Femoral revision with the Wagner SL revision stem - Evaluation of one hundred and twenty-nine revisions followed for a mean of 4.8 years

Background: It is difficult to achieve a successful revision total hip repl acement 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 thi rteen tone 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 resecti on arthroplasty to treat chronic deep infection. The prerevision defects we re classified with the system described by Pak et al. as well as with our s ystem. A functional evaluation of the patients and a survival analysis of t he 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 ye ars was 93.9% and 92.8%, respectively. The mean Merle d'Aubigne score impro ved from 7.7 points preoperatively to 14.8 points at the latest followup ex amination. 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 fem oral component with distal fixation, we will continue to use it in the majo rity of femoral revisions. However, the need for regular follow-up remains, since the rate of complications such as osteolysis of the femur, aseptic l oosening, periprosthetic fracture, and late infection may increase in the f uture.