Does the calcar femorale affect the position of uncemented short stems?

IF 1.3 4区 医学 Q3 ORTHOPEDICS
HIP International Pub Date : 2024-11-01 Epub Date: 2024-09-16 DOI:10.1177/11207000241277687
Jan Weidner, Michael Wyatt, Martin Beck
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引用次数: 0

Abstract

Background and purpose: Metaphyseal-stabilised short stems rely on sufficient metaphyseal fixation and are inserted by following the medial cortex. This type of stem is used extensively in our institution, and we observed on occasion unintended implant positioning with an increased distance between the implant and the medial cortex. A bony structure within the proximal femur which was first described in 1874 and named the calcar femorale, coincides with this phenomenon.The aim of this study was to investigate the impact of the calcar femorale on the position of a metaphyseal-stabilised short stem.

Patients and methods: The frequency of cases with an increased distance between medial cortex and the implanted short stem was analysed in 52 consecutive patients. Additionally, we performed an anatomical CT study with 60 cadaveric femora to obtain more detailed information on the anatomy of the calcar femorale. Detailed measurements regarding the calcar femorale and its relationship to the proximal femur were obtained. From this, we derived implications for the implantation of a short stem prosthesis.

Results: In 50% of all cases, we found an increased gap between the stem and the medial cortex. An increased gap did not significantly affect stem size, position, or subsidence rate, but in cases with an increased gap we found fewer stems with a radiologically optimum fit. The calcar could be identified in all 60 cadavers. The calcar femorale angle showed a high correlation with the mechanical antetorsion (0.87, p = 0.02) and the functional antetorsion (0.86, p = 0.05) of the femur.

Conclusions: The calcar femorale is a consistent anatomical structure which may be the cause for an increased gap medial to the short stem in 50% of our cases. It limits the intramedullary space and influences both stem size and orientation. The CF angle which correlates with femoral antetorsion may influence the anteversion of the stem.

股骨髁是否会影响非骨水泥短茎的位置?
背景和目的:骺端稳定短茎依靠足够的骺端固定,并沿着内侧皮质插入。在我们的机构中,这种短茎被广泛使用,我们有时会观察到植入物与内侧皮质之间的距离增大时,植入物会出现意外定位。股骨近端有一个骨性结构,于1874年首次被描述并命名为股骨钙质,与这一现象不谋而合。这项研究的目的是调查股骨钙质对骨骺稳定短柄定位的影响:我们分析了52名连续患者中内侧皮质与植入短茎之间距离增加的病例频率。此外,我们还对60例尸体股骨进行了CT解剖研究,以获得更多有关股骨钙质解剖的详细信息。我们获得了有关股骨小头及其与股骨近端关系的详细测量数据。由此,我们得出了植入短柄假体的意义:结果:在50%的病例中,我们发现假体柄与内侧皮质之间的间隙增大。间隙增大对柄的大小、位置或下沉率没有明显影响,但在间隙增大的病例中,我们发现放射学上最合适的柄较少。在所有60具尸体中,我们都能找到股骨颈。股骨小腿角与股骨的机械性反扭转(0.87,P = 0.02)和功能性反扭转(0.86,P = 0.05)高度相关:在我们的病例中,有50%的病例可能是由于股骨小头的解剖结构导致短柄内侧间隙增大。它限制了髓内空间,并影响骨干的大小和方向。与股骨反转相关的CF角可能会影响骨干的反转。
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来源期刊
HIP International
HIP International 医学-整形外科
CiteScore
4.20
自引率
0.00%
发文量
70
审稿时长
2 months
期刊介绍: HIP International is the official journal of the European Hip Society. It is the only international, peer-reviewed, bi-monthly journal dedicated to diseases of the hip. HIP International considers contributions relating to hip surgery, traumatology of the hip, prosthetic surgery, biomechanics, and basic sciences relating to the hip. HIP International invites reviews from leading specialists with the aim of informing its readers of current evidence-based best practice. The journal also publishes supplements containing proceedings of symposia, special meetings or articles of special educational merit. HIP International is divided into six independent sections led by editors of the highest scientific merit. These sections are: • Biomaterials • Biomechanics • Conservative Hip Surgery • Paediatrics • Primary and Revision Hip Arthroplasty • Traumatology
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