Femoral revision with the Wagner tapered stem

Abstract

Revision after failed femoral components may be technically demanding due to loss of peri-prosthetic bone. This retrospective study evaluated the long-term results of femoral revision using the cementless Wagner Self-Locking stem. Between 1992 and 1998, 68 consecutive hips in 66 patients underwent femoral revision using this implant. A total of 25 patients died from unrelated causes without further revision; the remaining 41 hips in 41 patients (12 men and 29 women) with a mean age of 61 years (29 to 80) were reviewed at a mean follow-up of 13.9 years (10.4 to 15.8). A transfemoral approach was used in 32 hips. A total of five stems required further revision because of infection in two, progressive subsidence in two and recurrent dislocation in one. Four hips had dislocated and eight stems had subsided ≥ 10 mm. The mean Harris hip score improved from 33 points pre-operatively to 75 points at final follow-up (p < 0.001). In all, 33 stems (91.7%) showed radiological signs of stable bone fixation. The cumulative survival rates at 15.8 years with femoral revision for any reason and for stem failure as the endpoints were 92.0% (95% confidence interval (CI) 86.0% to 98.4%) and 96.6% (95% CI 92.2% to 100%), respectively. The survivorship with revision and ≥ 10 mm migration of the stem as the endpoint was 83.6% (95% CI 76.6% to 91.4%). This study shows quite good survival and moderate clinical outcome when using a monoblock tapered titanium stem for supporting the regeneration of bone in complex revision hip surgery.

One-stage revision of infected hip arthroplasty: outcome of 39 consecutive hips

“…In all patients undergoing empirical therapy, antibiotics were streamlined as soon as the susceptibility testing was available. In patients with staphylococcal infection, the mean time between surgery and administration of rifampin was 8 days (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20). In six patients, evacuation of fluid retention was required during index hospitalisation, namely, 12-24 days after surgery.…”

“…For reimplantation, we used the same established implant systems, with documented long-term results, as we used in the routine for aseptic loosening [10]. In our case series, three of 13 cemented stems failed due to symptomatic aseptic loosening after a mean of 40 months.…”

“…In aseptic stem revisions, uncemented stems have shown reliable long-term results [10]. For PJI, uncemented reimplantations are performed in two-stage exchanges [11,12].…”

Classifying femoral bone deficiency: Picking the right tool for the job

“…13,14 In this scenario, we prefer to use a modular titanium fluted stem. [15][16][17][18] In the case of femoral remodeling resulting in retroversion, a modular titanium fluted stem is also chosen. This allows the surgeon to appropriately antevert the stem.…”

CORR Insights®: Nonmodular Tapered Fluted Titanium Stems Osseointegrate Reliably at Short Term in Revision THAs

“…This stem is made from titanium alloy, and includes a conical fixation zone, a 2°taper with circular cross-section, longitudinal ribs with relatively sharp ridges for rotational stability, and a grit-blasted rough surface to promote osseointegration [13]. This design concept has proven successful with reliable mid-term fixation and some evidence for bone regeneration [8], which is important in young patients and might be attributable to a low modulus of elasticity of this titanium alloy stem. Later implants imitated this fixation concept and the Wagner stem became the prototype for other tapered, fluted titanium stems.…”