The use of acetabular screws in total hip arthroplasty and its influence on wear and periacetabular osteolysis in the long-term follow-up

Abstract

Purpose The cementless implantation of hip replacement cups may be performed with and without the additional use of acetabular screws. If the surgeon uses screws or not depends on variable factors. In general, the use of screws is intended to increase the primary stability of the cup. Whether screws increase the initial stability of the cup construct, or even reduce it in part, is the subject of considerable debate in the literature. It is also unclear whether the additional screws lead to increased wear or increased periacetabular osteolysis over the long-term course. Methods Two hundred eleven patients from a previous study with a minimum follow-up of 10.7 years were included. Of these, 68 patients with 82 total hip arthroplasties (THA) were given clinical and radiological follow-up examinations. Of these, 52 had been fitted without screws and 30 with screws. On the basis of radiographs, annual wear and osteolysis were quantified. The clinical results were recorded by means of VAS, HHS, and WOMAC scores. Results Significantly more periacetabular osteolysis was found if additive acetabular screws had been used. No difference was found in relation to the volumetric wear per year. Likewise, no difference was found with regard to the clinical scores. Conclusions The use of additive acetabular screws leads to increased osteolysis in the periacetabular bone stock. Insofar as the primary stability of the cementless cup construct allows it, no additional acetabular screws should be used.

Revisions- und Wechselendoprothetik – Azetabulum

“…Als Versagensursachen von modularen Pfannensystemen kann dieser Abrieb sowohl auf der Seite der Gleitpaarung als auch durch das zusätzliche Interface zwischen azetabulärer Komponente (Metalback) und dem modularen Inlay (Backside Wear) auftreten [7]. Zentrale Öffnungen und Schraubenperforationen zementfreier modularer Pfannensysteme erlauben retrograd einen direkten Polyethylen-Knochen-Kontakt, in dessen Folge periazetabuläre Osteolysen und höhere Lockerungsraten publiziert wurden [8,9,10].…”

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

“…The use of screws in uncemented THA is intended to support and aid in the primary fixation of the press-fit cup; however, whether this is the case remains an unclear and debated topic in literature. 9 , 10 A meta-analysis performed by Fei et al 11 found screws had no significant impact on cup stability, however, a study by Tabata et al 12 indicated increased primary stability of the cup with the use of screws. Further, a registry study found that screws did not provide protection against acetabular cup loosening but also did not have any long-term negative consequences.…”

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

“…Additional screw fixation is often applied to improve acetabular cup stability during initial fixation [5]. Although it may not reduce the need for future revision or reoperation [6], there are reports of periacetabular osteolysis owing to the infiltration of joint fluid and polyethylene wear particles through the screw hole that may lead to loosening of the cup in the long term [5,[7][8][9]. Therefore, the long-term effectiveness of screws in acetabular cup THA remains unclear.…”