title: Femoral revision with the Wagner SL revision stem : evaluation of one hundred and twenty-nine revisions followed for a mean of 4.8 years.
abstract: 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.
authors.affiliation: Department of Orthopaedics Surgery, Eberhard-Karls-Universität Tübingen, Germany. paul.boehm@med.uni-tuebingen.de
authors.forename: P
authors.initials: P
authors.lastname: Böhm
authors.forename: O
authors.initials: O
authors.lastname: Bischel
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016001:Confidence Intervals; D005260:Female; D005269:Femur / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D005500:Follow-Up Studies; D006622:Hip Prosthesis / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010024:Osteoporosis / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D011336:Probability; D011474:Prosthesis Design; D011475:Prosthesis Failure; D011859:Radiography; D016059:Range of Motion, Articular; D012086:Reoperation / Q000295:instrumentation / Q000379:methods; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D016896:Treatment Outcome