The Femoral Head Center Shifts in a Mediocaudal Direction During Aging

Tim A.E.J. Boymans*, Hidde D. Veldman, Philip C. Noble, Ide C. Heyligers, Bernd Grimm

*Corresponding author for this work

Research output: Contribution to journalArticleResearchpeer-review

9 Citations (Scopus)


Background Accurate reconstruction of hip joint biomechanics is the key stone in total hip arthroplasty. Although proximal femur morphology is known to vary with both age and gender, few studies investigated this in the very elderly (ie, ≥80 years). The purpose of this study was to compare basic morphological parameters describing the position of the femoral head between very elderly and middle-aged subjects. Methods Computed tomographic scans of the femur of 90 very elderly (mean 84 years, range 80-105 years) and 58 middle-aged subjects (mean 52 years, range 20-79 years) were made. After 3-dimensional reconstruction, the neck-shaft angle, femoral neck anteversion angle, femoral head height, femoral neck length, and mediolateral offset (ML-offset) were determined. Results The neck-shaft angle was on average 3.6° less in elderly males (125.9° ± 5.0°) than in middle-aged males (129.5° ± 5.1°) (P <.001). The femoral neck anteversion angle was not significantly different between both age and gender groups. The femoral head height was −12.3 mm in elderly females compared to −10.5 mm (Δ 17%) in elderly males (P =.284) and even −8.0 mm (Δ 54%) in middle-aged males. The ML-offset was 10% (4.1 mm) larger in elderly compared to middle-aged males (P <.001). Conclusion These findings suggest that the femoral neck and head shift in a relative varus position during aging. Femoral prostheses with increased ML-offset and a lower caput-collum-diaphyseal angle are needed to accommodate the morphology of the femur in the very elderly. Care must be taken not to lengthen the operated leg, particularly in very elderly females.

Original languageEnglish
Pages (from-to)581-586
Number of pages6
JournalJournal of Arthroplasty
Issue number2
Publication statusPublished - 1 Feb 2017
Externally publishedYes


  • femoral head height
  • femur morphology
  • mediolateral offset
  • neck-shaft angle
  • total hip arthroplasty
  • very elderly


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