Uncemented cups with and without screw holes in primary THA: a Swedish Hip Arthroplasty Register study with 22,725 hips

Abstract

Background and purpose — Uncemented cups in total hip arthroplasty (THA) are often augmented with additional screws to enhance their primary stability. We investigated whether there is a difference in the risk for revision between cups with screw holes and cups without screw holes. Patients and methods — We analyzed the risk for cup revision of uncemented cups registered in the Swedish Hip Arthroplasty Register (SHAR) between 2000 and 2017 with respe ct to the presence of screw holes. Only patients with primary osteoarthritis (OA) were included. 22,725 cups, including 12,354 without screw holes and 10,371 with screw holes, were evaluated. Revision rates at 2 and 10 years after the primary operation were analyzed. Results — At a median follow-up time of 3.4 years (0–18), 459 cup revisions were reported. The main reasons for cup revision during the whole observation time were infection, 52% of all cup revisions, and dislocation, 26% of all cup revisions. The survival rate with cup revision due to aseptic loosening as endpoint was 99.9% (95% CI 99.8–99.9) at 2 years for both cups with and cups without screw holes, and the survival rates at 10 years were 99.5% (CI 99.3–99.7) and 99.1% (CI 98.6–99.5), respectively. Cups without screw holes showed a decreased risk of revision due to any reason at both 2 years (adjusted hazard ratio [HR] 0.6, CI 0.5–0.8) and 10 years (HR 0.7, CI 0.5–0.9). Interpretation — We found a very low revision rate for aseptic loosening with modern, uncemented cup designs. Cups with screw holes had an increased risk of revision due to any reason in patients with primary OA

How to Prevent Aseptic Loosening in Cementless Arthroplasty: A Review

“…Acetabular cups without screw holes have a lower rate of revision compared to ones with screw holes, as shown by Otten et al in a study on 22,725 primary total hip replacements [12]. The authors showed that the rate of aseptic loosening was not statistically significant between the two, but a limitation of the study was a mean follow-up of only 3.4 years (0-18) [12].…”

Can a Nomogram Predict the Failure Risk of Internal Fixation Devices in Chinese Patients Undergoing Hip Arthroplasty?

“…An earlier study has reported uctuations in the inclination and shape of the acetabular cup following screw insertion [24]. Notably, the risk of acetabular cup revision using screw holes is higher in patients with primary osteoarthritis [24][25]. The inclination and angle of patients are different, and balance must be achieved between restoring the original anatomical structure of patients and establishing stable joints [26].…”