Midterm results of titanium conical Wagner stem with challenging femoral anatomy: Survivorship and unique bone remodeling
Why this work is in the frame
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Bibliographic record
Abstract
BACKGROUND: Complex anatomy of the proximal femur makes total hip arthroplasty (THA) more challenging. Short, straight, fluted and conical titanium stem like the Wagner Cone can be helpful to address small femoral canal, increased femoral neck version, important leg length discrepancy or proximal femoral deformity. The outcome in these patients is less assured and associated with high rate of complications. Therefore, we did a retrospective study aiming to answer: 1) can the Wagner Cone stem provide acceptable mid- to long-term implant survivorship; 2) help minimizing perioperative adverse events; 3) produce favorable clinical outcome measured by WOMAC score; and 4) be associated with a favorable radiographic femoral bone remodeling at the last follow-up? HYPOTHESIS: Wagner Cone stem is an advantageous solution for the distorted proximal femur in complex THA. PATIENTS AND METHOD: Our cohort was derived from the patient registries where medical records of 88 patients (103 hips) who underwent primary THA using the Wagner prosthesis were retrospectively reviewed. Then, data was analyzed for patients' demographics and surgical data, and comparing preoperative, immediate postoperative and last follow-up data. Eleven patients (12 hips) were excluded (7 hips followed up less than 2 years or lost to follow-up, 3 hips that had the Wagner stem for revision and 2 Wagner stems inserted for periprosthetic fracture). This left 77 patients (91 hips) with Wagner cone stems implanted for more than 2 years between March 2003 and February 2017 by 7 surgeons in 3 academic hospitals. Implant revision, reoperations, WOMAC score and radiographic analyses were recorded at last follow-up. RESULTS: After a mean follow-up of 7.8 (range, 2.0-16.2) years, Wagner stem survivorship was 98.9% (95% CI: 94 to 100%) with one (1.1%) stem revision for failure of osteointegration. Five (5.5%) acetabular revisions, one for aseptic loosening, 2 for adverse reaction to metal debris and 2 for infection. One (1.1%) sciatic neuropathy and 4 (4.4%) intraoperative fractures were encountered. The mean WOMAC score was 90.5±11.4 (59-100). Radiographic analysis showed clear signs of stem osseointegration and hypertrophic bone remodeling in 82 cases (92.1%). CONCLUSIONS: Used in complex cases with proximal distorted femurs, the Wagner Cone stem demonstrated a low complication rate, a high-rate consistent adaptive bone remodeling, excellent clinical results, and midterm survival. It is a safe, reliable and advantageous option in complex primary THA. However, the contribution of the underlying cause of the secondary osteoarthritis on the long-term survival of the stem remains to be demonstrated. LEVEL OF EVIDENCE: IV; retrospective study.
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Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.007 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.002 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from it