Technical modifications for the Wagner SL hip arthroplasty. Short oblique osteotomy of the proximal 1/3 of the femur

Summary58 Wagner prostheses were implanted between 1989 and 1996. This was done through a simplified technique without trochanteric osteotomy or grafting. The Wagner transfemoral approach was only used once. The other operations were done through the Moore approach. Classical windows were not used since we feel they give a poor view and predispose to later fractures. We distinguished between the simple cases using the intra-medullary route with image intensifier control, and the difficult cases where the short oblique subtrochanteric osteotomy was used. This manouvre was the simplest way of removing the cement and the prosthesis and of inserting a Wagner prosthesis of 265 mm or longer which also requires a diaphyseal osteotomy to prevent cortical splitting. The Wagner transfemoral route is only needed for removal of uncemented prostheses. Infection is a good indication for this technique where a one stage revision is planned. This technique, like the pure intra-medullary route is derived from the principles of closed intra-medullary nailing.