An 80-year-old male with a recent history of a right IT femur fracture treated with short CMN 20 days prior presented to the emergency department with right hip pain. The pain began 2 days prior after twisting his right hip during a physical therapy session and gradually progressed to an inability to bear weight on the right lower extremity. The patient’s medical history was significant for coronary artery disease, atrial fibrillation for which he was on anticoagulation, cirrhosis, and hypertension. Before his hip fracture, he lived independently and volunteered at his local fire department. Physical examination revealed well-healed surgical scars on the right lateral hip and thigh, a shortened right lower extremity, and pain with passive range of motion in all planes. His neurovascular examination was normal. Inflammatory laboratory results were significant for an erythrocyte sedimentation rate of 72 mm/h, and C-reactive protein of 118 mg/L, and a white blood cell count of 6.8 × 109/L. Plain radiographs demonstrated a right IT femur fracture status post-CMN with a superior cut out of the cephalomedullary screw from the femoral head with erosion into the right acetabulum (). After internal medicine consultation and pre-operative risk assessment, the patient was consented for removal of hardware and right THA. A standard posterior approach was utilized for the procedure. The cephalomedullary nail was removed with minimal bone loss. Following nail removal, the hip was dislocated, and the femoral neck was recut with an oscillating saw and an osteotome. The femoral head was removed and reserved. The acetabulum, femur, and the femoral canal were then prepared to accept THA cup and stem. A DePuy summit femoral stem was then placed into the prepared canal and gently impacted until it was almost fully seated. There was no visible medial cortex of the proximal femur. An attempt was made to retrieve the lesser trochanter, but it was not possible to mobilize safely. Thus, a new calcar was fashioned manually from the previously removed femoral head using an oscillating saw. This graft is useful as it preserves the remaining bone stock of the patient and provides native bone that should allow for some healing and integration resulting in better stability. The graft harvest technique was similar to that reported by Thakkar et al. 2015 []. The newly fashioned calcar replacement was secured in place with a proximal and distal cerclage wire () with the new calcar secured the implant was then fully impacted. The femoral head was impacted onto the taper, the prosthesis was located and we were pleased with the stability and leg length. Following closure, the patient was transferred to the recovery room in stable condition. The patient tolerated the procedure without perioperative complications. Immediate post-operative radiographs demonstrated well seated and located right hip prosthesis with new calcar construction secured with cerclage wires and retained lesser trochanter fragment (). The patient was made weight-bearing as tolerated with a walker and instructed to avoid active abduction and to take anterolateral precautions. He was discharged on post-operative day 3 and was instructed to follow-up 3 weeks later for plain radiographs and a wound check. At the 3-week follow-up, radiographs demonstrated no interval changes in implant alignment (). He was managing pain adequately with Tylenol and reported a VAS score of 5. At 3 months postoperatively, he endorsed minimal hip pain and transitioned to outpatient physical therapy. One year postoperatively, radiographs demonstrated a right THA and cerclage wires in a stable and unchanged position, with complete healing of the femoral head to the calcar (). He had no acute complaints from his right hip at that time. At his 2-year follow-up, his radiographs were stable () and he was clinically doing well. Patient-reported outcomes were recorded at the 2-year follow-up, including SF-12 Physical Health score of 47.58, HOOS-Pain score of 72.50, HOOS – Sports and Recreational Activities score of 68.75, and HOOS, JR score of 67.52 (). He remains an independent ambulator and has returned to serving as a volunteer firefighter.