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Femoral Anteversion vs. Retroversion: Their Differences, Causes, and Treatment Options
Femoral Anteversion vs. Retroversion: Their Differences, Causes, and Treatment Options

In a previous blog, we’ve talked about how the unique ball-and-socket structure of the hip joint helps bear your weight, stand, and move around without a problem. However, it’s worth stressing that this is only possible if the femur is correctly aligned to the hip. 

When the thighbone and the knees are abnormally rotated relative to the body’s midline, you may have problems walking, running, or balancing yourself. You may even experience pain in the lower back or hip. These conditions can either be an anteversion or retroversion of the hip. 

Femoral Anteversion or Anteversion of the Hip

In anatomy, “version” refers to a condition in which an organ is turned from its normal position. Added with the prefix “ante,” the anteversion of the hip refers to a developmental abnormality wherein the thighbone and knee are excessively turned inward.

Femoral Retroversion or Retroversion of the Hip 

Also known as hip retroversion, femoral retroversion is the opposite of femoral anteversion. In this case, the femur and knee are twisted outward relative to the hip. This condition is not as common as femoral anteversion, but it still affects many children. 

Femoral Anteversion Vs. Retroversion 

The normal femoral anteversion in adults ranges from 15 to 20 degrees. With an excessively anteverted femur, the thigh bone's angle goes way above the average range and results in the inward-turning of the knees and feet.  

Usually, children are born with as much as 40 degrees of femoral anteversion. Their intrauterine positioning usually causes this torsional malalignment, but it gradually improves as they grow. 

On the other hand, femoral retroversion happens when the femoral neck angle is less than normal. Here, the thighbone is turned opposite, so the feet point outward rather than straight ahead. 

The anteversion and retroversion of the hip are often congenital conditions, and they appear to be related to how the baby is positioned while it is growing in the womb. The good news is that this torsional deformity usually decreases to around 15 degrees as the child grows, so no treatment may be necessary. 

Symptoms of Femoral Anteversion Vs. Retroversion

It can be tricky to distinguish femoral anteversion vs. retroversion, especially if there are other rotation deformities aside from the torsional malalignment. With this said, there are signs and symptoms you can watch out for: 

Symptoms of femoral anteversion often include: 

  • In-toeing or pigeon-toed walking 
  • Bowed legs 
  • Running with legs swinging out 
  • Tripping and falling often 

On the other hand, symptoms of femoral retroversion include: 

  • Out-toeing or duck-footed gait 
  • Flat feet 
  • Difficulty with running 
  • Poor balance or coordination 

While both femoral anteversion and retroversion do not always cause discomfort, they can eventually bring about pain in the lower back, hip, and knee. And if left untreated into adolescence, these abnormal femoral rotations can also contribute to the degeneration or arthritis of the hip. 

Causes of the Anteversion and Retroversion of the Hip

As mentioned earlier, the anteversion and retroversion of the hip conditions are often present at birth. Their exact cause remains unknown, but they appear to be influenced by the baby’s position while inside the womb. They also seem to be related to genetic factors, so some children may be more likely to be born with these deformities. 

With that said, femoral anteversion or retroversion can also occur from physical trauma, like sports injuries. A bone healing incorrectly from a fracture can lead to torsional deformities. 

If femoral anteversion or retroversion is suspected, a physician will do a physical examination of the legs and hips, observing the patient’s gait and watching out for the signs listed above. They may also request an x-ray or CT scan to diagnose the deformity properly. 

Treating the Anteversion and Retroversion of the Hip 

While these torsional deformities are often congenital, the good news is that they resolve on their own as children grow. Those born with femoral anteversion or retroversion generally walk normally once they reach 8 to 10 years of age without any intervention. 

However, it’s best to seek professional medical advice if the anteversion or retroversion persists or starts to impede walking or running. Your orthopedic specialist may recommend a surgical procedure called femoral osteotomy to correct the deformity. 

Here, the femoral head and neck are cut and repositioned inside the hip socket. In some cases, the hip socket may also be reshaped to hold the femoral head better. The repositioned femur is stabilized by metal plates and screws that hold it until it has healed. 

Femoral osteotomies are usually major and extensive procedures, so they often entail long recovery times. With that said, most patients who undergo this surgery are able to recover and return to their daily lives without serious complications. 

On top of this, innovations in orthopedic surgery make it possible to treat torsional malalignments through minimally invasive procedures, like hip arthroscopy. An arthroscopic procedure only involves making a small incision and using a camera to view inside the hip joint and make the necessary repairs. 

As this is an outpatient procedure, patients experience fairly minimal pain and can go home the same day. In addition, patients can return to work within 2-3 days after the surgery, while athletes can return to their sports activities between 3-6 months. 

Let the Experts Help You Get Back on Your Feet, Run, and Play to Your Heart’s Content

If the signs and symptoms of femoral anteversion or retroversion persist and start to impact your daily activities, don’t lose hope. There are various options available to treat these conditions, and experienced and trusted experts such as Dr. Benjamin Domb are ready to help you on the treatment journey. 

As an orthopedic surgeon specializing in hip arthroscopy and sports medicine, Dr. Domb has cared for numerous professionals and elite-level athletes. He has also performed countless hip arthroscopy surgeries on patients across the country traveling to Chicago. But most importantly, he and his staff care for every patient like a professional athlete. 


If you want to learn more about how arthroscopic surgeries or sports medicine can help your unique pain or injury, don’t hesitate to book an appointment today. We’ll be glad to discuss your options with you — and change your life for the better!