P J Warren1, P Thompson, M D A Fletcher. 1. The Department of Orthopaedic Surgery, Northwick Park Hospital, Watford Road, Harrow, Middlesex, UK.
Abstract
BACKGROUND: The Wagner SL uncemented revision stem has been utilised successfully for revision hip surgery where marked loss of proximal bone stock co-exists or where there is a periprosthetic fracture. Implanted via the transfemoral approach, one significant difficulty appears to be a tendency for implant subsidence, which in some cases has been troublesome enough to necessitate early revision (usually to a larger prosthesis). METHODS: A change in our operative practice allowed us to review the effects of using either wire cerclages or 2.0 mm Dall-Miles cables for prophylactic wiring of the distal femur. Seventeen Wagner SL stems, inserted via the transfemoral approach, were studied in 16 patients. RESULTS: We found those patients prophylactically wired with Dall-Miles cables demonstrated no subsidence in comparison with those in whom heavy wire cerclage had been utilised (mean subsidence 6 mm; p=0.001). In addition, we found that closure of the proximal osteotomy with wires conferred a more reliable rate of union in comparison with those closed with heavy sutures. CONCLUSION: We recommend the use of Dall-Miles cables for distal cerclage and osteotomy closure for the Wagner prosthesis.
BACKGROUND: The Wagner SL uncemented revision stem has been utilised successfully for revision hip surgery where marked loss of proximal bone stock co-exists or where there is a periprosthetic fracture. Implanted via the transfemoral approach, one significant difficulty appears to be a tendency for implant subsidence, which in some cases has been troublesome enough to necessitate early revision (usually to a larger prosthesis). METHODS: A change in our operative practice allowed us to review the effects of using either wire cerclages or 2.0 mm Dall-Miles cables for prophylactic wiring of the distal femur. Seventeen Wagner SL stems, inserted via the transfemoral approach, were studied in 16 patients. RESULTS: We found those patients prophylactically wired with Dall-Miles cables demonstrated no subsidence in comparison with those in whom heavy wire cerclage had been utilised (mean subsidence 6 mm; p=0.001). In addition, we found that closure of the proximal osteotomy with wires conferred a more reliable rate of union in comparison with those closed with heavy sutures. CONCLUSION: We recommend the use of Dall-Miles cables for distal cerclage and osteotomy closure for the Wagner prosthesis.
Authors: Bernd Fink; Alexandra Grossmann; Martin Fuerst; Peter Schäfer; Lars Frommelt Journal: Clin Orthop Relat Res Date: 2008-11-11 Impact factor: 4.176
Authors: Dieter C Wirtz; Sascha Gravius; Rudolf Ascherl; Miguel Thorweihe; Raimund Forst; Ulrich Noeth; Uwe M Maus; Matthias D Wimmer; Günther Zeiler; Moritz C Deml Journal: Acta Orthop Date: 2014-09-01 Impact factor: 3.717