Wagner SL prosthesis in revision hip arthroplasty to bridge femoral bone defects. Technic and results

Between 1988 and 1999 we used the Wagner SL revision prosthesis in 99 cases . The indications were aseptic and septic loosening, periprosthetic fractur es, and Girdlestone situations. These were mostly Paprosky types 2 and 3 me ta-and metadiaphyseal femoral bone defects. The intervention was the first revision in 49 cases and the second or up to the sixth revision in 50 cases . A transgluteal or transfemoral approach was usually chosen. We gradually re duced the anchorage area to a length of 8-12 cm. If after the first few pos toperative months an osseous integration without radiolucency is achieved, a long-lasting integration can be expected. Due to considerable subsidence during the 1st year,six stems had to be repl aced. Seven additional revisions were done because of hematoma and three be cause of seroma. According to the survival analysis, 92% of the stems remai ned in place after 10 years. No revision was executed between the 5th and 1 0th year. At the 1-year control, 96% of the patients were pain free and 90% were sati sfied. Nevertheless, 80% limped and 33% used at least one crutch. Mainly be cause of deterioration of general health,the walking distance was considera bly reduced between the 1st and the 5th postoperative year. There is little difference in the results after revision between a relative ly small and an extended defect. At present, we limit the use of the SL. re vision stem mainly to extended defects. Careful planning of the operation i s mandatory.