Hip Capsule Research Articles

Distribution and immunohistochemical properties of autonomic neurons supplying the ovine hip joint capsule

Combined retrograde tracing and double labelling immunohistochemistry were applied to study the distribution and chemical coding of autonomic neurons projecting to the ovine hip joint capsule. As revealed by retrograde tracing, fast blue-positive autonomic neurons supplying the lateral side of the hip joint capsule and the medial side of the hip joint capsule were located within the lumbar and sacral of the ipsilateral sympathetic chain ganglia and within the caudal mesenteric ganglion. Immunohistochemistry revealed that nearly all (sympathetic chain ganglia: 96% and caudal mesenteric ganglion: 98.8%) the neurons were adrenergic in nature (positive for dopamine β-hydroxylase). Many retrogradely labelled neurons also displayed immunoreactivity to neuropeptide Y (approximately 34% of fast blue-positive neurons within caudal mesenteric ganglion and sympathetic chain ganglia). Populations of Met-Enk<sup>+</sup> (20%) and Leu-Enk<sup>+</sup> (6%) neurons were present only in the sympathetic chain ganglia while within caudal mesenteric ganglion no enkephalinergic-labelled neurons were noted. Only a small population (2.2%) of hip joint capsule-projecting neurons were Gal-IR and they were observed only within the caudal mesenteric ganglion. No cholinergic neurons involved in the innervation of the hip joint capsule were found. However, fast blue-positive nerve cell bodies were surrounded by numerous cholinergic nerve fibres often forming basket-like formations. Single Gal<sup>+</sup> nerve fibres were found in the intraganglionic connective tissue. Substance P-positive or calcitonin gene-related peptide-positive intraganglionic nerve terminals were very numerous and formed “baskets” surrounding fast blue-positive perikarya within sympathetic chain ganglias and caudal mesenteric ganglion.

ROM mapping of ligamentous constraints on avian hip mobility: implications for extinct ornithodirans.

Studies of soft tissue effects on joint mobility in extant animals can help to constrain hypotheses about joint mobility in extinct animals. However, joint mobility must be considered in three dimensions simultaneously, and applications of mobility data to extinct taxa require both a phylogenetically informed reconstruction of articular morphology and justifications for why specific structures' effects on mobility are inferred to be similar. We manipulated cadaveric hip joints of common quail and recorded biplanar fluoroscopic videos to measure a 'ligamentous' range of motion (ROM), which was then compared to an 'osteological' ROM on a ROM map. Nearly 95% of the joint poses predicted to be possible at the hip based on osteological manipulation were rendered impossible by ligamentous constraints. Because the hip joint capsule reliably includes a ventral ligamentous thickening in extant diapsids, the hip abduction of extinct ornithodirans with an offset femoral head and thin articular cartilage was probably similarly constrained by ligaments as that of birds. Consequently, in the absence of extraordinary evidence to the contrary, our analysis casts doubt on the 'batlike' hip pose traditionally inferred for pterosaurs and basal maniraptorans, and underscores that reconstructions of joint mobility based on manipulations of bones alone can be misleading.

Hip Capsular Management

AbstractDue to both the currently available technology and anatomic constraints of the hip joint, capsulotomy is necessary to perform hip arthroscopy. Proper management of the hip capsule is a crucial component of hip arthroscopy that has evolved with increased awareness that capsular closure during hip arthroscopy reestablishes the normal anatomy of the iliofemoral ligament and thus restores the biomechanical characteristics of the hip joint. This article reviews the biomechanical rationale for hip access and closure, as well as recent clinical studies on patient-reported outcomes with regard to capsular closure. Additionally, capsulotomy techniques including capsulectomy as well as interportal and T-capsulotomy techniques are reviewed, and the authors' preferred technique for capsular management is described. While capsular closure is technically challenging and increases operative time, meticulous closure improves outcomes by reducing postoperative micro- and gross instability.

Application of polypropylene mesh in patient with recurrent femoral head dislocation after total hip arthroplasty (case from practice)

One of complications after total hip arthroplasty is femoral head dislocation. It occurrence in case of primary replacement can happen from 0,2 till 2 %. In such cases after primary dislocation and close reduction recurrence can happen in 16–59 %. In this article we present clinical case of the treatment of recurrent femoral head luxation after total hip arthroplasty. Patient had two revision surgeries, defect of hip joint capsule and ligaments was revealed, and this defect was replaced by polypropylene mesh implant during the last revision. There were not complications in postoperative period. On follow-up X-rays in 8 years there was full restoration of hip joint function (flexion more than 90°, abduction to 30°) and ability to walk. There was not recurrent head dislocation. Presented method of treatment reflects possibilities of modern medicine. Patient’s recovery — is the result of timely and qualified chosen methods of conservative and surgical treatment. Application of polypropylene mesh to close soft tissues defect in case of femoral head dislocation is discussion question. But our experience, absence of infection complication and recurrent dislocation can testify of a positive result.

Hip capsular thickness correlates with range of motion limitations in femoroacetabular impingement.

Femoroacetabular impingement (FAI) is a clinical entity of the hip causing derangements in range of motion, pain, gait, and function. Computer-assisted modeling and clinical studies suggest that patients with FAI have increased capsular thickness compared to those without.A retrospective chart review was performed to assess relationships between capsular thickness, hip range of motion, and demographic factors in patients with FAI. Local Research Ethics Board approval was obtained to extract electronic medical records for 188 patients at a single institution who had undergone hip arthroscopy. Procedures were performed from 2009 to 2017 by a single, fellowship-trained, board-certified sports medicine orthopaedic surgeon. Inclusion criteria were preoperative hip range of motion testing, positive clinical impingement testing, and magnetic resonance imaging (MRI) of the affected hip. Patient demographics, hip range of motion, and time to surgery were recorded. MRIs were reviewed by a board-certified musculoskeletal radiologist blinded to clinical data. Maximum thickness of the anterior hip capsule was measured in axial, axial oblique, and sagittal oblique sequences. Anterior capsular thickness was also measured at the level of the femoral head-neck junction in axial sequences (axial midline). Axial midline capsular thickness was negatively correlated with hip flexion (r = - 0.196, p = 0.0042) and internal rotation (r = - 0.143, p = 0.0278). Significant differences were seen between genders in axial midline thickness (5.3 ± 1.4mm males/4.8 ± 1.3mm females, p = 0.0079), flexion (113° ± 18° males/120° ± 17° females, p = 0.0029), and internal rotation (23° ± 13° males/29° ± 12° females, p = 0.0155). Significant differences also existed between side affected in flexion (116° ± 17° right/119° ± 17° left, p = 0.0396) and internal rotation (26° ± 12° right/29° ± 13° left, p = 0.0029). Positive correlation was observed between axial oblique capsular thickness and flexion (r = 0.2345) (p = 0.0229). Increased anterior hip capsular thickness at the femoral head-neck correlates with limitations in hip range of motion in FAI. The strength of this relationship may be affected between pathologies, genders, and affected side. Pathologic thickening of the hip capsule may contribute to restricted hip mobility on clinical examination, and elucidation of this relationship may provide guidance into capsular management during hip arthroscopy. 4, retrospective case series.

Arthroscopic decompression of extra-articular subspinal hip impingement

Complete arthroscopic decompression of the impinging subspinal soft tissues and resection of the hypertrophic bone formation between the anterior hip capsule and the anterior inferior iliac spine (AIIS) or decompression of ahypertrophic AIIS. Painful anterior hip impingement and decreased hip flexion following ahypertrophic osseous subspinal deformation. No clinical symptoms or decreased anterior hip function despite radiological osseous subspinal hip impingement. Hip arthroscopy in supine position on an extension table. Treatment of possible intraarticular hip pathologies in the central or peripheral compartment. Arthroscopic visualization of the hypertrophic impinging soft tissues below the AIIS and decompression using ashaver or radiofrequency device. Complete arthroscopic resection of the hypertrophic AIIS parts and the osseous subspinal deformation using ahigh speed burr under fluoroscopic control. Early functional rehabilitation with full weight-bearing and unlimited hip motion; 3weeks ossification prophylaxis and 8weeks of limitation for jumping and running sports activities. There are no comparative studies or medium- and long-term study results in the literature for arthroscopic AIIS decompression. However, currently published case series show an improvement of the determined scores.

Do the trace elements play a role in the etiopathogenesis of developmental dysplasia of hip?

Alterations in the connective tissue of the hip joint capsule and ligaments might account for the increased laxity seen in patients with developmental dysplasia of the hip. The tensile features of the connective tissue depend on collagen. A number of prior studies have noted the association between the trace elements and collagen biosynthesis. The aim of this research is to determine whether there exists an association between the trace elements and developmental dysplasia of the hip. This investigation included 27 patients with developmental dysplasia of the hip (18 females and nine males; mean age 24.3 ± 6.3 months, range 18–36 months) and 26 healthy controls (15 females and 11 males; mean age 23.8 ± 5.4 months, range 18-36 months). The levels of the serum trace elements in the groups were statistically compared. The Cu levels of the patients with developmental dysplasia of hip were statistically higher than those of the control group (p<0.05). The Zn, Fe, Mg, and Mn levels of the patients with developmental dysplasia of hip were statistically lower than those of the control group (p<0.05). We found an association between developmental dysplasia of the hip and the serum trace element levels. We, therefore, believe that the trace element levels may shed light on the etiopathogenesis of developmental dysplasia of the hip. This work should be supported by future studies concerning the causes of the alterations in the serum trace element levels seen in patients with developmental dysplasia of the hip.

Multicentre study on capsular closure versus non-capsular closure during hip arthroscopy in Danish patients with femoroacetabular impingement (FAI): protocol for a randomised controlled trial

IntroductionHip arthroscopy has become a standard procedure in the treatment of hip joint pain not related to osteoarthritis or dysplasia in the young and active patient. There has been increasing...

MRI Evaluation of Repaired Versus Unrepaired Interportal Capsulotomy in Simultaneous Bilateral Hip Arthroscopy: A Double-Blind, Randomized Controlled Trial.

Techniques used in hip arthroscopy continue to evolve, and controversy surrounds the need for capsular repair following this surgical intervention. The purpose of this study was to evaluate the magnetic resonance imaging (MRI) appearance of the hip capsule in patients with femoroacetabular impingement (FAI) who underwent simultaneous bilateral hip arthroscopy through an interportal capsulotomy with each hip randomized to undergo capsular repair or not undergo such a repair. This double-blind, randomized controlled trial included 15 patients (30 hips), with a mean age of 29.2 years, who underwent simultaneous bilateral hip arthroscopy utilizing a small (<3-cm) interportal capsulotomy for the treatment of FAI. The first hip treated in each patient was intraoperatively randomized to undergo capsular repair or no capsular repair. The contralateral hip then received the opposite treatment. MRI was performed at 6 and 24 weeks postoperatively, and the scans were analyzed by 2 musculoskeletal radiologists. The patients and the radiologists were blinded to the treatment performed on each hip. Capsular dimensions were measured at the level of the healing capsulotomy site and, for hips with a persistent defect, at locations both proximal and distal to the defect. These values were then analyzed at both time points to assess the rate and extent of capsular healing. At 6 weeks postoperatively, a continuous hip capsule (with no apparent capsulotomy defect) was observed in 8 hips treated with capsular repair and 3 hips without such a repair. Of the 19 hips with a discontinuous capsule at 6 weeks, 17 were available for follow-up at 24 weeks postoperatively; all 17 demonstrated progression to healing, with a contiguous appearance without defects and no difference in capsular dimensions between treatment cohorts. Arthroscopic repair of a small interportal hip capsulotomy site yields an insignificant increase in the percentage of continuous hip capsules seen on MRI at 6 weeks postoperatively compared with no repair. Repaired and unrepaired capsulotomy sites progressed to healing with a contiguous appearance on MRI by 24 weeks postoperatively. Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

Efficacy of lateral- versus medial-approach hip joint capsule denervation as surgical treatments of the hip joint pain; a neuronal tract tracing study in the sheep.

ObjectiveTo evaluate efficacy of denervation of the of the hip joint capsule (HJC), as a treatment of hip joint pain. Specifically, we tested the hypothesis that HJC denervation will significantly reduce the number of sensory neurons innervating the capsule.Study designDenervation of the HJC from a medial or lateral approach was followed by retrograde tracing of sensory neurons innervating the capsule.AnimalsTwenty adult male sheep (30–40 kg of body weight; Polish merino breed) were used in the study.MethodsThe hip joint was denervated from medial (n = 5) or lateral (n = 5) surgical approaches. Immediately after denervation, the retrograde neural tract tracer Fast Blue (FB) was injected into the HJC. An additional ten animals (n = 5 for medial and n = 5 for lateral approach) received the same treatment without HJC denervation to provide the appropriate controls.ResultsResults of the study revealed that the vast majority of retrogradely labelled sensory neurons innervating the HJC originate from fifth lumbar to second sacral dorsal root ganglia. Both the medial and the lateral denervations significantly reduced the number of sensory neurons innervating the HJC (39.2% and 69.0% reduction respectively).ConclusionsThese results show that denervation of the HJC is an effective surgical procedure for reduction of the sensory neuronal input to the HJC. Moreover, the lateral approach was found to be significantly more effective for reducing sensory innervation as compared to the medial one.

Hip joint articular soft tissues of non-dinosaurian Dinosauromorpha and early Dinosauria: evolutionary and biomechanical implications for Saurischia

ABSTRACTDinosauromorphs evolved a wide diversity of hind limb skeletal morphologies, suggesting highly divergent articular soft tissue anatomies. However, poor preservation of articular soft tissues in fossils has hampered any follow-on functional inferences. We reconstruct the hip joint soft tissue anatomy of non-dinosaurian dinosauromorphs and early dinosaurs using osteological correlates derived from extant sauropsids and infer trends in character transitions along the theropod and sauropodomorph lineagues. Femora and pelves of 107 dinosauromorphs and outgroup taxa were digitized using 3D imaging techniques. Key transitions were estimated using maximum likelihood ancestral state reconstruction. The hips of dinosauromorphs possessed wide a disparity of soft tissue morphologies beyond the types and combinations exhibited by extant archosaurs. Early evolution of the dinosauriform hip joint was characterized by the retention of a prominent femoral hyaline cartilage cone in post-neonatal individuals, with the cartilage cone independently reduced within theropods and sauropodomorphs. The femur of Dinosauriformes possessed a fibrocartilage sleeve on the metaphysis, which surrounded a hyaline core. The acetabulum of Dinosauriformes possessed distinct labrum and antitrochanter structures. In sauropodomorphs, hip congruence was maintained by thick hyaline cartilage on the femoral head, whereas theropods relied on acetabular tissues such as ligaments and articular pads. In particular, the craniolaterally ossified hip capsule of non-Avetheropoda neotheropods permitted mostly parasagittal femoral movements. These data indicate that the dinosauromorph hip underwent mosaic evolution within the saurischian lineage and that sauropodomorphs and theropods underwent both convergence and divergence in articular soft tissues, correlated with transitions in body size, locomotor posture, and joint loading.SUPPLEMENTAL DATA—Supplemental materials are available for this article for free at www.tandfonline.com/UJVPCitation for this article: Tsai, H. P., K. M. Middleton, J. R. Hutchinson, and C. M. Holliday. 2018. Hip joint articular soft tissues of non-dinosaurian Dinosauromorpha and early Dinosauria: evolutionary and biomechanical implications for Saurischia. Journal of Vertebrate Paleontology. DOI: 10.1080/02724634.2017.1427593.

Influence of the release and resection of anterior hip capsule for hip rotational angle in hip extension position

Influence of the release and resection of anterior hip capsule for hip rotational angle in hip extension position

Use of an Artificial Ligament Decreases Hip Dislocation and Improves Limb Function After Total Femoral Prosthetic Replacement Following Femoral Tumor Resection

BackgroundHip dislocation is a major complication of total femoral prosthetic reconstruction (TFR) after femoral tumor resection. Hip dislocation can occur because of inadequate functional abductor musculature, inadequate hip capsule repair, or a long lever arm after total femur replacement. To eliminate the negative effects of these factors on the risk of hip dislocation, the use of artificial ligaments may help to increase the stability of the hip joint. We aimed to determine whether application of an artificial ligament would improve limb function and active range of movement (ROM) after TFR. MethodsFifty-eight patients who underwent femoral tumor resection and TFR were included. A band-shaped artificial ligament was wrapped spirally around the proximal site of the total femur prosthesis for periacetabular soft tissue reconstruction in 12 patients. The other 46 patients did not consent to receiving the artificial ligament. Complications including hip dislocation and infection, limb function, and active hip ROM were compared between patients who did and did not receive the artificial ligament. ResultsThe hip dislocation rate was lower in the patients who received the artificial ligament. The risk of deep infection did not differ between groups. The group that received the ligament also achieved better limb function and active ROM on flexion and abduction. ConclusionPatients treated with total femur resection and endoprosthetic replacement with an artificial ligament for periacetabular soft tissue reconstruction had a more stable hip joint, better limb function, and greater active hip ROM than did patients who did not receive an artificial ligament.

The zona orbicularis of the hip joint: anatomical study and review of the literature

Objectives: Although it is used as a landmark during various orthopedic procedures of the hip, few studies have focused on the anatomy of the zona orbicularis. Therefore, the purpose of the present research was to study its morphology to improve our understanding of its structure and potential variation. Methods: Ten adult cadavers (four males and six females) underwent dissection of the left and right hip joints to observe the morphology and location of the zona orbicularis. A digital caliper was used to measure the length and width of the zona orbicularis. Results: We found a zona orbicularis on all sides and that when present anteriorly, many of the inferior fibers of the zona orbicularis were confluent with the fibers of the iliofemoral ligament. The mean length for right sides was 35.95 mm and the mean length for left sides was 43.93 mm. The mean width for right sides was 3.74 mm and the mean width for left sides was 4.4 mm. There were no significant differences between the right and left sides for zona orbicularis length or width. There was no significant association between age and sex but a statistically significant correlation (r=0.959) between right and left zona orbicularis lengths (p=0.041). However, there was no significant correlation between the right and left zona orbicularis widths (p>0.05). The fibers of the zona orbicularis were found to be thicker and more visible along the posterior aspect of the femoral neck. Conclusion: Anatomically, the zona orbicularis is a consistent structure of the hip joint capsule. This structure can be seen on high resolution imaging such as MRI and magnetic resonance arthrography. The lengths of this structure may differ between sides, although based on our study, there were no differences between left and right side widths or between sexes or among ages.

The functional and surgical relevance of the iliocapsularis muscle: an anatomical review

The iliocapsularis muscle covers the anterior aspect of the hip joint capsule. Although its anatomy has been described through cadaveric and radiologic studies, its true function is unknown. The iliocapsularis could be involved in preventing anterior synovial impingement, a possibility supported by electromyography studies. Moreover, hypertrophy of the iliocapsularis caused by hip dysplasia supports the proposal that it stabilizes the anterior aspect of the joint capsule. This review discusses the clinical relevance of the iliocapsularis.

Puncture Capsulotomy During Hip Arthroscopy for Femoroacetabular Impingement: Preserving Anatomy and Biomechanics

We describe an arthroscopic technique for the treatment of labral pathology and femoroacetabular impingement that provides excellent access to the central and peripheral compartments while preserving the biomechanically crucial components of hip joint stability. The hip capsule and the ligaments within it have been shown to be integral to hip biomechanical stability. Other popular techniques such as interportal and T-capsulotomy inherently damage the capsuloligamentous complex of the hip and can be associated with postoperative gross instability, micro-instability, heterotopic ossification, and seroma. Capsular closure may mitigate some of these effects but has been associated with capsular insufficiency and requires postoperative restrictions that can be prolonged. Our surgical technique focuses on careful portal placement, replacement when necessary, use of a switching stick to maximize peripheral compartment visualization, and joint access in the most minimally invasive manner while avoiding complications associated with extended capsulotomy. The objective of this Technical Note is to describe a technique by which full access to the joint can be obtained while not disrupting the biomechanics of the joint capsule.

MicroRNA-146a knockdown suppresses the progression of ankylosing spondylitis by targeting dickkopf 1

Ankylosing spondylitis (AS) seriously threatens healthy and life quality of patients, however, there is no extremely effective drug to cure the disease. Therefore, it is urgent to understand molecular basis in the progression of AS. MicroRNA-146a (miR-146a) has been demonstrated to be associated with the development of AS. However, its molecular mechanism has not been fully established. In this study, it is found that the expression levels of miR-146a and dickkopf 1 (DKK1) were respectively upregulated and downregulated in hip capsule tissues of AS patients. Moreover, a negative correlation was displayed between miR-146a and DKK1 expression. Functional analysis revealed that miR-146a inhibitor restrained cell proliferation and osteogenic potential as well as enhanced apoptosis in AS fibroblasts, while miR-146a overexpression enhanced proliferation and osteogenic potential of AS fibroblasts. Bioinformatics analysis, dual luciferase reporter assays, qRT-PCR and immunoblotting assays revealed that miR-146a inhibited DKK1 expression by directly targeting 3’UTR region of DKK1. Mechanism studies further revealed that loss of DKK1 partly reversed the effect of miR-146a inhibitor on cell proliferation, apoptosis and osteogenic potential in AS fibroblasts. Taken together, our finding revealed that miR-146a knockdown hindered AS progression partially by regulating target DKK1 expression, offering a potential therapy application for AS patients.

Anatomic Study of Innervation of the Anterior Hip Capsule: Implication for Image-Guided Intervention.

The purpose of this cadaveric study was to determine the pattern of anterior hip capsule innervation and the associated bony landmarks for image-guided radiofrequency denervation. Thirteen hemipelvises were dissected to identify innervation of the anterior hip capsule. The femoral (FN), obturator (ON), and accessory obturator (AON) nerves were traced distally, and branches supplying the anterior capsule documented. The relationships of the branches to bony landmarks potentially visible with ultrasound were identified. The anterior hip capsule received innervation from the FNs and ONs in all specimens and the AON in 7 of 13 specimens. High branches of the FN (originating above the inguinal ligament) were found exclusively in 12 specimens and passed between the anterior inferior iliac spine and the iliopubic eminence. The ONs were innervated exclusively by high branches (proximal to the division), by low branches (from the posterior branch), and by both in 4, 5, and 4 specimens, respectively. The most consistent landmark was the inferomedial acetabulum (radiographic "teardrop"). When present, the AON coursed over the iliopubic eminence before innervating the anterior hip capsule. Branches of the FNs and ONs consistently provided innervation to the anterior hip capsule. The AON also contributed innervation in many specimens. The relationship of the articular branches from these 3 nerves to the inferomedial acetabulum and the space between the anterior inferior iliac spine and iliopubic eminence may suggest potential sites for radiofrequency ablation.

The deep layer of the tractus iliotibialis and its relevance when using the direct anterior approach in total hip arthroplasty: a cadaver study

IntroductionSurgical approaches through smaller incisions reveal less of the underlying anatomy, and therefore, detailed knowledge of the local anatomy and its variations is important in minimally invasive surgery. The aim of this study was to determine the location, extension, and histomorphology of the deep layer of the iliotibial band during minimally invasive hip surgery using the direct anterior approach (DAA).Materials and methodsThe morphology of the iliotibial tract was determined in this cadaver study on 40 hips with reference to the anterior superior iliac spine and the tibia. The deep layer of the tractus iliotibialis was exposed up to the hip-joint capsule and length and width measurements taken. Sections of the profound iliotibial tract were removed from the hips and the thickness of the sections was determined microscopically after staining.ResultsThe superficial tractus iliotibialis had a length of 50.1 (SD 3.8) cm, while tensor fasciae latae total length was 18 (SD 2) cm [unattached 15 (SD 2.5) cm]. Length and width of the deep layer of the tractus iliotibialis were 10.4 (SD 1.3) × 3.3 (SD 0.6) cm. The deep iliotibial band always extended from the distal part of the tensor fascia latae (TFL) muscle to the lateral part of the hip capsule (mean maximum thickness 584 μm). Tractus iliotibialis deep layer morphology did not correlate to other measurements taken (body length, thigh length, and TFL length).ConclusionsThe length of the deep layer is dependent on the TFL, since the profound part of the iliotibial band reaches from the TFL to the hip-joint capsule. The deep layer covers the hip-joint capsule, rectus, and lateral vastus muscles in the DAA interval. To access the precapsular fat pad and the hip-joint capsule, the deep layer has to be split in all approaches that use the direct anterior interval.

Nerve Blocks in the Geriatric Patient With Hip Fracture: A Review of the Current Literature and Relevant Neuroanatomy

Introduction:Hip fracture is a common occurrence in the elderly population with high morbidity and mortality due to postoperative pain and opioid use. The goal of this article is to review the current literature on the neuroanatomy of the hip and the use of localized nerve block in controlling hip fracture pain.Methods:A thorough search of MEDLINE/PubMed, Embase, and the Cochrane Database of Systematic Reviews was conducted using the search terms “hip fracture” and “fascia iliaca block (FICB).” An additional search was conducted utilizing multiple search terms including “hip fracture,” “greater trochanter,” “femur,” “hip,” “anatomy,” “neuroanatomical,” and “anatomic.” Each search result was investigated for cadaveric studies on the innervation of the trochanteric region.Results:Twenty-five clinical studies examining the use of FICBs in hip fracture patients were identified. These studies show that FICB is safe and effective in controlling perioperative pain. Additionally, FICB has been shown to decrease opioid requirement and opioid-related side effects. Neuroanatomical studies show that the hip capsule is innervated by contributions from the femoral, obturator, sciatic, and superior gluteal nerves. Imaging studies suggest that FICB anesthetizes these branches through localized spread along the fascia iliaca plane. Cadaveric evidence suggests that the greater trochanter region is directly innervated by a single branch from the femoral nerve.Discussion:The proven efficacy of nerve blocks and their anatomic basis is encouraging to both the anesthesiologist and orthopedic surgeon. Their routine use in the hip fracture setting may improve patient outcomes, given the unacceptably high morbidity and mortality associated with opioid use.Conclusions:Localized nerve blocks, specifically FICB, have been shown to be safe and effective in managing acute hip fracture pain in geriatric patients, leading to decreased opioid use. Knowledge of the hip neuroanatomy may help guide future development of hip fracture pain blockade.