Are additional screws required for press-fit fixation of cementless acetabular cups? A systematic review and meta-analysis

Abstract

Background Press-fit cementless acetabular cup is widely used in total hip arthroplasty (THA). However, the use of additional screws for the acetabular cup has been extensively debated. The purpose of this review is to compare the stability, revision rate, wear rate, and clinical scores of cementless acetabular cups with and without screws in THA. Materials and Methods Comprehensive literature searches of the following databases were performed: Cochrane Library, Pubmed, Web of Science, OVID, Elsevier ClinicalKey, Clinicaltrials.gov, and EMBASE. We searched for trials that compared cementless acetabular cups with screws or without screws, and were published in the English language. We evaluated the stability of the prosthesis by osteolysis and migration. The clinical scores included Harris hip scores (HHS) and pain scores. Results Nineteen articles involving 4046 THAs met the inclusion criteria. Our analysis revealed that additional screws did not increase the stability of acetabular cups, and there was no statistical significance between the groups with and without screws in osteolysis and clinically relevant migration. Revision rates showed no significant difference between the groups with and without screws. There was no difference in wear between the two groups. Our analysis showed no difference in pain scores and HHS between groups. Conclusion Press-fit without screws could achieve sufficient acetabular cup stability. Acetabular cups without screws showed no difference from acetabular cups with screws in many outcomes. Additional screws are not required for cementless acetabular cups. Level of evidence: Level III.

Efficacy and Safety of Acetabular Cup without Screw Fixation in Total Hip Arthroplasty: A Systematic Review and Meta-Analysis

“…Although the measured outcomes showed no significant difference between the groups with and without the addition of screws in acetabular cup, in line with previous reviews [15][16][17], we concluded that the efficacy of acetabular cups without screw fixation remained uncertain, suggesting the need for prudent clinical application. Our conclusion was different from those of previous reviews.…”

“…In the two previous systematic reviews, there was methodological concern regarding observational studies and RCTs being judged separately, and the effect size of these studies with different study designs was synthesized together. Subsequently, an earlier systematic review that synthesized the effect size from observational studies and RCTs separately reported that it was unnecessary to add screws to the acetabular cup [17]. However, duplication of participants was assumed because the same studies with different observation periods were synthesized in the osteolysis section.…”

“…Several randomized controlled trials (RCTs) [8,[10][11][12][13][14] and a few systematic reviews [14][15][16] have investigated the effects of screw fixation in cementless cup THA. The first systematic review published by Ni et al in 2014 [14] was updated by Fei et al in 2020 [16] and Ni et al in 2022 [17]. While these reviews integrated the existing data to provide clinically useful data and reported no benefits of screw fixation, the risk-of-bias assessment was inadequate.…”

Acetabular cup fixation with and without screws following primary total hip arthroplasty: migration evaluated by radiostereometric analysis

“…Still, the use of screws to supplement acetabular fixation is unsettled in literature, leaving the choice to surgeon preference. 24 As such, the purpose of this study was to assess acetabular migration between cups fixated with and without the use of screws. Initial cup position is an important determinant of THA success since cup malposition increases the risk of revision surgery, as it can lead to impingement, reduced range of motion, dislocation, wear and osteolysis, loosening and cup failure.…”

Hip & Pelvis

“…A research team based in Liaoning (China) did an excellent job of performing a thorough systematic review of all trials comparing outcomes in screw augmentation versus no screw in press-fit uncemented cups. 3 They identified 19 trials with 4,046 hip arthroplasties that had similar outcomes (stability, Harris Hip Score (HHS), and pain). They report that the meta-analysis showed no difference for: stability, osteolysis and migration, wear, revision rates, HHS, or pain.…”