Midterm Results of Wagner Revision Stem

Aim: To evaluate the midterm results with the Wagner revision stem.

Methods: Between 1993–2002, 86 Wagner stems were implanted in 13 men and 73 women (mean age 66.7y). The indications were: aseptic loosening in 70 patients, Girdlestone in 5, periprosthetic fracture in 8 and stem breakage in 3. The bone loss, according to DGOT was classified as: type I-II: 23, type III:29, type IV-V: 22 and type VI: 12. In 30 patients we used the transfemoral approach, while in 39 a limited femoral osteotomy was performed.

Results: The mean follow-up was 4,7 y. The mean pre.op. Harris Hip Score was 43 and the mean p.op. was 83,4. In 18 patients significant bony growth was observed along the whole femur, while in 51 sufficient growth was present at the defect side. Complicatons included intraoperative fracture in 6 pts, which was treated with wire cerclage, transosseal sutures or a plate, supracondylar fracture in one patient which was treated with an angular plate and 6 dislocations due to rotational instability of the implant – which were treated by revision surgery. Stem subsidence of less than 2mm was noticed in 17 cases. Three patients presented a superficial wound infection, and one deep infection, that was treated with debridement and systematic antibiotic surgery.

Conclusions: Significant bony growth was noticed in the areas of the defect, as well as along the whole femur. Subsidence of the stem with secondary fixation without clinical consequences is common. Complications, such as dislocations, are consequence of rotational instability of the implant and early postoperative weight bearing.