Three-to 7-year results with the uncemented SL femoral revision prosthesis

Between 1988 and 1991, 40 Wagner SL femoral revision stems were implanted at the Orthopaedic Departments of the University of Basel and of the Kantonsspital Liestal, Switzerland. The indications were: 27 cases of extensive bone resorption and destruction of the proximal prosthetic bed, seven periprosthetic fractures, two Girdle-stone situations after removal of infected total hip arthroplasty (THA), 1 case each of primary arthroplasty for congenital dysplasia of the hip, failed osteosynthesis of a pertrochanteric fracture, subtrochanteric femoral fracture and femoral fracture with subsequent osteomyelitis. The average follow-up time was 47 months. The average age of the patients was 70 years (range 37-85 years). The average preoperative hip score was 32 points, postoperative 78 points. We noted to severe complications such as thrombosis, pulmonary embolism or nerve injury. No case of early infection has occurred to date. Four hips required further revision, one after a haematogenous infection of the prosthesis 2 years after implantation, one 4 weeks after surgery because of a stem which was significantly undersized compared with the medullary canal of the femur. Two hips were revised after 3 and 4 years, respectively, for continuous subsidence and loosening in the medullary canal. Both revisions were successfully achieved using a femoral component of larger diameter. We recommend the Wagner SL femoral revision stem, not as a routine procedure to treat loosening, but for patients with severe femoral bone resorption after THA or periprosthetic fractures, those in the Girdlestone situation and geriatric patients with pertrochanteric or subtrochanteric fractures.