CCD Angle – Definition, Normal Values & Relevance
The CCD angle (centrum-collum-diaphyseal angle) measures the angle between the femoral neck and the femoral shaft. It is a key reference value in orthopedic diagnostics.
Things worth knowing about "CCD Angle"
The CCD angle (centrum-collum-diaphyseal angle) measures the angle between the femoral neck and the femoral shaft. It is a key reference value in orthopedic diagnostics.
What Is the CCD Angle?
The CCD angle (also known as the centrum-collum-diaphyseal angle) is an anatomical measurement taken at the proximal femur (the upper end of the thigh bone). It describes the angle formed between the axis of the femoral neck (collum femoris) and the longitudinal axis of the femoral shaft (diaphysis). This angle is a fundamental reference value in orthopedics and trauma surgery, as it significantly influences the geometry and biomechanics of the hip joint.
Normal Values of the CCD Angle
The CCD angle changes throughout life, starting larger in infancy and gradually decreasing as the skeleton matures:
- Newborns: approximately 150°
- Children (approx. 10 years): approximately 140°
- Adults: normal range between 120° and 135°, with an average of approximately 126°
Deviations outside this normal range are considered pathological and may lead to functional impairment of the hip joint as well as gait disturbances.
Pathological Deviations
Coxa Valga
When the CCD angle exceeds 135°, the condition is referred to as coxa valga. In this case, the femoral neck is more upright than normal. Potential consequences include increased load on the femoral head, altered hip biomechanics, and a higher risk of hip dislocation. Common causes include neuromuscular disorders and congenital malformations.
Coxa Vara
A CCD angle of less than 120° is called coxa vara. Here, the femoral neck is inclined more steeply toward the shaft. This can result in a characteristic limping gait (Trendelenburg gait), leg shortening, and reduced hip mobility. Causes may include rickets, bone disorders, fractures, or genetic factors.
Diagnosis and Measurement
The CCD angle is typically measured on an anteroposterior (AP) pelvic X-ray. The physician draws one line along the femoral neck axis and another along the femoral shaft axis. The angle formed at their intersection is the CCD angle. This measurement is a standard procedure in orthopedic diagnostics and is used in the following situations:
- Hip pain
- Gait disturbances or limping
- Suspected hip dysplasia
- Proximal femur injuries (e.g., femoral neck fracture)
- Pre-operative planning for hip surgery
Clinical Relevance
The CCD angle plays a critical role in surgical planning, particularly for total hip arthroplasty (THA). The selection of the appropriate prosthetic neck and the correct implantation angle are guided largely by the preoperatively measured CCD angle. In pediatric and adolescent orthopedic procedures -- such as corrective osteotomy (surgical bone realignment) -- the CCD angle is equally essential as a planning parameter. Accurate reconstruction of the angle aims to normalize hip biomechanics and prevent or delay the onset of osteoarthritis (joint degeneration) in the long term.
References
- Niethard, F. U., Pfeil, J., Biberthaler, P.: Dual Series Orthopedics and Trauma Surgery. 8th edition. Thieme Verlag, Stuttgart, 2017.
- Debrunner, A. M.: Orthopedics and Orthopedic Surgery. 4th edition. Huber Verlag, Bern, 2005.
- Canale, S. T., Beaty, J. H.: Campbell's Operative Orthopaedics. 13th edition. Elsevier, Philadelphia, 2017.
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