[The value of the Wagner SL revision prosthesis for bridging large femoral defects]

Between 1988 and 1999 we used the Wagner SL revision prosthesis in 99 cases. The indications were aseptic and septic loosening, periprosthetic fractures, and Girdlestone situations. These were mostly Paprosky types 2 and 3 meta- 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 reduced the anchorage area to a length of 8-12 cm. If after the first few postoperative 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 replaced. Seven additional revisions were done because of hematoma and three because of seroma. According to the survival analysis, 92% of the stems remained in place after 10 years. No revision was executed between the 5th and 10th year. At the 1-year control, 96% of the patients were pain free and 90% were satisfied. Nevertheless, 80% limped and 33% used at least one crutch. Mainly because of deterioration of general health, the walking distance was considerably reduced between the 1st and the 5th postoperative year. There is little difference in the results after revision between a relatively small and an extended defect. At present, we limit the use of the SL revision stem mainly to extended defects. Careful planning of the operation is mandatory.