This study was conducted in accordance with the Declaration of Helsinki. Ethical approval was granted by the appropriate Institutional Review Board (IRB) of the Jordan University Hospital. A sample size of 400 anteroposterior view of the pelvis were selected, showing both hip joints and a sufficient part of the upper femur.

This is a multi-center retrospective study, which involved measuring the NSA using anteroposterior pelvic radiographs of adult patients. We hypothesized that there is no significant difference between the bilateral NSA and that the contralateral femur can be used as a template during proximal femur fracture pre-operative planning and other indications. This will guide orthopedic surgeons during the management of several pathologies around the femoral neck-shaft angle. The aim of the study is to determine side-to-side variability, to determine whether and to what extent imaging position, including standing and supine, can affect NSA measurement, to provide reference values, and to provide perspective on possible sex-based differences. It remains a subject of debate among orthopedic surgeons globally, since there is a limited literature on NSA measurements and there is no established measurement protocol to measure NSA. Nevertheless, other studies failed to find significant side asymmetry. showed a 1.3° significant difference between both sides. Moreover, some studies revealed greater neck-shaft angles in females, while others found higher values in males. However, opposite findings have also been reported. These values are subject to a wide range of discrepancies, as it was demonstrated that age varies inversely with the angle. A recent study showed a mean value of 131.3°. A multi-national analysis of 8271 femora found that human neck-shaft angles varied from 120° to 140°, with a mean of 126.4°. Neck-shaft angle is considered one of the most commonly measured indicators of hip anatomy. Therefore, anteroposterior radiographs were standardized in order to measure the NSA and minimize the protectional errors due to hip rotation. Especially in cases of significant discrepancies, the surgeon’s decision may be affected as a result. As a result of its critical significance, preoperative imaging techniques and measurement methods must be accurate, as they may affect the reliability and measurement accuracy that may render patients unable to achieve their maximal potential functional capacity. It plays a role in diagnosis or management of several hip and femur problems, such as osteoarthritis, hip fractures, greater trochanteric pain syndrome, cerebral palsy, and femoroacetabular impingement. Level III retrospective comparative study.įemoral neck-shaft angle (NSA), also known as the caput-collum-diaphyseal angle, is the intersection between the proximal femoral shaft axis and the femoral neck axis. However, this study does not provide definitive clinical evidence, and further clinical-oriented research is required. In contrast, significant asymmetry between the right and left NSA was found in the supine radiographs. Our findings indicated no significant variability in upright radiographs between the right and left NSA. On supine radiographs there was no statistically significant difference between male and female NSA ( p = 0.85).

There was a significant difference between NSA of the right and left femur among the patients in the supine position ( p < 0.001). In supine radiograph, the overall mean NSA for the supine position was 133.06° ± 5.71°. On both sides, male NSA was higher than female NSA ( p < 0.001). There was no significant difference between right and left femur NSA among the patients ( p = 0.95). In the upright radiograph, the overall mean NSA was 131.21° ± 4.72°. ResultsĪ total of 400 pairs of femoral necks were reviewed, comprising of 200 males and 200 females. Paired t-test, Pearson correlation coefficient, and independent sample t-test were used ( p < 0.01). Matching was performed according to sex (exact matching) and age. We measured bilateral NSA in a retrospective study of 200 standing and 200 supine anteroposterior pelvis radiographs that met the inclusion criteria, while paying special attention to bilateral hip symmetry. The secondary aim was to determine a reference value and precisely understand the effects of sex on NSA measurement. The primary aim of the study was to establish if NSA measurement may be affected by imaging position (standing and supine) and provide evidence regarding whether the contralateral NSA can be used as a template. Neck-shaft angle (NSA) is of paramount importance to orthopedic surgeons due to its implications for various pathologies of the hip and femur.

Normal hip xray review