Femoral neck abnormalities

Last updated: March 14, 2023

Summarytoggle arrow icon

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.

Overviewtoggle arrow icon

  • 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.

Coxa varatoggle arrow icon

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

Coxa valgatoggle arrow icon

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

Femoral anteversiontoggle arrow icon

Toddlers that repeatedly or easily stumble may have femoral anteversion.

Femoral retroversiontoggle arrow icon

Referencestoggle arrow icon

  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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