Hip Anteversion and Retroversion: What Are They and Could They Be Causing Your Pain?
Hip anteversion means the top of the thigh bone (femur) or the hip socket angles too far forward. Hip retroversion means it angles too far back. Both change the way your leg sits and moves. This can cause hip, knee or lower back pain, especially when your body is upright and carrying your weight.
Key takeaways
- Anteversion and retroversion describe the twist angle of the femur or the hip socket.
- They often show up as in-toeing (feet turning in) or out-toeing (feet turning out) when you walk.
- Pain may appear in the hip, knee or back because the rest of the body compensates.
- Scans done lying down can miss these alignment problems, because gravity and muscle tension are taken away.
- A standing whole-body EOS scan shows how the hip angle affects your whole chain of alignment.
What is hip anteversion and retroversion?
Hip anteversion is a twist in the femur or the acetabulum (hip socket) that makes the joint point further forward than normal. Hip retroversion is the opposite: the joint points further backward. Everyone has a natural angle of twist. Problems start when that angle sits outside the usual range and begins to affect how you stand, walk and spread your weight.
The twist can be in the femur itself (femoral anteversion or femoral retroversion) or in the socket it sits in (acetabular retroversion or anteversion). Sometimes both are affected at the same time.
Think of the femur as a key in a lock. If the key is slightly twisted, it still fits, but it does not turn smoothly. Over time the joint may pinch (impingement) on one side or sit too loosely on the other. This leads to cartilage wear and pain.
What are the signs of femoral anteversion or retroversion?
The signs depend on which way the twist goes. Many people have lived with these patterns all their lives without knowing there is a structural reason behind them.
Feet that naturally point inward (anteversion) or outward (retroversion) when you stand or walk.
A deep ache in the front of the hip or groin, often worse after long walks or sitting cross-legged.
The twist higher up changes how your kneecap tracks. This causes pain that scans of the knee alone may not explain.
Your pelvis tilts to make up for the hip angle, which can overload the lower spine.
If you notice any mix of in-toeing and out-toeing with hip, knee or back discomfort, the cause may sit in the angle of your femur or socket, not in the place where you feel the pain.
What causes hip anteversion or retroversion in adults?
In most adults, femoral anteversion or retroversion is a structural trait that developed during growth. The femur slowly twists into its final position through childhood and the teenage years. Sometimes that process leaves more or less twist than average.
The twist angle is set during growth and stays into adulthood.
The socket itself may face too far forward or backward, separately from the femur.
Years of compensating for the twist can lead to cartilage wear and early joint changes.
Because these patterns are structural, they tend to be long-standing. You may have been told your hip "looks normal" on a standard X-ray taken while lying down. That is because the twist is best seen when you are standing and your muscles are working to hold you upright.
How is hip version assessed with a standing EOS scan?
A standing EOS scan captures your whole skeleton, from head to feet, in one upright image. This is the key difference. When you lie down for a standard X-ray, CT scan or MRI, gravity is taken away and your muscles relax. That can hide the true angle of the hip and the knock-on effects it has further up or down the body.
With EOS, your clinician can see how the hip twist affects your knee alignment, pelvic tilt, spine curve and even how your weight is spread across both legs. Because it captures the full picture in one scan, it removes the guesswork of putting together separate images of separate body parts.
EOS also uses about 90% less radiation than a standard X-ray, around ten times less. That makes it a practical choice when a full standing assessment is needed.
Wondering if your hip angle could be behind your symptoms? A standing EOS scan shows the full picture.
Book a free video consultationWhat can be done about hip anteversion or retroversion?
The first step is getting an accurate picture of how far the twist goes and how it affects the rest of your body. Without that information, treatment often targets the wrong area.
Once the alignment picture is clear, your treating clinician (orthopaedic surgeon, physiotherapist or sports medicine specialist) can tailor a plan. Options might include targeted physiotherapy to strengthen the muscles around the hip, gait retraining, or in more significant cases, surgical correction. ScanAlign provides the diagnostic imaging that guides those decisions. It does not provide treatment itself.
When MRI is the better tool: EOS is excellent at showing bone position, joint angles and whole-body alignment. If your clinician suspects a labral tear, cartilage damage or soft-tissue injury inside the hip, MRI is usually the better choice for those specific details. The two scans work well together.
Your body is a connected chain from your feet to your head. A twist at the hip can tilt the pelvis, curve the spine and change how your knees track. Treating only the painful area without understanding the alignment pattern underneath often means the problem keeps coming back. A whole-body standing image helps make sure the full picture is considered from the start.
Before you start a treatment, or change the one you are on, it is worth getting a detailed diagnosis. Knowing whether the cause sits in your pelvis, your legs or your spine changes what will actually help.
Frequently asked questions about hip anteversion and retroversion
They are closely linked. Femoral anteversion refers only to the twist in the thigh bone. Hip anteversion is a broader term that can also include the angle of the socket (acetabular anteversion). Both affect how the joint sits and moves.
Yes. Acetabular retroversion in particular can make the front of the socket pinch against the femoral head during movement. This is a form of hip impingement. It often shows up as groin pain or deep pain in the front of the hip, especially with bending or sitting for long periods.
In-toeing is one of the most common signs of femoral anteversion. But it can also come from tibial torsion (a twist in the shin bone) or from the structure of the foot. A standing whole-body scan helps find where in the chain the twist starts.
A single X-ray taken lying down gives limited information about the twist angle. The version of the femur is a three-dimensional measurement. It is much better captured with imaging that includes standing weight-bearing views or cross-sectional techniques.
EOS captures a full standing image of your skeleton in one go. This lets your clinician see how the hip twist affects your leg rotation, knee alignment, pelvic tilt and spine. It shows your real-world alignment under gravity, which scans done lying down can miss.
Yes. EOS uses about 90% less radiation than a standard X-ray, around ten times less. You can find more about safety and what to expect on our FAQs page.
No. ScanAlign is a private self-pay clinic and you can refer yourself. You start with a free video consultation, where a specialist radiographer reviews your history and confirms whether a scan is right for you.
The price for patients travelling from abroad is confirmed during the free video consultation, and you can read more on our FAQs and cost page.
It can. When the femur is twisted inward more than usual, the kneecap may track differently. This puts extra stress on the front of the knee. It is why knee pain sometimes continues even after tests focused on the knee come back normal.
The twist angle is mostly set by the time you finish growing. However, the symptoms it causes often become noticeable later in life, as joint wear progresses or activity levels change. Previous hip surgery can also change the version angle.
See how your hip alignment affects your whole body
A standing EOS scan at ScanAlign, 19 Harley Street, London, shows bones, joints and alignment from head to feet, all in one image. Start with a free video consultation from home.
Book a free video consultationLearn more about hip alignment and EOS imaging, or see how EOS works on our main EOS scan page.
Author: Abbas Dhami (Specialist Diagnostic Radiographer)
Sources
- Tönnis D, Heinecke A. Acetabular and femoral anteversion: relationship with osteoarthritis of the hip. Journal of Bone and Joint Surgery (American). 1999;81(12):1747-1770.
- Reynolds D, Lucas J, Klaue K. Retroversion of the acetabulum: a cause of hip pain. Journal of Bone and Joint Surgery (British). 1999;81(2):281-288.
- NHS. Hip pain in adults: causes and when to get help. nhs.uk. Available at: https://www.nhs.uk/conditions/hip-pain/
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.