Use of Wagner Cementless Self-Locking Stems for Massive Bone Loss in Hip Arthroplasty

Abstract

Implantation of a Wagner cementless self-locking revision stem provided satisfactory results for 82% of patients. Hence, in some difficult conditions, this device is a good choice of management.

Femoral revision with the Wagner tapered stem

“…8,9 Subsequent studies reported comparable signs of femoral reconstruction, with survival rates of > 90% after five to ten years (Table II). [10][11][12][13][14][15][16][17]20,[34][35][36][37][38][39] New bone formation is promoted by numerous factors, including a low modulus of elasticity and mechanical stability, careful removal of peri-prosthetic cement and granulation tissue, and the use of a trochanteric osteotomy. 10,[14][15][16] In difficult cases, the transfemoral approach helps gain access to the femur for easier removal of the component and retained cement, creating a fracture-like situation in the proximal femur while keeping the fragments well vascularised to stimulate healing.…”

“…Our results are the same as those in other series. 10,12,[15][16][17]20,[34][35][36][40][41][42][43][44][45] The clinical results could be open to question, because at the latest examination only 18 patients obtained an HHS > 80 points. However, these were generally elderly, and some had severe bone defects that could not have been adequately dealt with using conventional prostheses.…”

“…Excellent spontaneous bone regeneration with early restoration of bone stock was described at mid-term followup. [10][11][12][13][14][15][16] The aim of this retrospective study was to present the long-term clinical and radiological results of the cementless, distally fixed Wagner Self-Locking (SL) stem (Sulzer Orthopedics Ltd, Winterthur, Switzerland) in femoral revision surgery.…”

Managing femoral bone loss in revision total hip replacement

“…Pain scores were less in the modular tapered group, and dislocation rates were lower than that reported in the monoblock revision stems. [4][5][6][7]10,11 However despite early reports of failures, clearly there remains a role for monoblock tapered fluted stems. In fact, Bohn and Bischel recently reported a 95.2% survival rate in 129 consecutive femoral revisions using the Wagner SL revision stem.…”

“…2,3 As it was difficult to control when the stem engaged the diaphysis and component undersizing, subsidence occurred in about 20% of patients, which altered leg lengths and/or led to instability in up to 25% of patients. [4][5][6][7] As a result many implant companies and surgeons moved to modular tapered, fluted stems.…”