Femoral neck abnormalities

Last updated: January 17, 2022

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Femoral neck abnormalities are axial malalignments of the femoral neck involving the caput-collum-diaphyseal angle and the femoral angle of anteversion. Four common femoral version abnormalities are discussed here: coxa vara, coxa valga, femoral anteversion, and femoral retroversion. Clinical features include an abnormal gait and pain with prolonged weight-bearing. Some abnormalities may resolve spontaneously. However, severe cases require surgical correction. Common complications include secondary arthrosis and femoroacetabular impingement.

  • Definition: axial malalignments of the femoral neck involving the caput-collum-diaphyseal angle (CCD angle) and the angle of anteversion
  • Femoral neck axis: a line that equally divides the femoral neck through the center of the femoral head [1]
  • Caput-collum-diaphyseal angle (CCD angle) [1]
  • Femoral anteversion angle [3][4]
  • Hilgenreiner epiphyseal angle [5]
    • The angle formed by the intersection of a line drawn from the triradiate cartilages (Hilgenreiner line) and another line drawn through the capital femoral physis
    • Used to measure the severity of femoral deformities
    • Normal angle: ∼ 25°

Femoral neck anomalies are initially diagnosed using plain x-ray.

Overview of coxa vara [5][6]
Congenital Developmental Acquired
Clinical features
  • Depends on the underlying disorder

Overview of coxa valga [6][8]
Congenital Secondary


Clinical features
  • AP x-ray of the hips: increased angle between femoral neck and shaft
  • Spontaneous normalization can be expected once skeletal development is complete.
  • Physiotherapy
  • Persistent cases: varus derotation osteotomy (VDRO)
  • Treatment of underlying disease
  • Physiotherapy
  • Surgical correction may be considered.
  • Secondary arthrosis

Toddlers that repeatedly or easily stumble may have femoral anteversion.

  1. Waldt et al.. Measurements and Classifications in Musculoskeletal Radiology. Georg Thieme Verlag ; 2014
  2. Adekoya-Cole T, Akinmokun O, Soyebi K, Oguche O. Femoral neck shaft angles: A radiological anthropometry study. Niger Postgrad Med J. 2016; 23 (1): p.17. doi: 10.4103/1117-1936.180130 . | Open in Read by QxMD
  3. Scorcelletti M, Reeves ND, Rittweger J, Ireland A. Femoral anteversion: significance and measurement. J Anat. 2020; 237 (5): p.811-826. doi: 10.1111/joa.13249 . | Open in Read by QxMD
  4. Decker S, Suero EM, Hawi N, Müller CW, Krettek C, Citak M. The physiological range of femoral antetorsion. Skeletal Radiol. 2013; 42 (11): p.1501-1505. doi: 10.1007/s00256-013-1687-3 . | Open in Read by QxMD
  5. Beals RK. Coxa Vara in Childhood: Evaluation and Management. J Am Acad Orthop Surg. 1998; 6 (2): p.93-99. doi: 10.5435/00124635-199803000-00003 . | Open in Read by QxMD
  6. Moeckel E, Mitha N. Textbook of Pediatric Osteopathy. Elsevier Health Sciences ; 2008
  7. Roberts DW, Saglam Y, De La Rocha A, Frasquillo BN, Tulchin-Francis K, Kim HKW. Long-term Outcomes of Operative and Nonoperative Treatment of Congenital Coxa Vara. Journal of Pediatric Orthopaedics. 2018; 38 (4): p.193-201. doi: 10.1097/bpo.0000000000000782 . | Open in Read by QxMD
  8. Siebenrock KA, Steppacher SD, Haefeli PC, Schwab JM, Tannast M. Valgus Hip With High Antetorsion Causes Pain Through Posterior Extraarticular FAI. Clinical Orthopaedics & Related Research. 2013; 471 (12): p.3774-3780. doi: 10.1007/s11999-013-2895-9 . | Open in Read by QxMD
  9. Fadaei B, Nourai M, Rizi A. In-toeing and out-toeing gait conservative treatment; hip anteversion and retroversion: 10-year follow-up. Journal of Research in Medical Sciences. 2015; 20 (11): p.1084. doi: 10.4103/1735-1995.172833 . | Open in Read by QxMD
  10. Lerch TD, Todorski IAS, Steppacher SD, et al. Prevalence of Femoral and Acetabular Version Abnormalities in Patients With Symptomatic Hip Disease: A Controlled Study of 538 Hips. Am J Sports Med. 2017; 46 (1): p.122-134. doi: 10.1177/0363546517726983 . | Open in Read by QxMD

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