Abstract
Purpose
Total hip arthroplasty (THA) in patients with small or unusual proximal femoral anatomy is challenging due to sizing issues, control of version, and implant fixation. The Wagner Cone is a monoblock, fluted, tapered stem with successful outcomes for these patients; however, there is limited information on subsidence, a common finding with cementless stems.
Methods
We retrospectively reviewed our cases using the modified Wagner Cone (Zimmer, Warsaw, IN) implanted over a 13-year period (2006–2019) in patients with small or abnormal proximal femoral anatomy. We performed 144 primary THAs in 114 patients using this prosthesis. Mean follow-up was 4.5 ± 3.4 years (range, 1–13 years). Common reasons for implantation were hip dysplasia (52%) and osteoarthritis in patients with small femoral proportions (22%). Analysis of outcomes included assessment of stem subsidence and stability.
Results
Survival was 98.6% in aseptic cases; revision-free survival was 97.9%. Femoral subsidence occurred in 84 cases (58%). No subsidence progressed after 3 months. Of those that subsided, the mean distance was 2.8 ± 2.0 mm. There was less subsidence in stems that stabilized prior to six weeks (2.2 ± 1.4 mm) compared to those that continued until 12 weeks (3.9 ± 1.6, p = 0.02). Harris Hip, UCLA, and WOMAC scores significantly improved from pre-operative evaluation (p < 0.001*, p < 0.003*, p ≪ 0.001*); there was no difference in outcome between patients with and without subsidence (p = 0.430, p = 0.228, p = 0.147).
Conclusion
The modified Wagner Cone demonstrates excellent clinical outcomes in patients with challenging proximal femoral anatomy. Subsidence is minor, stops by 3 months, and does not compromise clinical outcome.
![](http://media.springernature.com/m312/springer-static/image/art%3A10.1007%2Fs00264-022-05608-6/MediaObjects/264_2022_5608_Fig1_HTML.png)
![](http://media.springernature.com/m312/springer-static/image/art%3A10.1007%2Fs00264-022-05608-6/MediaObjects/264_2022_5608_Fig2_HTML.jpg)
![](http://media.springernature.com/m312/springer-static/image/art%3A10.1007%2Fs00264-022-05608-6/MediaObjects/264_2022_5608_Fig3_HTML.jpg)
![](http://media.springernature.com/m312/springer-static/image/art%3A10.1007%2Fs00264-022-05608-6/MediaObjects/264_2022_5608_Fig4_HTML.png)
Similar content being viewed by others
References
Wagner H, Wagner M (2000) Cone prosthesis for the hip joint. Arch Orthop Trauma Surg 120:88–95. https://doi.org/10.1007/pl00021223
Schuh A, Jezussek D, Bennemann M, Hönle W (2007) Pathogenesis of hip osteoarthritis. MMW Fortschr Med 149:27–28
Pak P, de Steiger R (2008) Cone femoral prosthesis for osteoarthritis of the hip with femoral dysplasia. J Orthop Surg (Hong Kong) 16:206–210. https://doi.org/10.1177/230949900801600216
Jacobsen S (2006) Adult hip dysplasia and osteoarthritis. Studies in radiology and clinical epidemiology. Acta Orthop Suppl 77:1–37
Schuh A, Schraml A, Hohenberger G (2009) Long-term results of the Wagner cone prosthesis. Int Orthop 33:53–58. https://doi.org/10.1007/s00264-007-0460-4
Parry MC, Vioreanu MH, Garbuz DS, Masri BA, Duncan CP (2016) The Wagner Cone Stem for the management of the challenging femur in primary hip arthroplasty. J Arthroplasty 31:1767–1772. https://doi.org/10.1016/j.arth.2016.02.007
Noble PC, Kamaric E, Sugano N, Matsubara M, Harada Y, Ohzono K, et al. (2003) Three-dimensional shape of the dysplastic femur: implications for THR. Clin Orthop Relat Res 417:27–40. 30.3097/01.blo.0000096819.67494.32.
Nakamura Y, Mitsui H, Kikuchi A, Toh S, Katano H (2011) Total hip arthroplasty using a cylindrical cementless stem in patients with a small physique. J Arthroplasty 26:77–81. https://doi.org/10.1016/j.arth.2009.10.014
Berry DJ (1999) Total hip arthroplasty in patients with proximal femoral deformity. Clin Orthop Relat Res 369:262–272. https://doi.org/10.1097/00003086-199912000-00027
Böhm P, Bischel O (2001) Femoral revision with the Wagner SL revision stem: evaluation of one hundred and twenty-nine revisions followed for a mean of 4.8 years. J Bone Joint Surg Am 83:1023–31
Claramunt RT, Marqués F, León A, Vilà G, Mestre C, Verdié LP (2011) Total hip replacement with an uncemented Wagner cone stem for patients with congenital hip dysplasia. Int Orthop 35:1767–1770. https://doi.org/10.1007/s00264-011-1218-6
Zhen P, Liu J, Lu H, Chen H, Li X, Zhou S (2017) Developmental hip dysplasia treated by total hip arthroplasty using a cementless Wagner cone stem in young adult patients with a small physique. BMC Musculoskelet Disord 18:192. https://doi.org/10.1186/s12891-017-1554-9
Zhang Q, Goodman SB, Maloney WJ, Huddleston JI (2016) Can a conical implant successfully address complex anatomy in primary THA? Radiographs and hip scores at early follow-up. Clin Orthop Relat Res 474:459–464. https://doi.org/10.1007/s11999-015-4480-x
Castelli CC, D’Angelo F, Molina M, Ferrario A, Cherubino P (1999) Radiographic evaluation of the “Conus” uncemented stem. Hip Int 9(3):133–138. https://doi.org/10.1177/112070009900900301
Ström H, Mallmin H, Milbrink J, Petrén-Mallmin M, Nivbrant B, Kolstad K (2003) The cone hip stem: a prospective study of 13 patients followed for 5 years with RSA. Acta Orthop Scand 74:525–530. https://doi.org/10.1080/00016470310017901
Faldini C, Nanni M, Leonetti D, Miscione MT, Acri F, Giannini S (2011) Total hip arthroplasty in developmental hip dysplasia using cementless tapered stem. Results after a minimum 10-year follow-up. Hip Int 21:415–420. https://doi.org/10.5301/HIP.2011.8588
Faldini C, Miscione MT, Chehrassan M, Acri F, Pungetti C, d’Amato M et al (2011) Congenital hip dysplasia treated by total hip arthroplasty using cementless tapered stem in patients younger than 50 years old: results after 12-years follow-up. J Orthop Traumatol 12:213–218. https://doi.org/10.1007/s10195-011-0170-y
Pavone V, Costarella L, Privitera V, Sessa G (2009) Bilateral total hip arthroplasty in subjects with multiple epiphyseal dysplasia. J Arthroplasty 24:868–872. https://doi.org/10.1016/j.arth.2008.06.023
Sandiford NA, Garbuz DS, Masri BA, Duncan CP (2017) Nonmodular tapered fluted titanium stems osseointegrate reliably at short term in revision THAs. Clin Orthop Relat Res 475:186–192. https://doi.org/10.1007/s11999-016-5091-x
Regis D, Sandri A, Bonetti I, Braggion M, Bartolozzi P (2011) Femoral revision with the Wagner tapered stem: a ten- to 15-year follow-up study. J Bone Joint Surg Br 93:1320–1326. https://doi.org/10.1302/0301-620X.93B10.25927
Gutiérrez Del Alamo J, Garcia-Cimbrelo E, Castellanos V, Gil-Garay E (2007) Radiographic bone regeneration and clinical outcome with the Wagner SL revision stem: a 5-year to 12-year follow-up study. J Arthroplasty 22:515–524. https://doi.org/10.1016/j.arth.2006.04.029
Jacobs CA, Christensen CP (2009) Progressive subsidence of a tapered, proximally coated femoral stem in total hip arthroplasty. Int Orthop 33:917–922. https://doi.org/10.1007/s00264-008-0583-2
Lim CT, Amanatullah DF, Huddleston JI, Hwang KL, Maloney WJ, Goodman SB (2017) Cortical strut allograft support of modular femoral junctions during revision Total Hip Arthroplasty. J Arthroplasty 32:1586–1592. https://doi.org/10.1016/j.arth.2016.12.011
Pachter CS, Garfinkel JH, Romness DW, Gladnick BP (2019) Radiographic calibration with a prosthetic femoral head allows accurate preoperative templating for Total Hip Arthroplasty. Orthopedics 42:e346–e349. https://doi.org/10.3928/01477447-20190321-06
Engh CA, Massin P, Suthers KE (1990) Roentgenographic assessment of the biologic fixation of porous-surfaced femoral components. Clin Orthop Relat Res 257:107–128
Gruen TA, McNeice GM, Amstutz HC (1979) “Modes of failure” of cemented stem-type femoral components: a radiographic analysis of loosening. Clin Orthop Relat Res 141:17–27
Phillips NJ, Stockley I, Wilkinson JM (2002) Direct plain radiographic methods versus EBRA-Digital for measuring implant migration after total hip arthroplasty. J Arthroplasty 17:917–925. https://doi.org/10.1054/arth.2002.34529
Perka C, Fischer U, Taylor WR, Matziolis G (2004) Developmental hip dysplasia treated with total hip arthroplasty with a straight stem and a threaded cup. J Bone Joint Surg Am 86:312–319. https://doi.org/10.2106/00004623-200402000-00014
Buly R (2005) The S-ROM stem: versatility of stem/sleeve combinations and head options. Orthopedics 28:s1025-1032
McCarthy JC, Bono JV, O’Donnell PJ (1997) Custom and modular components in primary total hip replacement. Clin Orthop Relat Res 344:162–171
DiFazio F, Shon WY, Salvati EA, Wilson PD (2002) Long-term results of total hip arthroplasty with a cemented custom-designed swan-neck femoral component for congenital dislocation or severe dysplasia: a follow-up note. J Bone Joint Surg Am 84:204–207. https://doi.org/10.2106/00004623-200202000-00006
Colo E, Rijnen WHC, Gardeniers JWM, van Kampen A, Schreurs BW (2016) Satisfying results of primary hip arthroplasty in patients with hip dysplasia at a mean follow up of 20 years. Clin Orthop Relat Res 474:2462–2468. https://doi.org/10.1007/s11999-016-4998-6
Kong X, Sun Y, Yang M, Zhou Y, Chen J, Chai W et al (2019) Total hip arthroplasty with modular stem for Crowe I and II developmental dysplasia of the hip. J Orthop Surg Res 14:362. https://doi.org/10.1186/s13018-019-1408-2
Mattingly DA (2005) The S-ROM modular femoral stem in dysplasia of the hip. Orthopedics 28:s1069-1073
Li L, Yu M, Yang C, Gu G (2016) Total hip arthroplasty (S-ROM stem) and subtrochanteric osteotomy for Crowe type IV developmental dysplasia of the hip. Indian J Orthop 50:195–200. https://doi.org/10.4103/0019-5413.177575
Clair AJ, Cizmic Z, Vigdorchik JM, Poultsides LA, Schwarzkopf R, Rathod PA et al (2019) Nonmodular stems are a viable alternative to modular stems in revision Total Hip Arthroplasty. J Arthroplasty 34:S292–S296. https://doi.org/10.1016/j.arth.2019.03.007
Grünig R, Morscher E, Ochsner PE (1997) Three- to 7-year results with the uncemented SL femoral revision prosthesis. Arch Orthop Trauma Surg 116:187–197. https://doi.org/10.1007/BF00393708
Girard J, Roche O, Wavreille G, Canovas F, Le Béguec P (2011) Stem subsidence after total hip revision: 183 cases at 5.9 years follow-up. Orthop Traumatol Surg Res 97:121–126. https://doi.org/10.1016/j.otsr.2010.10.006
Ries C, Boese CK, Dietrich F, Miehlke W, Heisel C (2019) Femoral stem subsidence in cementless total hip arthroplasty: a retrospective single-centre study. Int Orthop 43:307–314. https://doi.org/10.1007/s00264-018-4020-x
Clair AJ, Gabor JA, Patel KS, Friedlander S, Deshmukh AJ, Schwarzkopf R (2020) Subsidence following revision Total Hip Arthroplasty using modular and monolithic components. J Arthroplasty 35(6S):S299–S303. https://doi.org/10.1016/j.arth.2020.03.008
Author information
Authors and Affiliations
Contributions
K. L., K. W., and S. B. G. conceived and planned the study. K. L. and K. W. gathered all the data. All authors reviewed the data and participated in writing and reviewing the manuscript.
Corresponding author
Ethics declarations
Ethics approval
This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Human Subjects Institutional Review Board of Stanford University (August 24, 2021, eProtocol 10669).
Consent to participate
Informed consent was obtained from all individual participants included in the study.
Consent for publication
No patient radiographs or other specific identifying data are included in this study.
Competing interests
The authors declare no competing interests.
Additional information
Publisher's note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
Springer Nature or its licensor holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Lawson, K., Hwang, K.L., Montgomery, S. et al. Outcome of the Wagner Cone femoral component for difficult anatomical conditions during total hip arthroplasty. International Orthopaedics (SICOT) 47, 117–124 (2023). https://doi.org/10.1007/s00264-022-05608-6
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00264-022-05608-6