Evaluation of femoral neck shaft angle on plain radiographs and its clinical implications

Subodh Kumar Pathak, Pritam Maheshwari, Prahlad Ughareja, Daksh Gadi, Prashanth Raj M., Sandeep Kumar Gour


Background: The femoral neck-shaft angle is the measurement of the angle formed between the oblique oriented neck with the vertical shaft and is an important anatomic measurement for the evaluation of biomechanics of hip. The neck shaft angle is important in surgeries that involve the neck of femur, Intertrochanteric fractures, slipped capital femoral epiphysis, and developmental dysplasia of hip. Different variation of neck shaft angle has been seen in different literature and all the orthopedic implants are designed according to the values of the western literature which is different from the Indian subcontinent.

Methods: Pelvic radiographs of patients who presented to Accident and emergency care or the outpatient department were used in the study 110 patients radiographs were assessed in the study. There were 55 males and 55 females in our study. The mean age for males was 46.5 years and that for females was 43.2 years. The pelvis radiographs were studied for neck shaft angle .The measurements were performed bilaterally on the digital screen using the PACS (picture archiving and communication system) with handheld 360 degree goniometer.

Results: The mean neck shaft angle in our study was129.26 degree for males and 126.62 degree for females .The overall mean neck shaft angle in 110 radiographs was 128.60 degree.

Conclusions: We conclude that consideration of neck shaft angles in orthopedics surgery and designing of implant can give more angle options for the surgeons which can improve the overall prognosis of the patient.


Proximal femur, Neck shaft angle, Femoral neck, Geometry, Implants

Full Text:



Wright D, Whyne C, Hardisty M, Kreder HJ, Lubovsky O. Functional and anatomic orientation of the femoral head. Clin Orthop Relat Res. 2011;469(9):2583–9.

Sugano N, Noble PC, Kamaric E, Salama JK, Ochi T, Tullos HS. The morphology of the femur in developmental dysplasia of thehip. J Bone Joint Surg Br Vol. 1998;80(4):711–9.

Mills HJ, Horne JG, Purdie GL. The relationship between proximal femoral anatomy and osteoarthrosis of the hip. Clin Orthop Relat Res. 1993;288:205–8.

Kaur P, Mathew S, George U. A study of neck shaft angle in the North-West Indian population on radiograph. Int J Basic Appl Med Sci. 2013;3:9-15

Olsen M, Davis ET, Gallie PA, Waddell JP, Schemitsch EH. The reliability of radiographic assessment of femoral neck-shaft and implant angulation in hip resurfacing arthroplasty. J Arthroplast. 2009;24(3):333–40.

Lechler P, Frink M, Gulati A, Murray D, Renkawitz T, Bucking B, et al. The influence of hip rotation on femoral offset in plain radiographs Acta Orthop. 2014;85(4):389–95

Konig G. Radiography of the proximal end of femur for measurements of angles (author’s translation). Z Orthop Grenzgeb. 1977;115(3):310–20.

Irdesel J, Ari I. The proximal femoral morphometry of Turkish women on radiographs. Eur J Anat. 2006;10(1):21-60.

Igbigbi, PS, Msamati BC. The femoral collodiaphyseal angle in Malawian adults. Am J Orthop. 2002;31(12):682-5.

Ravichandran D, Muthukumaravel N, Jaikumar R, Das H, Rajendran M. Proximal femoral geometry in Indians and its clinical applications. J Anat Soc India. 2011;60:6-12.

Hoaglund FT, Low WD. Anatomy of the femoral neck and head, with comparative data from Caucasians and Hong Kong Chinese. Clin Orthopaed Rel Res. 1980;152:10–6.

Togwood PA, Skalak A, Cooperman DR . Proximal Femoral Anatomy in the normal human population. Clin Orthopaed Rel Res. 2008;467:876-85.

Saika KC, Bhuyan SK, Rongphar R. Arthropometric study of the hip joint in northeastern region population with computed tomography. Indian J Orthop. 2008;42:260-6.

Gilligan I, Chandraphak S, Mahakkanukrauh P. Femoral neck-shaft angle in humans: Variation relating to climate, clothing, lifestyle, sex, age and side. J Anat. 2013;223:133-51.

Chibber SR, Singh I. Asymmetry in muscle weight and one sided dominance in the human lower limbs. J Anat. 1970;106:553-6.

De Sousa E, Fernandes RMP, Mathias MB, Rodrigues MR, Ambram AJ, Babinski MA . Morphometric study of the proximal femur extremity in Brazilians. In J Morphol. 2010;28:835-40.

Chiu CK, Chan CYW. Is the femoral neck geometry adequate for placement of the proximal femoral nail in the Malaysian population? A review of 100 cases. Med J Malaysia. 2009;64:1.

Igbigbi PS. Collo-diaphysial angle of the femur in East African subjects. Clin Anat. 2003;16:416-9.

Otsianyi WK, Naipanoi AP, Koech A. The femoral collodiaphyseal angle amongst selected Kenyan ethnic groups. J Morphol Sci. 2011;28:129-31.