title: Femoral revision with the Wagner tapered stem: a ten- to 15-year follow-up study.
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.
authors.affiliation: Azienda Ospedaliera Universitaria Integrata, Department of Orthopaedics, Piazzale LA Scuro, 10, 37134 Verona, Italy. regisdario@siot.it
authors.forename: D
authors.initials: D
authors.lastname: Regis
authors.forename: A
authors.initials: A
authors.lastname: Sandri
authors.forename: I
authors.initials: I
authors.lastname: Bonetti
authors.forename: M
authors.initials: M
authors.lastname: Braggion
authors.forename: P
authors.initials: P
authors.lastname: Bartolozzi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000295:instrumentation* / Q000379:methods; D001861:Bone Regeneration; D004812:Epidemiologic Methods; D005260:Female; D005269:Femur / Q000000981:diagnostic imaging / Q000601:surgery*; D006622:Hip Prosthesis; D006801:Humans; D008297:Male; D008875:Middle Aged; D010027:Osteotomy / Q000009:adverse effects / Q000379:methods; D011474:Prosthesis Design; D011475:Prosthesis Failure; D011859:Radiography; D012086:Reoperation / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D016896:Treatment Outcome