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The Journal of Bone and Joint Surgery (American) 83:1023-1031 (2001)
© 2001 The Journal of Bone and Joint Surgery, Inc.

Femoral Revision with the Wagner SL Revision Stem

Evaluation of One Hundred and Twenty-nine Revisions Followed for a Mean of 4.8 Years

Paul Böhm, MD and Oliver Bischel, MD

Investigation performed at the Department of Orthopedic Surgery, Eberhard-Karls-Universität Tübingen, Tübingen, Germany
Paul Böhm, MD
Oliver Bischel, MD
Orthopädische Universitätsklinik, Eberhard-Karls-Universität Tübingen, Hoppe-Seyler-Strasse 3, 72076 Tübingen, Germany. E-mail address for P. Böhm: paul.boehm{at}med.uni-tuebingen.de

Although none of the authors has received or will receive benefits for personal or professional use from a commercial party related directly or indirectly to the subject of this article, benefits have been or will be received, but are directed solely to a research fund, foundation, educational institution, or other nonprofit organization with which one or more of the authors is associated. No funds were received in support of this study.

Background: It is difficult to achieve a successful revision total hip replacement when a patient has severe proximal femoral bone loss. The Wagner SL revision stem has some theoretical advantages, but the durability of this prosthesis is not known.

Methods: We reviewed the results of 129 revisions of the femoral component with a Wagner SL revision stem in 123 patients. The indication for revision was aseptic loosening in ninety-seven hips, periprosthetic fracture in thirteen (one of which also had an infection), and septic loosening in sixteen. In the three remaining hips, a Wagner revision stem was inserted during a second-stage reimplantation after the performance of a Girdlestone resection arthroplasty to treat chronic deep infection. The prerevision defects were classified with the system described by Pak et al. as well as with our system. A functional evaluation of the patients and a survival analysis of the revision stems were performed.

Results: The mean duration of follow-up was 4.8 years (range, two months to 11.1 years). Six revision stems required repeat revision. With removal of the stem for any cause or the worst case (removal of the stem for any cause and/or lost to follow-up) as the end point, cumulative survival at 11.1 years was 93.9% and 92.8%, respectively. The mean Merle d’Aubigné score improved from 7.7 points preoperatively to 14.8 points at the latest follow-up examination. The most recent radiographs showed good or excellent restoration of the proximal part of the femur in 113 hips (88%).

Conclusions: Because of the encouraging results of implantation of this femoral component with distal fixation, we will continue to use it in the majority of femoral revisions. However, the need for regular follow-up remains, since the rate of complications such as osteolysis of the femur, aseptic loosening, periprosthetic fracture, and late infection may increase in the future.


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