Highly Porous Tantalum Acetabular Components Without Ancillary Screws Have Similar Migration to Porous Titanium Acetabular Components With Screws at 2 Years: A Randomized Controlled Trial
“…After a preliminary review, 3928 studies were excluded because of overlapping records or obviously irrelevant studies; 1209 articles were excluded because they were case reports, reviews, were not human studies, or were in a language other than English; and 17 articles were excluded because there was no comparison, the improper acetabular cup was used, or there was no available data. Therefore, a total of 19 articles [ 4 , 7 – 11 , 15 , 17 – 19 , 23 – 31 ] with 21 studies comparing the cementless press-fit acetabular cup with and without screws were included. Fig.…”
Section: Resultsmentioning
confidence: 99%
“…[ 8 ] Cohort study 791 9.6 (5–15) Posterolateral Ceramic; PE Ceramic; Metal Osteolysis; migration; revision – 8 Howie et al. [ 17 ] RCT 66 2 Posterior PE Cobalt-chrome Osteolysis; translation; Rotation; HHS 5 – Iorio et al. [ 25 ] Cohort study 775 2–10 NA PE NA Osteolysis; migration; revision – 8 Merican et al.…”
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.
“…After a preliminary review, 3928 studies were excluded because of overlapping records or obviously irrelevant studies; 1209 articles were excluded because they were case reports, reviews, were not human studies, or were in a language other than English; and 17 articles were excluded because there was no comparison, the improper acetabular cup was used, or there was no available data. Therefore, a total of 19 articles [ 4 , 7 – 11 , 15 , 17 – 19 , 23 – 31 ] with 21 studies comparing the cementless press-fit acetabular cup with and without screws were included. Fig.…”
Section: Resultsmentioning
confidence: 99%
“…[ 8 ] Cohort study 791 9.6 (5–15) Posterolateral Ceramic; PE Ceramic; Metal Osteolysis; migration; revision – 8 Howie et al. [ 17 ] RCT 66 2 Posterior PE Cobalt-chrome Osteolysis; translation; Rotation; HHS 5 – Iorio et al. [ 25 ] Cohort study 775 2–10 NA PE NA Osteolysis; migration; revision – 8 Merican et al.…”
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.
“…29 It is worth noting that double examinations were previously conducted to investigate the precision of RSA measurements at our center on the same implant. Howie et al 27 reported a mean precision of 0.009 mm (99% confidence interval: 0.010-0.029 mm) for proximal RSA migration measurements.…”
Section: Rsa Methodologymentioning
confidence: 99%
“…A uniplanar RSA setup was used. Two mobile radiographic machines (Shimadzu Mobile X‐ray machine) were positioned 1.6 m above a calibration cage (Cage DRX‐1; RSA Biomedical) with a resultant 40° angle between the tubes in the same manner as previously described 27 . The calibration cage contained two 35 cm × 43 cm high‐resolution digital radiographic cassettes (Direct Digitizer AeroDR System 2; Konica Minolta Inc.).…”
While finite element (FE) models have been used extensively in orthopedic studies, validation of their outcome metrics has been limited to comparison against ex vivo testing. The aim of this study was to validate FE model predictions of the initial cup mechanical environment against patient‐matched in vivo measurements of acetabular cup migration using radiostereometric analysis (RSA). Tailored musculoskeletal and FE models were developed using a combination of three‐dimensional (3D) motion capture data and clinical computerized tomography (CT) scans for a cohort of eight individuals who underwent primary total hip replacement and were prospectively enrolled in an RSA study. FE models were developed to calculate the mean modulus of cancellous bone, composite peak micromotion (CPM), composite peak strain (CPS) and percentage area of bone ingrowth. The RSA cup migration at 3 months was used to corroborate the FE output metrics. Qualitatively, all FE‐predicted metrics followed a similar rank order as the in vivo RSA 3D migration data. The two cases with the lowest predicted CPM (<20 µm), lowest CPS (<0.0041), and high bone modulus (>917 MPa) were confirmed to have the lowest in vivo RSA 3D migration (<0.14 mm). The two cases with the largest predicted CPM (>80 µm), larger CPS (>0.0119) and lowest bone modulus (<472 MPa) were confirmed to have the largest in vivo RSA 3D migration (>0.78 mm). This study enabled the first corroboration between tailored musculoskeletal and FE model predictions with in vivo RSA cup migration. Investigation of additional patient‐matched CT, gait, and RSA examinations may allow further development and validation of FE models.
“…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].…”
Background and Objectives: Adequate initial fixation of the uncemented acetabular component in total hip arthroplasty is necessary to achieve long-term survival. Although screw fixation contributes to improved cup stability, there is currently no consensus on the use of this method. This study aimed to assess the existing randomized controlled trials (RCTs) on the efficacy and safety of cup fixation in total hip arthroplasty without screws. Materials and Methods: We searched the EMBASE, MEDLINE, Cochrane Central Register of Controlled Trials, World Health Organization International Clinical Trials Registry Platform, and ClinicalTrials.gov databases to identify RCTs published before February 2022. Primary outcomes were reoperation, cup migration, and Harris Hip Score. Secondary outcomes were the presence of a radiolucent line in the acetabular region, translation and rotation movement, and polyethylene wear. We conducted meta-analyses using the random-effects models. The revised Cochrane risk-of-bias tool was used to assess the risk of bias for outcomes of interest; the Grading of Recommendations, Assessment, Development, and Evaluation approach was used to summarize the body of evidence. Results: We included six reports from four studies. Total hip arthroplasty without screw fixation to the acetabular cup had little to no effect on reoperation (pooled relative risk, 0.98; 95% confidence interval, 0.14–6.68; I2 = 0%), cup migration (pooled relative risk, 1.72; 95% confidence interval, 0.29–10.33; I2 = 1%), Harris Hip Score (mean difference, 1.19; 95% confidence interval, −1.31–3.70; I2 = 0%), radiolucent line (pooled relative risk, 5.91; 95% confidence interval, 0.32–109.35), translation and rotation of all axes, and polyethylene wear (mean difference, 0.01; 95% confidence interval, −0.01–0.04; I2 = 0%), with very low certainty of evidence on all measures. Conclusions: The efficacy of acetabular cups without screw fixation in total hip arthroplasty remains uncertain, suggesting the need for prudent clinical application. Further large-scale, well-designed studies with low risk of bias are required.
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