Clin Orthop Surg.  2017 Dec;9(4):413-419. 10.4055/cios.2017.9.4.413.

Calcar Femorale in Patients with Osteoarthritis of the Hip Secondary to Developmental Dysplasia

• Tetsunaga
• Fujiwara K
• Endo H
• Tetsunaga
• Shiota N
• Sato T
• Ozaki T

• KMID: 2412241
• DOI: http://doi.org/10.4055/cios.2017.9.4.413

Abstract

BACKGROUND
We investigated whether the calcar femorale, a cortical septum in the region of the lesser trochanter of the femur, correlates with results of femoral stem implantation in patients with osteoarthritis of the hip secondary to developmental dysplasia using computed tomography.
METHODS
This retrospective study included 277 hips (41 males and 236 females; age, 37 to 92 years) of patients who had presented to Okayama Medical Center with hip pain. Of these, a total of 219 hips (31 males and 188 females) had previously undergone total hip arthroplasty. According to the Crowe classification, 147 hips were classified as Crowe grade I, 72 hips as Crowe grade II-IV, and 58 hips as normal.
RESULTS
The calcar femorale was identified in 267 hips (96.4%). The calcar femorale was significantly shorter and more anteverted in Crowe grade II-IV hips than in Crowe grade I or normal hips. Significant differences in the shape of the calcar femorale were found according to the severity of hip deformity. Three stem designs were analyzed: single-wedge (59 hips), double-wedge metaphyseal filling (147 hips), and modular (13 hips). Single-wedge stems were inserted more parallel to the calcar femorale rather than femoral neck anteversion, while other types of stems scraped the calcar femorale.
CONCLUSIONS
The angle of the calcar femorale differs according to the severity of hip deformity, and the calcar femorale might thus serve as a more useful reference for stem insertion than femoral neck anteversion in total hip arthroplasty using a single-wedge stem.

Keyword

Femoral neck; Hip dislocation; Total hip replacement

MeSH Terms

Adult
Aged
Aged, 80 and over
Arthroplasty, Replacement, Hip/instrumentation/*methods
Female
Femur/*anatomy & histology/diagnostic imaging
Hip Dislocation, Congenital/*complications
Hip Prosthesis
Humans
Male
Middle Aged
Osteoarthritis, Hip/*etiology/surgery
Retrospective Studies
Tomography, X-Ray Computed

Figure

• 

  Fig. 1 Different types of calcar femorale in three different individuals: ridge type (A), spur type (B), and septum type (C). (D) Length of the calcar femorale was measured from the axial computed tomography section, and the calcar femorale angle was measured with reference to the posterior condylar axis (G). (E) Anteversion of the femoral neck was defined as the angle between the neck axis at the level just below the head and the posterior condylar axis (G). (F) Stem anteversion was defined as the angle between the stem axis and the posterior condylar axis (G).

• 

  Fig. 2 Contact location between the calcar femorale and the stem. Contact locations were divided into six types using axial computed tomography cuts at the level of maximum length of the calcar femorale: dorsal (A), dorso-medial (B), medial (C), ventro-medial (D), ventral (E), and no contact (F).

• 

  Fig. 3 Different types of calcar femorale. A calcar femorale was observed in all normal hips. In Crowe II–IV, the most common type of calcar femorale was ridge type. Values are presented as number of hips (%).

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  Fig. 4 Length of the calcar femorale (A) and difference between calcar femorale angle and femoral neck anteversion (B) measured on computed tomography scans. *p < 0.05.

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  Fig. 5 Contact between the calcar femorale and the three types of stems assessed on axial computed tomography sections. In most cases, a single-wedge stem was inserted in contact with the calcar femorale, while other types of stems scraped the calcar femorale. Values are presented as number of hips (%). Group T: single-wedge stem, Group S: double-wedge metaphyseal filling stem, Group A: modular stem.

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