Coxa Vara and Coxa Valga: What Do They Mean for Your Hip?
Coxa vara and coxa valga describe the angle between the neck of your thighbone and its shaft. When this angle is smaller than normal, it is called coxa vara. When it is larger, it is called coxa valga. Both can alter how forces travel through your hip and may contribute to pain, limping, or uneven leg length.
Key takeaways
- The neck-shaft angle of a healthy adult hip typically sits between about 125 and 135 degrees.
- Coxa vara (angle too small) tilts the leg inward and can shorten it. Coxa valga (angle too large) does the opposite.
- Both conditions change the leverage of your hip muscles, which can lead to a limp or compensatory strain elsewhere.
- Lying-down scans relax the joint and may not reflect the angle under real weight-bearing load.
- A standing whole-body scan captures how your hip geometry works when you are upright and active.
What is the neck-shaft angle of the hip?
The neck-shaft angle is the angle formed where the neck of your femur (thighbone) meets its main shaft. In a typical adult, this angle sits between roughly 125 and 135 degrees. It determines how your hip joint lines up and how efficiently your muscles can hold you steady when you stand and walk.
When this angle falls below the normal range, the condition is called coxa vara. The femoral neck points more steeply downward, effectively tipping the leg inward and sometimes making it functionally shorter.
When the angle is larger than normal, it is called coxa valga. The neck sits more horizontally, pushing the leg slightly outward and sometimes making it functionally longer.
Neither term is a disease in itself. They describe a shape variation. But when the variation is significant, it changes the way forces pass through your hip joint and the muscles around it, often creating knock-on problems elsewhere in the body.
What are the signs of coxa vara or coxa valga?
The signs depend on how far the angle sits from normal and which direction it leans. Many people have a mildly unusual angle and feel nothing at all. Larger variations tend to produce more noticeable effects.
The hip muscles lose their mechanical advantage. You may notice a Trendelenburg-type dip, where the pelvis drops on the opposite side during walking.
A steeper neck (vara) can shorten the leg on that side. A flatter neck (valga) can lengthen it. This may contribute to leg length discrepancy.
Abnormal loading through the joint surface can cause deep aching around the hip or groin, particularly after long walks or standing.
Your body adapts. You may feel pain in your knee, lower back, or opposite hip rather than the hip that is structurally different.
What causes coxa vara or coxa valga in adults?
In adults, an abnormal neck-shaft angle usually has one of these origins. Sometimes more than one factor combines.
The angle may have been set during bone growth and simply carried into adulthood without symptoms until wear builds up.
A healed fracture of the femoral neck or shaft can leave the angle permanently altered, especially if the bone healed in a shifted position.
Conditions such as osteomalacia, Paget's disease, or avascular necrosis can soften or reshape bone, gradually changing the angle.
After hip surgery or implant placement, the effective angle can shift. Accurate measurement helps guide any revision planning.
How is hip geometry measured when you are standing up?
It is measured with a standing, weight-bearing X-ray that captures the full length of both legs on a single image. This shows the true neck-shaft angle under real loading conditions, not the relaxed position your bones settle into when you lie on a table.
A standing EOS scan captures both hips, both legs, your pelvis, and your spine in one low-dose image. Because you are upright, the image shows how your hip angle behaves under your body weight. The muscles, ligaments, and gravity all act naturally, so the measurement reflects how your body actually works.
ScanAlign standing EOS imaging uses about 90% less radiation than a standard X-ray, around ten times less. The full-length view also reveals whether one leg is effectively longer or shorter, and whether your pelvis or spine is compensating for the hip angle.
A conventional X-ray or CT taken while you lie down removes gravity and muscle tension from the picture. The angle measured on a lying-down image can differ from the standing one because the joint is not loaded. This may understate the real effect of coxa vara or coxa valga on your alignment.
Lying-down imaging is still useful in some situations, for example immediately after a fracture or during surgery. But for understanding how your hip works day to day, a weight-bearing image gives a more complete answer.
When is MRI the better tool? EOS shows bones, joints, and alignment. If your clinician suspects soft-tissue damage, labral tears, or nerve problems around the hip, MRI is usually the better choice. The two types of imaging complement each other.
What helps if you have coxa vara or coxa valga?
The right approach depends on how far the angle is from normal, what symptoms you have, and what else is happening in your alignment. ScanAlign is a diagnostic imaging clinic, not a treatment provider. Our role is to give you and your clinician the measurements needed to make clear, informed decisions.
Accurate standing measurements matter because they help your clinician:
- Confirm whether the angle is genuinely abnormal or within normal variation.
- See whether your pelvis, spine, or opposite hip is compensating.
- Plan any corrective procedure, including implant selection, with precise geometry.
- Track changes over time by comparing like-for-like standing images.
If you want to understand your hip geometry under real weight-bearing conditions, you can book a standing hip scan or start with a free video consultation to discuss whether it is the right step for you.
Book a free video consultationFrequently asked questions
Coxa vara means the angle between the neck and shaft of your thighbone is smaller than normal. This makes the neck point more steeply downward, which can shorten the leg on that side and change how forces travel through the hip joint.
Coxa valga is the opposite. The neck-shaft angle is larger than normal, so the femoral neck sits more horizontally. This can make the leg slightly longer and alter the leverage of the muscles around the hip.
In a typical adult, the neck-shaft angle falls between about 125 and 135 degrees. It varies between individuals and can change with age or bone conditions.
Yes. A steeper angle (vara) can functionally shorten the leg, while a flatter angle (valga) can lengthen it. This is one of the more common reasons these conditions cause symptoms.
It can. When the angle is significantly reduced, the hip abductor muscles lose mechanical advantage. This can produce a Trendelenburg gait, a distinctive dip of the pelvis on the opposite side during each step.
When you lie down, gravity and muscle relaxation change the position of your bones. A standing image shows the angle under your actual body weight, which is closer to how your hip works during daily activities like walking and standing.
Yes. An EOS scan uses about 90% less radiation than a standard X-ray, around ten times less. It is a quick, non-invasive scan where you simply stand still for a few seconds.
No. ScanAlign accepts self-referrals. You can book directly or start with a free video consultation to discuss whether a scan is the right step for you.
Pricing details are available on our FAQs page. You can also ask about costs during your free video consultation.
Yes. The neck-shaft angle directly influences which implant size and design will restore normal mechanics. Surgeons use accurate angle measurements to choose the right components and plan the correct positioning.
Understand your hip alignment
A standing scan shows your hip geometry under real weight-bearing conditions. Start with a free video consultation to find out if it is the right step for you.
Book a free video consultationWritten by Abbas Dhami (Specialist Diagnostic Radiographer)
Sources
- Boese CK, et al. "The femoral neck-shaft angle on plain radiographs: a systematic review." Skeletal Radiology, 2016; 45(1):19-28.
- NHS. "Hip pain in adults." NHS.uk, accessed 2024.
- Deschênes S, et al. "Diagnostic imaging of spinal deformities: reducing patients' radiation dose with a new slot-scanning X-ray imager." Spine, 2010; 35(9):989-994.
This page is general information and not a diagnosis.
ScanAlign is the trading name of CoreMed Solutions Ltd and operates under The Harley Street Hospital's CQC licence.