Skip to main content

Advertisement

SpringerLink
Log in

Acetabular screws do not improve early revision rates in primary total hip arthroplasty. An instrumented registry analysis

  • Original Paper
  • Published:
International Orthopaedics Aims and scope Submit manuscript

Abstract

Background

Initial stability of uncemented acetabular components in total hip arthroplasty (THA) is important for osseointegration and potentially enhanced by screw fixation. We used Australian Orthopaedic Association National Joint Replacement Registry data to determine whether screw usage influences uncemented acetabular component survival.

Methods

Primary THA with uncemented acetabular components performed for osteoarthritis from 1999 to 2018 was included. Survivorship was calculated using Kaplan-Meier estimates of cumulative percent revision (CPR). Comparisons used Cox proportional hazards method. An instrumental variable analysis adjusted for surgeon preference for screws as a confounding factor was used.

Results

Three hundred thirty thousand one hundred ninety-two THAs were included (31.8% with screws, 68.2% without). Two hundred twenty thousand six hundred seven were included in the instrumental variable analysis. Revision rate of acetabular components (all causes) was higher with screws during the first six years (hazard ratio (HR) = 1.45 (95% CI 1.34, 1.57), p < 0.001) and lower thereafter (HR = 0.81 (95% CI 0.67, 0.98), p = 0.027). Revision rate of acetabular components for loosening was higher with screws over the entire study period (HR = 1.73 (95% CI 1.51, 1.98), p < 0.001). Overall THA revision rate was higher with screws during the first six years (HR = 1.20 (95% CI 1.15, 1.26), p < 0.001) but lower thereafter (HR = 0.89 (95% CI 0.81, 0.98), p = 0.020). Revision rate for dislocation was higher with screws over the entire period (HR = 1.16 (95% CI 1.06, 1.26), p < 0.001). Instrumental variable analysis revealed higher revision rates with acetabular screws in the first six years. (HR = 1.18 (95% CI 1.09–1.29), p < 0.001).

Conclusion

Screws did not confer a protective effect against acetabular loosening and were not associated with long-term negative consequences.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others

Data availability

Data was extracted from the AOANJRR database.

References

  1. Tabata T, Kaku N, Hara K, Tsumura H (2015) Initial stability of cementless acetabular cups: press-fit and screw fixation interaction--an in vitro biomechanical study. Eur J Orthop Surg Traumatol 25(3):497–502. https://doi.org/10.1007/s00590-014-1571-4

    Article  PubMed  Google Scholar 

  2. Pilliar RM, Lee JM, Maniatopoulos C (1986) Observations on the effect of movement on bone ingrowth into porous-surfaced implants. Clin Orthop Relat Res 208:108–113

    Google Scholar 

  3. Fujishiro T, Hayashi S, Kanzaki N, Hashimoto S, Shibanuma N, Kurosaka M (2014) Effect of screw fixation on acetabular component alignment change in total hip arthroplasty. Int Orthop 38(6):1155–1158. https://doi.org/10.1007/s00264-013-2271-0

    Article  PubMed  PubMed Central  Google Scholar 

  4. Suksathien Y, Piyapromdee U, Tippimanchai T (2019) Cup alignment change after screw fixation in total hip arthroplasty. Indian J Orthop 53(5):618–621. https://doi.org/10.4103/ortho.IJOrtho_451_18

    Article  PubMed  PubMed Central  Google Scholar 

  5. Huk OL, Bansal M, Betts F, Rimnac CM, Lieberman JR, Huo MH, Salvati EA (1994) Polyethylene and metal debris generated by non-articulating surfaces of modular acetabular components. J Bone Joint Surg Br 76(4):568–574

    Article  CAS  Google Scholar 

  6. AOA (2019) Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR). Hip, knee & shoulder arthroplasty: 2019 Annual Report. AOA, Adelaide

  7. Columbo JA, Martinez-Camblor P, MacKenzie TA, Staiger DO, Kang R, Goodney PP, O'Malley AJ (2018) Comparing long-term mortality after carotid endarterectomy vs carotid stenting using a novel instrumental variable method for risk adjustment in observational time-to-event data. JAMA Netw Open 1(5):e181676. https://doi.org/10.1001/jamanetworkopen.2018.1676

    Article  PubMed  PubMed Central  Google Scholar 

  8. New Zealand Joint Registry Nineteen Year Report. (2018). https://nzoa.org.nz/system/files/DH8152_NZJR_2018_Report_v6_4Decv18.pdf

  9. NJR (2018) National Joint Registry Report For England, Wales and Northern Ireland. vol 15th Annual Report

  10. Hsu JT, Chang CH, Huang HL, Zobitz ME, Chen WP, Lai KA, An KN (2007) The number of screws, bone quality, and friction coefficient affect acetabular cup stability. Med Eng Phys 29(10):1089–1095. https://doi.org/10.1016/j.medengphy.2006.11.005

    Article  PubMed  Google Scholar 

  11. Won CH, Hearn TC, Tile M (1995) Micromotion of cementless hemispherical acetabular components. Does press-fit need adjunctive screw fixation? J Bone Joint Surg Br 77(3):484–489

    Article  CAS  Google Scholar 

  12. Otten V, Mukka S, Nilsson K, Crnalic S, Karrholm J (2019) Uncemented cups with and without screw holes in primary THA: a Swedish hip arthroplasty register study with 22,725 hips. Acta Orthop 90(3):258–263. https://doi.org/10.1080/17453674.2019.1599777

    Article  PubMed  PubMed Central  Google Scholar 

  13. Ni SH, Guo L, Jiang TL, Zhao J, Zhao YG (2014) Press-fit cementless acetabular fixation with and without screws. Int Orthop 38(1):7–12. https://doi.org/10.1007/s00264-013-2075-2

    Article  PubMed  Google Scholar 

  14. Fei C, Wang PF, Wei W, Qu SW, Yang K, Li Z, Zhuang Y, Zhang BF, Zhang K (2020) Relationship between use of screws and acetabular cup stability in total hip arthroplasty: a meta-analysis. J Int Med Res 48(2):300060520903649. https://doi.org/10.1177/0300060520903649

    Article  PubMed  Google Scholar 

  15. Natera L, Valera M, Gomez EM, Ibanez N, Crusi X, Sancho R (2017) Survival of hydroxyapatite-coated cups: acetabular screws involve a lower rate of revision surgery due to aseptic loosening. Hip Int 27(2):153–161. https://doi.org/10.5301/hipint.5000435

    Article  PubMed  Google Scholar 

  16. Pidhorz LE, Urban RM, Jacobs JJ, Sumner DR, Galante JO (1993) A quantitative study of bone and soft tissues in cementless porous-coated acetabular components retrieved at autopsy. J Arthroplast 8(2):213–225. https://doi.org/10.1016/s0883-5403(09)80015-6

    Article  CAS  Google Scholar 

  17. Swarts E, Bucher TA, Phillips M, Yap FH (2015) Does the ingrowth surface make a difference? A retrieval study of 423 cementless acetabular components. J Arthroplast 30(4):706–712. https://doi.org/10.1016/j.arth.2014.10.028

    Article  Google Scholar 

  18. Otten VT, Crnalic S, Rohrl SM, Nivbrant B, Nilsson KG (2016) Stability of uncemented cups - long-term effect of screws, pegs and HA coating: a 14-year RSA follow-up of Total hip Arthroplasty. J Arthroplast 31(1):156–161. https://doi.org/10.1016/j.arth.2015.07.012

    Article  Google Scholar 

  19. Minten MJ, Heesterbeek PJ, Spruit M (2016) No effect of additional screw fixation of a cementless, all-polyethylene press-fit socket on migration, wear, and clinical outcome. Acta Orthop 87(4):363–367. https://doi.org/10.1080/17453674.2016.1190244

    Article  PubMed  PubMed Central  Google Scholar 

  20. Pakvis D, Luites J, van Hellemondt G, Spruit M (2012) A cementless, elastic press-fit socket with and without screws. Acta Orthop 83(5):481–487. https://doi.org/10.3109/17453674.2012.720116

    Article  PubMed  PubMed Central  Google Scholar 

  21. Rohrl SM, Nivbrant B, Strom H, Nilsson KG (2004) Effect of augmented cup fixation on stability, wear, and osteolysis: a 5-year follow-up of total hip arthroplasty with RSA. J Arthroplast 19(8):962–971. https://doi.org/10.1016/j.arth.2004.06.024

    Article  Google Scholar 

  22. Thanner J, Karrholm J, Herberts P, Malchau H (2000) Hydroxyapatite and tricalcium phosphate-coated cups with and without screw fixation: a randomized study of 64 hips. J Arthroplast 15(4):405–412. https://doi.org/10.1054/arth.2000.2963

    Article  CAS  Google Scholar 

  23. Rohrl SM, Nivbrant B, Snorrason F, Karrholm J, Nilsson KG (2006) Porous-coated cups fixed with screws: a 12-year clinical and radiostereometric follow-up study of 50 hips. Acta Orthop 77(3):393–401. https://doi.org/10.1080/17453670610046316

    Article  PubMed  Google Scholar 

  24. Fehring KA, Owen JR, Kurdin AA, Wayne JS, Jiranek WA (2014) Initial stability of press-fit acetabular components under rotational forces. J Arthroplast 29(5):1038–1042. https://doi.org/10.1016/j.arth.2013.10.009

    Article  Google Scholar 

  25. Goodnough LH, Bonano JC, Finlay AK, Aggarwal VK, Huddleston JI 3rd, Maloney WJ, Goodman SB, Amanatullah DF (2020) Selective screw fixation is associated with early failure of primary acetabular components for aseptic loosening. J Orthop Res. https://doi.org/10.1002/jor.24649

  26. Blakeney WG, Khan H, Khan RJ (2015) Cluster hole versus solid cup in total hip arthroplasty: a randomized control trial. J Arthroplast 30(2):223–229. https://doi.org/10.1016/j.arth.2014.08.027

    Article  Google Scholar 

  27. New Zealand National Joint Registry Report (2017). vol 18th Annual Report

  28. Gallen RA, Khan RJK, Haebich SJ, Karamfiles SH, Khan H (2018) Solid cup vs cluster hole in total hip arthroplasty: a 10-year randomized control trial. J Arthroplast 33(4):1113–1119. https://doi.org/10.1016/j.arth.2017.10.058

    Article  Google Scholar 

Download references

Acknowledgements

We acknowledge the Australian Orthopaedic Association National Joint Replacement Registry for the access to the data used in this study.

Author information

Authors and Affiliations

  1. Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Port Road, Adelaide, SA5000, Australia

    Mary Nugent & Lucien B. Solomon

  2. Wakefield Orthopaedic Clinic, Adelaide, SA5000, Australia

    David G. Campbell

  3. Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR), Adelaide, SA5000, Australia

    Peter L. Lewis & Alana R. Cuthbert

Authors
  1. Mary Nugent
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. David G. Campbell
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Peter L. Lewis
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Alana R. Cuthbert
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Lucien B. Solomon
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

MN: manuscript preparation and editing

DGC: project conception and advice and manuscript editing

PLL: manuscript editing and data requisition from AOANJRR

ARC: statistical analysis

LBS: manuscript editing and advice

Corresponding author

Correspondence to Mary Nugent.

Ethics declarations

Ethics approval

The AOANJRR is approved by the Australian Federal Government as a Declaration of Quality Assurance Activity under section 124X of the Australian Federal Health Insurance Act, 1973. All investigations were conducted in accordance with ethical principles of research (the Helsinki Declaration II).

Consent to participate

All patients consented to data collection by the AOANJRR (anonymized analysis).

Consent to publish

Consent for AOANJRR includes use of database in published reports and scientific papers.

Conflict of interest

  • Financial interests

    DGC received royalties from Smith & Nephew (unrelated work) and research support from Stryker (unrelated work). LBS received research support funding from Zimmer Biomet (unrelated work). PL is a paid director of the Australian Orthopaedic Association National Joint Replacement Registry. MN and AC have no financial interests.

  • Non-financial interests

    LBS holds positions on the editorial board of the Journal of Clinical Medicine and is a committee member of the Australian and New Zealand Orthopaedic Research Society.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Nugent, M., Campbell, D.G., Lewis, P.L. et al. Acetabular screws do not improve early revision rates in primary total hip arthroplasty. An instrumented registry analysis. International Orthopaedics (SICOT) 45, 593–604 (2021). https://doi.org/10.1007/s00264-021-04949-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00264-021-04949-y

Keywords

Search

Navigation