the femur is also covered by hyaline cartilage.
The rim of the acetabulum is raised slightly by a fibrocartilaginous collar (the acetabular labrum). Inferiorly, the labrum bridges across the acetabular notch as the transverse acetabular ligament and converts the notch into a foramen (Fig. 6.31A).
The ligament of the head of the femur is a flat band of delicate connective tissue that attaches at one end to the fovea on the head of the femur and at the other end to the acetabular fossa, transverse acetabular ligament, and margins of the acetabular notch (Fig. 6.31B). It carries a small branch of the obturator artery, which contributes to the blood supply of the head of the femur.
The synovial membrane attaches to the margins of the articular surfaces of the femur and acetabulum, forms a tubular covering around the ligament of the head of the femur, and lines the fibrous membrane of the joint (Figs. 6.31B and 6.32). From its attachment to the margin of the head of the femur, the synovial membrane covers the neck of the femur before reflecting onto the fibrous membrane (Fig. 6.32).
The fibrous membrane that encloses the hip joint is strong and generally thick. Medially, it is attached to the margin of the acetabulum, the transverse acetabular ligament, and the adjacent margin of the obturator foramen (Fig. 6.33A). Laterally, it is attached to the intertrochanteric line on the anterior aspect of the femur and to the neck of the femur just proximal to the intertrochanteric crest on the posterior surface.