Risk factors of chronic subscapularis tendon tear

Background@#Chronic subscapularis tendon tear (SBT) is a degenerative disease and a common pathologic cause of shoulder pain. Several potential risk factors for chronic SBT have been reported. Although metabolic abnormalities are common risk factors for degenerative disease, their potential etiological roles in chronic SBT remains unclear. The purpose of this study was to investigate potential risk factors for chronic SBT, with particular attention to metabolic factors. @*Methods@#This study evaluated single shoulders of 939 rural residents. Each subject undertook a questionnaire, physical examinations, blood tests, and simple radiographs and magnetic resonance imaging (MRI) evaluations of bilateral shoulders. Subscapularis tendon integrity was determined by MRI findings based on the thickness of the involved tendons. The association strengths of demographic, physical, social, and radiologic factors, comorbidities, severity of rotator cuff tear (RCT), and serologic parameters for SBT were evaluated using logistic regression analyses. The significance of those analyses was set at p<0.05. @*Results@#The prevalence of SBT was 32.2% (302/939). The prevalence of partial- and full-thickness tears was 23.5% (221/939) and 8.6% (81/939), respectively. The prevalence of isolated SBT was 20.2% (190/939), SBT combined with supraspinatus or infraspinatus tendon tear was 11.9% (112/939). In multivariable logistic regression analysis, dominant side involvement (p<0.001), manual labor (p=0.002), diabetes (p<0.001), metabolic syndrome (p<0.001), retraction degree of Patte tendon (p<0.001), posterosuperior RCT (p=0.010), and biceps tendon injury (p<0.001) were significantly associated with SBT. @*Conclusions@#Metabolic syndrome is a potential risk factor for SBT, as are these factors: overuse activity, diabetes, posterosuperior RCT, increased retraction of posterosuperior rotator cuff tendon, and biceps tendon injury.

Is the Frozen Shoulder Classification a Reliable Assessment?

BACKGROUND: Although a common shoulder disease, there are no accepted classification criteria for frozen shoulder (FS). This study therefore aimed to evaluate the accuracy of the conventionally used FS classification system. METHODS: Primary FS patients (n=168) who visited our clinic from January 2010 to July 2015 were included in the study. After confirming restrictions of the glenohumeral joint motion and absence of history of systemic disease, trauma, shoulder surgery, shoulder muscle weakness, or specific x-ray abnormalities, the Zuckerman and Rokito's classification was employed for diagnosing primary FS. Following clinical diagnosis, each patient underwent a shoulder magnetic resonance imaging (MRI) and blood tests (lipid profile, glucose, hemoglobin A1c, and thyroid function). Based on the results of the blood tests and MRIs, the patients were reclassified, using the criteria proposed by Zuckerman and Rokito. RESULTS: New diagnoses were ascertained including blood test results (16 patients with diabetes, 43 with thyroid abnormalities, and 149 with dyslipidemia), and MRI revealed intra-articular lesions in 81 patients (48.2%). After re-categorization based on the above findings, only 5 patients (3.0%) were classified having primary FS. The remaining 163 patients (97.0%) had either undiagnosed systemic or intrinsic abnormalities (89 patients), whereas 74 patients had both. CONCLUSIONS: These findings demonstrate that most patients clinically diagnosed with primary FS had undiagnosed systemic abnormalities and/or intra-articular pathologies. Therefore, a modification of the Zuckerman and Rokito's classification system for FS may be required to include the frequent combinations, rather than having a separate representation of systemic abnormalities and intrinsic causes.

Conservative Treatment of Pyogenic Spondylitis in the Elderly

STUDY DESIGN: Retrospective study. OBJECTIVES: To analyze the outcomes of conservative management in elderly patients over 65 years of age who were diagnosed with pyogenic spondylitis. SUMMARY OF LITERATURE REVIEW: The surgical treatment of pyogenic spondylitis can lead to complications in elderly patients in a poor general condition or with underlying diseases. MATERIALS AND METHODS: We performed a retrospective review of 32 patients who were diagnosed with pyogenic spondylitis and had a minimum of 12 months of follow-up. Age, sex, comorbidities, clinical symptoms, and the involved segments were analyzed retrospectively. The diagnosis was assessed using clinical, laboratory, and radiologic findings. Antibiotic therapy was either specific (if positive culture results were found) or broad-spectrum cephalosporin (when the pathogenic agent was not isolated). Outcomes were assessed using residual pain and neurologic deficits. RESULTS: The mean onset time was 23.5 days (range, 3-90 days). The mean period of intravenous antibiotic therapy was 36.3 days (range, 10-90 days). All cases underwent conservative management, and 4 patients with progressive neurologic deficits due to epidural abscess underwent posterior laminectomy and abscess drainage. In all cases, the infection was successfully treated, although 12 cases reported residual lower back pain and 2 continued to exhibit minor neurologic deficits. CONCLUSIONS: In elderly patients with pyogenic spondylitis, satisfactory results were obtained with conservative management using antibiotics and orthosis after an early diagnosis, unless progressive neurologic symptom instability or spine deformities were noted.

Cytoprotective Mechanism of Cyanidin and Delphinidin against Oxidative Stress-Induced Tenofibroblast Death

Age-related rotator cuff tendon degeneration is related to tenofibroblast apoptosis. Anthocyanins reduce oxidative stress-induced apoptotic cell death in tenofibroblasts. The current study investigated the presence of cell protective effects in cyanidin and delphinidin, the most common aglycon forms of anthocyanins. We determined whether these anthocyanidins have antiapoptotic and antinecrotic effects in tenofibroblasts exposed to H₂O₂, and evaluated their biomolecular mechanisms. Both cyanidin and delphinidin inhibited H₂O₂-induced apoptosis in a dose-dependent manner. However, at concentrations of 100 μg/ml or greater, delphinidin showed cytotoxicity against tenofibroblasts and a decreased antinecrotic effect. Cyanidin and delphinidin both showed inhibitory effects on the H₂O₂-induced increase in intracellular ROS formation and the activation of ERK1/2 and JNK. In conclusion, both cyanidin and delphinidin have cytoprotective effects on cultured tenofibroblasts exposed to H₂O₂. These results suggest that cyanidin and delphinidin are both beneficial for the treatment of oxidative stress-mediated tenofibroblast cell death, but their working concentrations are different.

Clinical Results of Supracondylar Dome Osteotomy for Cubitus Varus and Valgus Deformities in Adults

BACKGROUND: Cubitus varus and cubitus valgus deformities are common complications of distal humeral fractures in children. We evaluated the usefulness of supracondylar dome osteotomy as a treatment option for adults with cubitus varus or valgus deformity developed during childhood. METHODS: Ten patients who had received supracondylar dome osteotomy and stabilization with plates to treat cubitus varus or valgus deformity between July 2006 and August 2013 were included in this study. Their mean age at the time of surgery was 36.50 ± 10.22 years. The mean follow-up duration was 54.80 ± 32.50 months. We evaluated humerus-elbow-wrist angles (HEWA), improvements in the lateral prominence index (LPI) or medial prominence index (MPI), Mayo elbow performance scores (MEPS), and overall results in accordance with the Banerjee criteria. RESULTS: For the six patients with cubitus varus, the mean postoperative HEWA, mean correction angle, and mean improvement in LPI were 9.72° ± 3.95°, 27.67° ± 10.75°, and 6.92% ± 3.40%, respectively. For the four patients with cubitus valgus, the mean postoperative HEWA, mean correction angle, and mean improvement in MPI were 14.73° ± 2.97°, 11.55° ± 3.26°, and 11.33% ± 6.39%, respectively. There was no significant difference between postoperative and preoperative mean MEPS. The subjective ulnar nerve symptoms were alleviated in all patients. The overall results were excellent in six and good in four patients. CONCLUSIONS: This study suggests that supracondylar dome osteotomy with secure fixation using double plates may be useful in correcting cubitus varus or cubitus valgus deformity, yielding good functional outcomes in adults.

Clinical Results of Supracondylar Dome Osteotomy for Cubitus Varus and Valgus Deformities in Adults

BACKGROUND: Cubitus varus and cubitus valgus deformities are common complications of distal humeral fractures in children. We evaluated the usefulness of supracondylar dome osteotomy as a treatment option for adults with cubitus varus or valgus deformity developed during childhood. METHODS: Ten patients who had received supracondylar dome osteotomy and stabilization with plates to treat cubitus varus or valgus deformity between July 2006 and August 2013 were included in this study. Their mean age at the time of surgery was 36.50 ± 10.22 years. The mean follow-up duration was 54.80 ± 32.50 months. We evaluated humerus-elbow-wrist angles (HEWA), improvements in the lateral prominence index (LPI) or medial prominence index (MPI), Mayo elbow performance scores (MEPS), and overall results in accordance with the Banerjee criteria. RESULTS: For the six patients with cubitus varus, the mean postoperative HEWA, mean correction angle, and mean improvement in LPI were 9.72°± 3.95°, 27.67°± 10.75°, and 6.92% ± 3.40%, respectively. For the four patients with cubitus valgus, the mean postoperative HEWA, mean correction angle, and mean improvement in MPI were 14.73°± 2.97°, 11.55°± 3.26°, and 11.33% ± 6.39%, respectively. There was no significant difference between postoperative and preoperative mean MEPS. The subjective ulnar nerve symptoms were alleviated in all patients. The overall results were excellent in six and good in four patients. CONCLUSIONS: This study suggests that supracondylar dome osteotomy with secure fixation using double plates may be useful in correcting cubitus varus or cubitus valgus deformity, yielding good functional outcomes in adults.

Prevalence and Risk Factors of Upper Extremity Musculoskeletal Diseases among Farmers in Gyeongnam

OBJECTIVE: To evaluate the prevalence and risk factors of upper extremity musculoskeletal diseases (MSDs) among Korean farmers. METHODS: The study was carried out from June 2013 to August 2015 on 850 farmers and 203 non-farmers (controls) in Gyeongnam Province. Physical examinations were performed by rheumatologists, orthopedists, and rehabilitation specialists. Plain radiography, a nerve conduction examination, and magnetic resonance imaging were performed, and the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire was used to assess upper extremity function. RESULTS: Thirty-four different types of upper extremity MSDs were detected in the 1,053 study subjects. The prevalence of any MSD in farmers was 8.96-fold higher than in control (p<0.001). The most obvious difference in prevalence between farmers and non-farmers was hand osteoarthritis (48.2% vs. 4.9%). Mean total DASH score was higher for farmers than non-farmers (14.29+/-13.66 vs. 10.03+/-10.85, p<0.001). Among farmers, myofascial pain syndrome, rotator cuff tear, and epicondylitis were more prevalent among overhead workers (growing persimmons, pears, and grapes) than in non-overhead workers (growing rice and upland crops). The following factors were associated with a rotator cuff tear; older age, overhead work, high waist circumference, and lower level of education. Hand osteoarthritis was found to be associated with older age, a female gender, high waist circumference, and longer total work time. CONCLUSION: The prevalence of upper extremity MSDs is much higher in farmers than non-farmers and greater still for farmers doing overhead work. Various factors contribute to the occurrence of upper extremity MSDs, and thus, the authors suggest an efficient preventive strategy, which involves consideration of type of work and risk factors, be established for farmers to reduce upper extremity MSDs.

Risk Factors of Past Injuries among of the Sports Climbing Athletes Who Participated in the National Sports Festival / 대한스포츠의학회지

The purpose of this study is to evaluate the risk factors regarding the injuries from sports climbing through an epidemiologic study. We performed a questionnaire survey on sports climbers who participated in the 93th Annual Sports Festival in Daegu, in October 2012. Sixty-nine climbers (male: 57, female: 12) responded to the survey. The t-test was used for comparisons of the incidence of injury, according to sex and career. The multiple linear regression analysis and the logistic regression analysis were used for the evaluation of risk factors that affected the occurrence of injury. Overall, 58 (84.06%) climbers had history of injury. The incidences of climbing related injuries were higher than the incidences of cross-training related injuries. However, there were no significant difference (p=0.680). Also, there was no significant difference between males and females (p=0.467), and professionals and amateurs (p=0.076). Fifty (72.46%) out of 69 climbers had history of traumatic injuries, and 40 (57.97%) climbers had history of overuse injuries. Significant risk factors for traumatic injuries are leading (odds ratio, OR=17.854), speed (OR=45.246), and bouldering (OR=13.595). Significant risk factors for overuse injuries are leading (OR=23.252) and bouldering (OR=41.260). Significant risk factors for middle phalanx injuries, which happens most frequently in climbing related injuries, are leading (OR=20.625) and bouldering (OR=25.756). For traumatic injuries, leading, speed, and bouldering are prone to cause injuries, and leading and bouldering are significant factors for overuse injuries. Therefore, it is considered that the systematic organized training can help reduce the incidence of injury.

Nodular Fasciitis with Cortical Erosion of the Hand

Nodular fasciitis is a benign, reactive myofibroblastic tumor that is often mistaken for a sarcoma because of its histological appearance and rapid growth. Involvement of a finger is extremely rare. We report a case of nodular fasciitis of the thumb, accompanied by bone erosion. Magnetic resonance findings suggested the possibility of a malignancy, which could have led to misdiagnosis as a malignant soft tissue sarcoma. Instead, the lesion was treated by excisional biopsy, which confirmed nodular fasciitis. There has been no evidence of local recurrence at recent follow-up, 1 year after surgery. This case illustrates that, to avoid unnecessarily aggressive surgery, nodular fasciitis must be included in the differential diagnosis for any finger lesion that resembles a sarcoma, even if bone erosion is present.

Nodular Fasciitis with Cortical Erosion of the Hand

Nodular fasciitis is a benign, reactive myofibroblastic tumor that is often mistaken for a sarcoma because of its histological appearance and rapid growth. Involvement of a finger is extremely rare. We report a case of nodular fasciitis of the thumb, accompanied by bone erosion. Magnetic resonance findings suggested the possibility of a malignancy, which could have led to misdiagnosis as a malignant soft tissue sarcoma. Instead, the lesion was treated by excisional biopsy, which confirmed nodular fasciitis. There has been no evidence of local recurrence at recent follow-up, 1 year after surgery. This case illustrates that, to avoid unnecessarily aggressive surgery, nodular fasciitis must be included in the differential diagnosis for any finger lesion that resembles a sarcoma, even if bone erosion is present.

Risk Factors of Past Injuries among of the Rowing Athletes Who Participated in the National Sports Festival / 대한스포츠의학회지

The purposes of this study were basic data collection and evaluation of the risk factors regarding rowing injuries through an epidemiologic study. We performed a questionnaire survey from rowers who participated in the 91th Annual Sports Festival in Jinju, Gyeongnam, in October 2010. 145 rowers (male: 84, female: 61) responded to the survey. The t-test was used for comparisons for the type of injury, age, and gender. The multiple linear regression analysis and the logistic regression analysis was used for the evaluation of risk factors. Overall, 100 (69.0%) rowers had a history of injury. The incidence of overuse injuries was significantly higher than the incidence of traumatic injuries (2.07+/-2.59/rower vs. 1.46+/-2.08/rower, p=0.027). The incidence of injuries for the adult group was significantly higher than those in the youth group (4.42+/-4.45/rower vs. 2.61+/-3.63/rower, p=0.008). There was no significant difference between males and females (3.85+/-4.33/rower vs. 3.08+/-3.87/rower, p=0.275). Also, the incidence of cross-training related injury was significantly higher in traumatic injuries rather than in overuse injuries (0.92+/-1.54/rower vs. 0.5+/-1.07/rower, p=0.008). In addition, rowing injuries were more related with overuse injuries. Risk factors regarding overall rowing injuries were training time, and training using stairs. Traumatic injuries were related with diverse cross-training and time spent cross-training. Therefore, in order to reduce the incidence of rowing injuries, time and the number of cross-training sessions should be reduced. Moreover, highly risky training such as using stairs should be replaced with other low risk training methods.

Spontaneously Regressed Bilateral Scapulothoracic Bursitis / 대한정형외과학회잡지

Scapulothoracic bursitis causes snapping scapular syndrome, which is characterized by shoulder pain accompanying bony crepitation during shoulder motion, or as an isolated entity causing shoulder discomfort. The pathogenesis of scapulothoracic bursa formation is thought to be related to chronic repetitive mechanical stress on the periscapular tissue, usually from the result of a bone abnormality (a protrusion of the scapula or rib cage). Scapulothracic bursitis is treated with conservative management and the result can be successful. Accurate diagnosis is important because surgery is not necessary except for cases with pain, excessive friction, or dysfunction. We report a patient with rapidly developed bilateral scapulothoracic bursitis without pain and snapping, which can be confused with a soft tissue sarcoma. In this case, conservative management was used to treat the patient.

Intraosseous Epidermal Inclusion Cyst in the Distal Phalanx of Thumb with Cortical Destruction: A Case Report and Review of Literature

Intraosseous epidermal inclusion cyst is a rare benign, cystic lesion. It is thought to result from traumatic implantation of epidermal elements into bone. Radiologic findings of intraosseous epidermal inclusion cysts are well-defined, lytic lesions. It is difficult to diagnose intraosseous epidermal inclusion cyst without pathologic diagnosis. We experienced a 43-year-old man with a history of trauma followed by painless expansion of his left thumb. Radiographs demonstrated a severe expansile, ill-defined lytic lesion with cortical destruction in the distal phalanx of left thumb, mimicking neoplastic bone lesion or infectious lesion. An intraosseous epidermal inclusion cyst was confirmed by pathologic diagnosis, which was lined by stratified squamous epithelium, containing keratinized cellular debris.

Revision Total Knee Arthroplasty with a Cemented Posterior Stabilized, Condylar Constrained or Fully Constrained Prosthesis: A Minimum 2-year Follow-up Analysis

BACKGROUND: The clinical and radiological outcomes of revision total knee arthroplasty with a cemented posterior stabilized (PS), condylar constrained knee (CCK) or a fully constrained rotating hinge knee (RHK) prosthesis were evaluated. METHODS: This study reviewed the clinical and radiological results of 36 revision total knee arthroplasties with a cemented PS, CCK, and RHK prosthesis in 8, 25, and 13 cases, respectively, performed between 1998 and 2006. The mean follow-up period was 30 months (range, 24 to 100 months). The reason for the revision was aseptic loosening of one or both components in 15, an infected total knee in 18 and a periprosthetic fracture in 3 knees. The average age of the patients at the time of the revision was 65 years (range, 58 to 83 years). The original diagnosis for all primary total knee arthroplasties was osteoarthritis except for one case of a Charcot joint. All revision prostheses were fixed with cement. The bone deficiencies were grafted with a cancellous allograft in the contained defect and cortical allograft fixed with a plate and screws in the noncontained defect. A medial gastrocnemius flap was needed to cover the wound dehiscence in 6 of the 18 infected cases. RESULTS: The mean Knee Society knee score improved from 28 (range, 5 to 43) to 83 (range, 55 to 94), (p < 0.001) and the mean Knee Society function score improved from 42 (range, 10 to 66) to 82 (range, 60 to 95), (p < 0.001) at the final follow-up. Good or excellent outcomes were obtained in 82% of knees. There were 5 complications (an extensor mechanism rupture in 3 and recurrence of infection in 2 cases). Three cases of an extensor mechanism defect (two ruptures of ligamentum patellae and one patellectomy) were managed by the RHK prosthesis to provide locking stability in the heel strike and push off phases, and two cases of recurrent infection used an antibiotic impregnated cement spacer. The radiological tibiofemoral alignment improved from 1.7degrees varus to 3.0degrees valgus in average. Radiolucent lines were observed in 18% of the knees without progressive osteolysis. CONCLUSIONS: Revision total knee requires a more constrained prosthesis than primary total knee arthroplasty because of the ligamentous instability and bony defect. This short to midterm follow-up analysis demonstrated that a well planned and precisely executed revision can reduce pain and improve the knee function significantly. Infected cases showed as good a result as those with aseptic loosening through the use of antibiotics-impregnated cement beads and proper soft tissue coverage with a medial gastrocnemius flap.

Therapeutic Embolization for Pseudoaneurysm of the Anterior Tibial Artery after Tibial Nailing / 대한정형외과학회잡지

Closed intramedullary nailing is a favorite surgical technique for tibial shaft fracture. After closed interlocking intramedullary nailing, proximal and distal locking screws are inserted for increasing rotational force and axial stability. Vascular complications associated with tibial nailing for fractures are very rare. Here, we described a case of a pseudoaneurysm of the anterior tibial artery after tibial nailing. We opted for minimally invasive treatment consisiting of thrombin injection and vascular plug insertion. Because pseudoaneurysm of the anterior tibial artery can induce severe complications, one should, when performing closed intramedullary nailing, make a quick diagnosis and start treatment right away.

The Follow Up Results of Residual Spinoglenoid Ganglion Cyst after Arthroscopic Decompression and Superior Labral Repair: Cases Report

PURPOSE: There are many known treatment modalities for spinoglenoid ganglion cyst accompanied by suprascapular nerve palsy. However, to the author's knowledge, there is no report on the follow-up outcomes focused on remnant cysts. MATERIALS AND METHODS: Six (n=6) patients with spinoglenoid ganglion cyst accompanied by suprascapular nerve palsy, with a mean follow-up of 15 months (12-23months) following arthroscopic cyst decompression and superior labral repair, were enrolled. Residual cyst was investigated by ultrasonography and MRI. RESULTS: Immediate postoperative ultrasonography revealed complete remission of ganglion cyst in one patient and reduced ganglion cyst size in five patients. Three-month follow-up ultrasonography showed spontaneous complete remission of the residual cysts in all patients. No recurrence on MRI was seen at one-year follow-up. CONCLUSION: Residual spinoglenoid ganglion cyst remaining after arthroscopic decompression and superior labral repair tends to resolve spontaneously within 3 months of surgery.

Poland Syndrome: A Case Report

PURPOSE: Poland syndrome is rare disease which is characterized by absence of unilateral pertoralis major muscle accompanied by ipsilateral syndactyly or brachydactyly, which was described first by Alfred Poland in 1841. MATERIALS AND METHODS: We performed the physical examination, laboratory test and radiologic evaluation to 18 year old male, who complaint asymmetry of right anterior chest. RESULTS: We diagnosed the Poland syndrome due to absence of right pectoralis major muscle and brachydactyly of right hand. CONCLUSION: Current authors report a patient who had hypopalsia of pectoralis muscles, which needed differential diagnosis with pectoralis major rupture.

Biological Characteristics of Rotator Cuff Tendon

PURPOSE: Rotator cuff disease is the most common shoulder disease. Rotator cuff tear, which is related to cuff tendon degeneration, is commonly encountered in clinical practice. MATERIALS AND METHODS: Knowledge about the biology of the normal rotator cuff is fundamental to understanding the pathophysiology of and degenerative processes in rotator cuff tendon tears. Furthermore, such basic knowledge provides a rationale for and facilitates the development of treatment modalities. RESULTS AND CONCLUSION: Therefore, we reviewed the biology of the normal rotator cuff tendon, theories to explain the pathophysiology of rotator cuff tendon tear, and current research on apoptosis of rotator cuff tenofibroblasts.

Effectiveness of the New Modified Smith-Robinson Bone Graft for Cervical Anterior Interbody Fusion / 대한정형외과학회잡지

PURPOSE: We attempted to evaluate the effectiveness of the new modified Smith-Robinson bone graft method for performing cervical anterior interbody fusion. MATERIALS AND METHODS: Forty-two patients had anterior interbody fusion on the cervical spine, using an anterior approach and the new modified Smith-Robinson's method (NMSR), between September 2001 and June 2006. There were 30 males and 12 females, with an average age of 51.2 years and the mean follow up period was 39.5 months. We measured the area from C4 to C6 in 32 cases. This was compared with the contact area of the bone graft of the NMSR method and the Original Smith-Robinson method (OSR). We also checked the time to bone union and changes of Cobb's angle at the final follow-up to evaluate the effectiveness of the NMSR. RESULTS: Bony fusion was obtained in all cases. The average size of the OSR were 169 and 152 mm2, in the males and females respectively, whereas those of the NMSR were 263, and 228 mm2. Therefore, the average size of the NMSR increased to 94 mm2 and 76 mm2 than those of the OSR method in the males and females. The average time to radiological bone union was 9.6 weeks and the changes of Cobb's angle at final follow-up were 2.5+/-2.6degrees. CONCLUSION: The NMSR technique was a very effective method for cervical anterior interbody fusion. It could enlarge the bone graft size about 50-56% compared with the OSR technique. It also shortened the period of bone union and also increased the bone union rate.

Revision Total Hip Replacement using a Cementless Wagner SL Femoral Stem

PURPOSE: To evaluate the clinical and radiological changes of femoral revision with the Wagner SL stem. MATERIALS AND METHODS: 21 femoral revisions were performed in 21 patients (16 males and 5 females; mean age 58.9 years) between June 1997 and July 2005, utilizing the Wagner SL stem. The follow-up period was a mean of 31 months (range 25-84 months). Causes of revision included aseptic loosening (14 cases), periprosthetic fracture (4 cases), recurrent total hip dislocation (2 cases), and neglected bipolar hip dislocation (1 case). Greater trochanteric osteotomy was performed in 10 cases, and extended trochanteric osteotomy was performed in 6 cases. Clinical results were assessed using Harris hip score. Radiographic parameters such as stem subsidence, calcar atrophy, and stressshielding were also assessed. RESULTS: The mean Harris hip score improved from 45.7 to 91.3. There was no removal of the implanted Wagner stem. One case of nonunion of the greater trochanter was treated by fixation with Dall-Miles cables and a trochanteric plate. There was one case of limb shortening of 2 cm. CONCLUSION: The Wagner SL stem provided immediate stability and allowed early weight-bearing. Bony regeneration around the stem was achieved without resorting to a bone graft.