The neck–shaft angle: an update on reference values and associated factors

Figures & data

Figure 1. The neck–shaft angle (x) is composed of a and b; a = femoral neck axis, b = femoral shaft axis.

Table 1. Study cohort characteristics. Data are presented as mean (SD) [range]

Factor	Total (n = 3,226)	Men (n = 1,587)	Women (n = 1,639)
Age	53 (14) [21–90]	53 (14) [21–90]	52 (13) [21–88]
Weight, kg	80 (15) [44–143]	88 (13) [53–143]	73 (13) [44–126]
Height, cm	170 (9) [146–202]	177 (7) [156–202]	164 (6) [146–189]
BMI	28 (4) [17–48]	28 (4) [18–42]	27 (5) [17–48]
Waist, cm^a	90 (13) [55–145]	96 (11) [66–145]	84 (12) [54–122]

a Waist circumference (2 women and 1 man missing).

Table 2. Descriptive results neck-shaft angle. Data are presented as mean (SD) [range]

Neck-shaft angle	Total^a (n = 6,452)	Men (n = 3,174)	Women (n = 3,278)
Right	127.7 (7.1) [96–153]	127.7 (7.1) [96–153]	127.9 (7.1) [99–152]
Left^b	126.0 (7.4) [101–153]	125.3 (7.7) [101–151]	126.8 (7.1) [103–153]
Mean ^b,c	126.9 (6.7) [102–151]	126.5 (6.8) [102–151]	127.4 (6.6) [102–149]

a Paired t-test (total right vs. total left): p < 0.001.

b Sign test (men vs. women): p < 0.001.

c Mean of left and right side.

Figure 2. The negative association between neck–shaft angle and body mass index is shown.

Figure 3. The positive association between neck–shaft angle and body height is shown.

Table 3. Neck-shaft angle in other studies

Author, year	Method	Population	Age (range)	n	Mean (SD)
Alonso et al. 2000	DXA	Spain	70	235 M	126.3 (4.4)
			70	310 F	124.6 (4.2)
Doherty et al. 2008	AP radiograph	England	64	1,103	R 128.3 (7.1)
					L 128.3 (7.1)
Kaptoge et al. 2008	DXA	US	74	6,839 F	127.2 (6.0)
Elbuken et al., 2012	DXA	Turkey	(20–108)	18,943	M 129.6
					F 129.1
Bagaria et al. 2012	AP radiograph	India	(20–80)	141 M	127.7 (3.9)
				70 F	126.6 (4.8)
Gilligan et al. 2013	Femora	–	–	8,271	126.4 (5.6)
Mitra et al. 2014	AP radiograph	Iran	35 (24–42)	100 M	R 127.5 (5.3)
					L 127.6 (5.6)
			44 (28–57)	100 F	R 125.4 (6.0)
					L 126.6 (6.3)
Boese et al. 2015	CT, coronal Reconstruction (femoral neck plane)	Germany	53 (18–89)	200 M	129.6 (5.9)
			54 (18–100)	200 F	131.9 (6.8)
					R 130.8 (6.7)
					L 130.8 (6.3)
Dimitriou et al. 2016	3D CT	US	47 (31–58)	61	R 126.7 (4.8)
					L 126.6 (4.5)
Present study	MRI coronal plane	Germany	53 (21–90)	1,587 M	126.5 (6.8)
			52 (21–88)	1,639 F	127.4 (6.6)

DXA = Dual-energy X-ray absorptiometry, M = male, F = female, R = right hip, L = left hip

Alonso C G, Curiel M D, Carranza F H, Cano R P, Perez A D. Femoral bone mineral density, neck–shaft angle and mean femoral neck width as predictors of hip fracture in men and women: Multicenter Project for Research in Osteoporosis. Osteoporos Int 2000; 11(8): 714–20.

 PubMed Web of Science ®Google Scholar

Doherty M, Courtney P, Doherty S, Jenkins W, Maciewicz R A, Muir K, Zhang W. Nonspherical femoral head shape (pistol grip deformity), neck shaft angle, and risk of hip osteoarthritis: a case-control study. Arthritis Rheum 2008; 58(10): 3172–82.

 PubMedGoogle Scholar

Kaptoge S, Beck T J, Reeve J, Stone K L, Hillier T A, Cauley J A, Cummings S R. Prediction of incident hip fracture risk by femur geometry variables measured by hip structural analysis in the study of osteoporotic fractures. J Bone Miner Res 2008; 23(12): 1892–1904.

 PubMed Web of Science ®Google Scholar

Elbuken F, Baykara M, Ozturk C. Standardisation of the neck–shaft angle and measurement of age-, gender- and BMI-related changes in the femoral neck using DXA. Singapore Med J 2012; 53(9): 587–90.

 PubMed Web of Science ®Google Scholar

Bagaria V, Deshpande S, Kuthe A, Rasalkar D D, Paunipagar B K, Madhugiri T S. Radiographic study of the hip joint to determine anthropometric parameters for Indian population. Eur J Radiol 2012 81(2): 312–16.

 PubMed Web of Science ®Google Scholar

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(2): 133–51.

 PubMed Web of Science ®Google Scholar

Mitra A, Khadijeh B, Vida A P, Ali R N, Farzaneh M, Maryam V F, Vahid Y. Sexing based on measurements of the femoral head parameters on pelvic radiographs. J Forensic Leg Med 2014; 23: 70–5.

 PubMed Web of Science ®Google Scholar

Boese C K, Jostmeier J, Oppermann J, Dargel J, Chang D, Eysel P, Lechler P. The neck shaft angle: CT reference values of 800 adult hips. Skeletal Radiol 2015; 45(4): 455–63.

 PubMed Web of Science ®Google Scholar

Dimitriou D, Tsai T, Yue B, Rubash H E, Kwon Y, Li G. Side-to-side variation in normal femoral morphology: 3D CT analysis of 122 femurs. Orthop Traumatol Surg Res 2016; 102(1): 91–7.

 PubMed Web of Science ®Google Scholar