A controlled diaphyseal expansion osteotomy for the implantation of a wagner cone prosthesis in a stenotic femoral canal encountered in a polio limb: a case report of the technique


  • Tushar S. Kadam Department of Orthopaedics, Seth G. S. Medical College and King Edward VII Memorial Hospital, Mumbai, Maharashtra, India
  • Mohan M. Desai Department of Orthopaedics, Seth G. S. Medical College and King Edward VII Memorial Hospital, Mumbai, Maharashtra, India




Arthroplasty, Femur, Osteotomy, Poliomyelitis


Dysplastic hips pose a significant technical challenge to arthroplasty surgeons. Such deformed hips might be encountered either in congenital and developmental conditions or as sequel of neuromuscular disorders (like poliomyelitis), following infections, or after childhood surgical procedures of the hip. The scientific literature, focussing on total hip arthroplasty (THA), for coxarthrosis in patients with residual poliomyelitis, is relatively rare. Several anatomical distortions seen in dysplastic femurs are described, one of which includes an undersized diaphysis with a stenotic medullary canal. We present a case of a 28 years old male with residual poliomyelitis who underwent a cementless THA for a non united transcervical neck of femur fracture. The patient had an extremely narrow medullary canal which posed a formidable difficulty in the procedure. This was overcome by a novel diaphyseal expansion osteotomy, which enabled the implantation of Wagner Cone prosthesis. This technique, which has hitherto not been described in the literature, can significantly facilitate the implantation of an appropriately sized stem in an undersized femur while at the same time ensuring a good long-term result.

Author Biographies

Tushar S. Kadam, Department of Orthopaedics, Seth G. S. Medical College and King Edward VII Memorial Hospital, Mumbai, Maharashtra, India

Senior Registrar

Department of Orthopaedics

Mohan M. Desai, Department of Orthopaedics, Seth G. S. Medical College and King Edward VII Memorial Hospital, Mumbai, Maharashtra, India

Professor and Chief of Unit

Department of Orthopaedics


Haddad FS, Masri BA, Garbuz DS, Duncan CP.Primary total replacement of the dysplastic hip. Instr Course Lect.2000;49:23-39.

Cabanela ME, Weber M. Total hip arthroplasty in patients with neuromuscular disease. Instr Course Lect. 2000;49:163-8.

Post-Polio Syndrome Fact Sheet,2019. Available at:https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Post-Polio-Syndrome-Fact-Sheet.Accessed:September22, 2019.

Yoon BH, Lee YK, Yoo JJ, Kim HJ, Koo KH.Total hip arthroplasty performed in patients with residual poliomyelitis: does it work? Clin Orthop Relat Res. 2014;472(3):933-40.

Queally JM, Abdulkarim A, Mulhall KJ.Total hip replacement in patients with neurological conditions. J Bone Joint Surg Br.2009;91(10):1267-73.

Sobrón FB, Martínez-Ayora Á, Cuervas-Mons M, Quevedo T, Laguna R, Vaquero J.Total hip arthroplasty in patients of post-polio residual paralysis: a retrospective case series. Indian J Orthop. 2017;51(4):434-39.

Sugano N, Noble PC, Kamaric E, Salama JK, Ochi T, Tullos HS.The morphology of the femur in developmental dysplasia of the hip. J Bone Joint Surg Br. 1998;80(4):711-9.

Bicanic G, Barbaric K, Bohacek I, Aljinovic A, Delimar D.Current concept in dysplastic hip arthroplasty: techniques for acetabular and femoral reconstruction. World J Orthop. 2014;5(4):412-24.

Sheth NP, Melnic CM, Rozell JC, Paprosky WG.Management of severe femoral bone loss in revision total hip arthroplasty. Orthop Clin North Am.2015;46(3):329-42.

Brown JM, Mistry JB, Cherian JJ, Elmallah RK, Chughtai M, Harwin SF, et al.Femoral component revision of total hip arthroplasty. Orthopedics.2016;39(6):1129-39.

Parry MC, Vioreanu MH, Garbuz DS, Masri BA, Duncan CP.The Wagner cone stem for the management of the challenging femur in primary hip arthroplasty. J Arthroplasty.2016;31(8):1767-72.

Schuh A, Schraml A, Hohenberger G.Long-term results of the Wagner cone prosthesis. Int Orthop. 2009;33(1):53-8.

Waligora AC IV, Owen JR, Wayne JS, Hess SR, Golladay GJ, Jiranek WA.The effect of prophylactic cerclage wires in primary total hip arthroplasty: a biomechanical study. J Arthroplasty. 2017;32(6):2023-27.

Herzwurm PJ, Walsh J, Pettine KA, Ebert FR.Prophylactic cerclage: a method of preventing femur fracture in uncemented total hip arthroplasty. Orthopedics.1992;15(2):143-6.

Young PS, Patil S, Meek RMD.Intraoperative femoral fractures: prevention is better than cure. Bone Joint Res.2018;7(1):103-4.

Nwankwo CD, Parrish R, Leasure J, McGann WA. Prophylactic cerclage with braided polyblend suture during femoral broaching. Orthopedics.2016;39(6):1183-87.

Incavo SJ, DiFazio F, Wilder D, Howe JG, Pope M. Longitudinal crack propagation in bone around femoral prosthesis. Clin Orthop Relat Res.1991;(272):175-80.

Lenz M, Perren SM, Gueorguiev B,Richards RG, Hofmann GO, Fernandez dell'Oca A, et al.A biomechanical study on proximal plate fixation techniques in periprosthetic femur fractures. Injury. 2014;45 Suppl 1:S71-5.

Kalhor M, Nötzli HP, Stover MD, Ganz R. Extreme ectasia of the femoral diaphysis secondary to loosening of a long Wagner stem. A case report. J Bone Joint Surg Am.2004;86(3):590-4.

Perka C, Fischer U, Taylor WR, Matziolis G. Developmental hip dysplasia treated with total hip arthroplasty with a straight stem and a threaded cup. J Bone Joint Surg Am. 2004;86(2):590-4.