The Journal of Bone and Joint Surgery. British volumeVol. 82-B, No. 6 HipFree AccessThe calcar femorale in cemented stem fixation in total hip arthroplastyB. M. Wroblewski, P. D. Siney, P. A. Fleming, P. BobakB. M. WroblewskiProfessor of Orthopaedic Biomechanics, Consultant Orthopaedic SurgeonSearch for more papers by this author, P. D. SineySenior Research FellowSearch for more papers by this author, P. A. FlemingResearch AssistantSearch for more papers by this author, P. BobakSenior Clinical FellowSearch for more papers by this authorPublished Online:1 Aug 2000https://doi.org/10.1302/0301-620X.82B6.0820842AboutSectionsPDF/EPUB ToolsAdd to FavouritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InRedditEmail AbstractThe calcar femorale is a vertical plate of bone lying deep to the lesser trochanter and is formed as a result of traction of the iliopsoas which separates the femoral cortex into two distinct layers, the calcar femorale and the medial femoral cortex. They fuse together proximally to form the medial femoral neck. A stem placed centrally will abut against the calcar femorale with little or no space for cement. Clearing of the calcar will offer space for a cement layer, which will support the stem proximally on the posterior aspect. We compared two consecutive groups of Charnley low-friction arthroplasties, with and without clearing of the calcar.In 330 patients who had an arthroplasty without clearing the calcar, there were ten revisions for aseptic loosening of the stem and six other stems were considered ‘definitely loose’, giving a rate of failure of 4.8%. In 111 patients in whom the calcar was cleared there was only one revision for aseptic loosening and no stems were classed as ‘definitely loose’, giving a rate of failure of 0.9%.Survivorship analysis has again shown the need for long-term follow-up; the differences became clear after ten years but because of the relatively small numbers, statistical analysis is not yet applicable.We now clear the calcar femorale routinely and advocate optimal access to the medullary canal and insertion of the stem in the area of the piriform fossa.FiguresReferencesRelatedDetailsCited byCalcar femorale variation in extant and fossil hominids: Implications for identifying bipedal locomotion in fossil homininsJournal of Human Evolution, Vol. 167Strategies for managing the destruction of calcar femorale19 May 2021 | BMC Musculoskeletal Disorders, Vol. 22, No. 1Achievement of optimal implant alignment using taper wedge stems with cup-first THA through the MIS antero-lateral approach7 July 2020 | European Journal of Orthopaedic Surgery & Traumatology, Vol. 30, No. 8ReferencesThe design features of cemented femoral hip implantsT. Scheerlinck, P.-P. Casteleyn1 November 2006 | The Journal of Bone and Joint Surgery. British volume, Vol. 88-B, No. 11The premature failure of the Charnley Elite-Plus stemB. M. WROBLEWSKI1 June 2006 | The Journal of Bone and Joint Surgery. British volume, Vol. 88-B, No. 6Medium-term results of the Charnley low-offset femoral stemA. Ebied, D. A. Hoad-Reddick, V. Raut1 July 2005 | The Journal of Bone and Joint Surgery. British volume, Vol. 87-B, No. 7Ten-year survival of the MS-30 matt-surfaced cemented stemB. J. Berli, D. Schäfer, E. W. Morscher1 July 2005 | The Journal of Bone and Joint Surgery. British volume, Vol. 87-B, No. 7Outcome with the MS-30 Stem Vol. 82-B, No. 6 Metrics History Published online 1 August 2000 Published in print 1 August 2000 InformationCopyright © 2000, The British Editorial Society of Bone and Joint Surgery: All rights reservedPDF download