Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2022 Aug 5;58(8):1058.
doi: 10.3390/medicina58081058.

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

Takanori Miura  1 , Hiroaki Kijima  2 , Ryota Kimura  2 , Jun Watanabe  3   4   5 , Yuji Okazaki  3   6 , Naohisa Miyakoshi  2
Affiliations
Meta-Analysis

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

Takanori Miura et al. Medicina (Kaunas). .

Abstract

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.

Keywords: bone screws; cementless acetabular cup; hip osteoarthritis; meta-analysis; systematic review; total hip replacement.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflict of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript; or in the decision to publish the results.

Figures

Figure 1
Figure 1
PRISMA flow diagram of the literature results. (CENTRAL: the Cochrane Central Register of Controlled Trials; ICTRP: the World Health Organization International Clinical Trials Registry Platform).
Figure 2
Figure 2
Risk-of-bias summary [8,10,11,12,13,14].
Figure 3
Figure 3
Forest plot of reoperation in the without and with screw fixation groups [10,14]. (M-H: Mantel-Haenszel test, df: degrees of freedom).
Figure 4
Figure 4
(a) Forest plot of acetabular cup migration with and without screw fixation. (b) Forest plot for sensitivity analysis for the cup migration [10,11,12,13].
Figure 5
Figure 5
Forest plot of Harris Hip Score in the without and with screw fixation groups [10,11,13,14]. (IV: inverse variance method).
Figure 6
Figure 6
Forest plot of translation and rotation cup movement between the without and with screw fixation groups [10,11,13,14].
Figure 7
Figure 7
Forest plot of polyethylene wear between the without and with screw fixation groups [11,13,14].
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Liu X., Niebur G.L. Bone ingrowth into a porous coated implant predicted by a mechano-regulatory tissue differentiation algorithm. Biomech. Model. Mechanobiol. 2008;7:335–344. doi: 10.1007/s10237-007-0100-3. - DOI - PubMed
    1. Bobyn J.D., Stackpool G.J., Hacking S.A., Tanzer M., Krygier J.J. Characteristics of bone ingrowth and interface mechanics of a new porous tantalum biomaterial. J. Bone Jt. Surg. Br. 1999;81:907–914. doi: 10.1302/0301-620X.81B5.0810907. - DOI - PubMed
    1. Lehil M.S., Bozic K.J. Trends in total hip arthroplasty implant utilization in the United States. J. Arthroplast. 2014;29:1915–1918. doi: 10.1016/j.arth.2014.05.017. - DOI - PubMed
    1. Pijls B.G., Nieuwenhuijse M.J., Fiocco M., Plevier J.W., Middeldorp S., Nelissen R.G., Valstar E.R. Early proximal migration of cups is associated with late revision in THA: A systematic review and meta-analysis of 26 RSA studies and 49 survivalstudies. Acta Orthop. 2012;83:583–591. doi: 10.3109/17453674.2012.745353. - DOI - PMC - PubMed
    1. Tabata T., Kaku N., Hara K., Tsumura H. Initial stability of cementless acetabular cups: Press-fit and screw fixation interaction-an in vitro biomechanical study. Eur. J. Orthop. Surg. Traumatol. 2015;25:497–502. doi: 10.1007/s00590-014-1571-4. - DOI - PMC - PubMed