Division of Lower Limb Reconstruction & Oncology, Vancouver General Hospital, Vancouver, British Columbia, Canada.
Division of Orthopaedic Surgery, University of British Columbia, Vancouver, British Columbia, Canada.
J Bone Joint Surg Am. 2024 Aug 21;106(16):1461-1469. doi: 10.2106/JBJS.23.00849. Epub 2024 May 30.
The Wagner Cone Prosthesis was designed to address complex femoral deformities during total hip arthroplasty (THA), but its mid-term component survivorship and functional outcomes remain undetermined. The objectives of this study were to determine the implant survivorship, patient satisfaction, functional outcomes, osseointegration as seen radiographically, implant subsidence, and complications of THA using the Wagner Cone Prosthesis stem at intermediate-term follow-up.
This study involved 302 patients with proximal femoral deformities, including developmental hip dysplasia and Legg-Calvé-Perthes disease, who underwent a total of 320 primary THAs using the Wagner Cone Prosthesis. The average age at the time of surgery was 49.4 ± 14.5 years (range, 18.8 to 85.6 years). Patient satisfaction was recorded using a self-administered questionnaire assessing satisfaction in 4 domains. The University of California at Los Angeles (UCLA) activity score, the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), the Oxford Hip Score (OHS), the Forgotten Joint Score (FJS), radiographic outcomes, and complications were recorded. The mean follow-up time was 10.1 years (range, 5.2 to 15.5 years).
Survivorship of the Wagner Cone Prosthesis was 98.7% (95% confidence interval [CI]: 97.2% to 100%) with stem revision as the end point and 95.8% (95% CI: 93.5% to 98.2%) with reoperation for any reason as the end point at 10 years postoperatively. In total, 3 stems were revised: 2 for infection and 1 for chronic hip dislocation. The median patient satisfaction score was 95 (interquartile range [IQR], 80 to 100), median UCLA score was 6 (IQR, 6 to 7), median WOMAC score was 18 (IQR, 16 to 22), median OHS was 40 (IQR, 36 to 47), and median FJS was 80 (IQR, 76 to 88) at the time of final follow-up. All Wagner Cone stems that were not revised showed radiographic evidence of osseointegration, with a mean stem subsidence of 0.9 ± 0.8 mm at the most recent follow-up.
The use of the Wagner Cone Prosthesis stem in patients with complex femoral anatomy undergoing primary THA is associated with excellent component survivorship, high levels of patient satisfaction, good functional outcomes, and reliable osseointegration with minimal stem subsidence as seen on radiographs at intermediate-term follow-up.
Therapeutic Level IV . See Instructions for Authors for a complete description of levels of evidence.
Wagner 圆锥假体被设计用于解决全髋关节置换术（THA）中的复杂股骨畸形问题，但中期的组件生存率和功能结果仍未确定。本研究的目的是在中期随访时确定使用 Wagner 圆锥假体柄的 THA 的植入物生存率、患者满意度、功能结果、影像学上的骨整合、植入物下沉和并发症。
本研究纳入了 302 名患有股骨近端畸形的患者，包括发育性髋关节发育不良和 Legg-Calvé-Perthes 病，共进行了 320 例 Wagner 圆锥假体的初次 THA。手术时的平均年龄为 49.4±14.5 岁（18.8-85.6 岁）。患者满意度通过自我管理的问卷进行评估，该问卷评估了 4 个领域的满意度。记录了加利福尼亚大学洛杉矶分校（UCLA）活动评分、西部安大略省和麦克马斯特大学骨关节炎指数（WOMAC）、牛津髋关节评分（OHS）、遗忘关节评分（FJS）、影像学结果和并发症。平均随访时间为 10.1 年（5.2-15.5 年）。
Wagner 圆锥假体的生存率为 98.7%（95%置信区间[CI]：97.2%-100%），以翻修作为终点，以任何原因进行再次手术作为终点的生存率为 95.8%（95%CI：93.5%-98.2%），术后 10 年。共有 3 个柄被翻修：2 个因感染，1 个因慢性髋关节脱位。患者满意度中位数为 95（四分位距[IQR]：80-100），UCLA 评分中位数为 6（IQR：6-7），WOMAC 评分中位数为 18（IQR：16-22），OHS 评分中位数为 40（IQR：36-47），FJS 评分中位数为 80（IQR：76-88）。在最后一次随访时，所有未翻修的 Wagner 圆锥假体均显示出影像学上的骨整合证据，最近一次随访时的平均假体下沉量为 0.9±0.8mm。
在接受初次 THA 的复杂股骨解剖患者中使用 Wagner 圆锥假体柄与良好的组件生存率、较高的患者满意度、良好的功能结果以及可靠的骨整合相关，影像学上显示最小的假体下沉。
治疗性 IV 级。有关证据水平的完整描述，请参见作者说明。
