Transfemoral implantation of the Wagner SL stem: The abolition of subsidence and enhancement of osteotomy union rate using Dall-Miles cables

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). 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. 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. We recommend the use of Dall-Miles cables for distal cerclage and osteotomy closure for the Wagner prosthesis.