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Clinical Trial
. 2024 Jan;34(1):42-48.
doi: 10.1177/11207000231164711. Epub 2023 Apr 5.

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

Jennifer S Polus  1   2   3 , Edward M Vasarhelyi  4 , Brent A Lanting  4 , Matthew G Teeter  1   2   3   5
Affiliations
Clinical Trial

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

Jennifer S Polus et al. Hip Int. 2024 Jan.

Abstract

Background: Early cup migration after total hip arthroplasty (THA) is correlated to late revision due to aseptic loosening. However, the use of screws for increased cup stability remains unclear and debated. The purpose of this study is to assess acetabular migration between cups fixated with and without the use of screws.

Methods: Patients underwent primary THA using either a direct anterior (DA) or a direct lateral (DL) approach. The DA surgeon routinely supplemented cup fixation with 1 or 2 screws while the DL surgeon used no screws. At 7 follow-up visits up to 2 years post operation, patients underwent radiostereometric analysis (RSA) imaging for implant migration tracking. The primary outcome was defined as proximal cup migration measured with model-based RSA.

Results: 68 patients were assessed up to 2 years post operation, n = 43 received screws and n = 25 did not. The use of screws had a significant effect on cup migration (p = 0.018). From 2 weeks to 2 years post operation, the total mean migration was 0.403 ± 0.681 mm and 0.129 ± 0.272 mm (p = 0.319) for cups with and without screws, respectively. The number of screws used also had a significant impact, with cups fixated with 1 screw migrating more than cups fixated with 2 (p = 0.013, mean difference 0.712 mm).

Conclusions: Acetabular cups fixated with only 1 screw resulted in greater migration than cups with no screws or 2 screws, though the mean magnitude was well under the 1.0 mm threshold for unacceptable migration. However, 3 of the 24 patients who received only 1 screw exceeded the 1.0 mm threshold for unacceptable migration. Ultimately, the results of this study show that the use of 2 screws to supplement cup fixation can provide good implant stability that is equivalent to a secure press-fit component with no screws.Clinical trial registration: ClinicalTrials.gov (NCT03558217).

Keywords: Acetabular cup; migration; radiostereometric analysis; screw fixation; total hip arthroplasty.

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Conflict of interest statement

Declaration of conflicting interestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: EMV: Receives grants from DePuy, Microport; Receives consulting fees from DePuy, Zimmer Biomet; Receives institutional and research support from DePuy, Smith and Nephew, Stryker, Zimmer Biomet; Participates on an advisory board with Hip Innovation Technology.BAL: Receives grants, consulting fees, and institutional and research support from DePuy, Smith and Nephew, Stryker.All other authors declare that there is no conflict of interest.

Figures

Figure 1.
Figure 1.
CONSORT study flow diagram.
Figure 2.
Figure 2.
Comparing proximal migration (y-axis translation) between cups fixated with or without screws (p = 0.018).
Figure 3.
Figure 3.
Comparing proximal migration (y-axis translation) between cups fixated with 1 or 2 screws (p = 0.013), 1 or no screws (p = 0.0004) and 2 or no screws (p = 0.758).
See this image and copyright information in PMC

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