Technical modifications for the Wagner SL hip arthroplasty. Short oblique osteotomy of the proximal 1/3 of the femur

Abstract

Summary: 58 Wagner prostheses wereimplanted between 1989 and 1996. This was done through a simplified technique without trochanteric osteotomy or grafting. The Wagner transfemoral approach was only used once. The other operations were done through the Moore approach. Classical windows were not used since we feel they give a poor view and predispose to later fractures. We distinguished between the simple cases using the intra-medullary route with image intensifier control, and the difficult cases where the short oblique subtrochanteric osteotomy was used. This manõuvre was the simplest way of removing the cement and the prosthesis and of inserting a Wagner prosthesis of ~65 mm or longer which also requires a diaphyseal osteotomy to prevent cortical splitting. The Wagner transfemoral route is only needed for removal of uncemented prostheses. Infection is a good indication for this technique where a one stage revision is planned. This technique, like the pure intra-medullary route is derived from the principles of closed intra-medullary nailing.

Tricortical Bone Grafts for Treatment of Malaligned Tibias and Fibulas

“…Sixteen patients (94%) achieved healing after one surgery, and one patient achieved union after a second surgery. Some authors have reported the use of osteotomies with or without insertion of a tricortical iliac crest bone graft for treating malunions and nonunions of the lower extremity and ankle osteoarthritis [4,9,[11][12][13][14][16][17][18]. In these reports, this technique was used for ankle fusions after failed total ankle arthroplasty, tibia-fibula malunions, and for bone block fusions of the foot and ankle.…”

“…Surgical realignment presumably restores normal joint reaction forces and corrects the mechanical axis of the limb. Techniques used to correct long bone malunions and malaligned nonunions include oblique or closing or opening wedge osteotomy, dome osteotomy, corticotomy, distraction osteogenesis, and tricortical bone grafts [2,5,9,[11][12][13][14][16][17][18].…”

“…This technique is particularly useful for treatment of malunions and malaligned nonunions of the distal tibia and fibula, in which other techniques would be difficult or ineffective. The major disadvantages include the requirement for harvesting bone at a distant site and creating two separate healing surfaces at the site of deformity correction [1,3,4,12,13,17,18].…”