School of Biomedical Engineering, Western University, London, Ontario, Canada.
Imaging Research Laboratories, Robarts Research Institute, Western University, London, Ontario, Canada.
Hip Int. 2024 Jan;34(1):42-48. doi: 10.1177/11207000231164711. Epub 2023 Apr 5.
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.
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.
68 patients were assessed up to 2 years post operation, = 43 received screws and = 25 did not. The use of screws had a significant effect on cup migration ( = 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 ( = 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 ( = 0.013, mean difference 0.712 mm).
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).
全髋关节置换术后早期杯迁移与无菌性松动导致的晚期翻修有关。然而，使用螺钉增加杯稳定性的效果仍不清楚，存在争议。本研究旨在评估使用和不使用螺钉固定的髋臼杯之间的髋臼迁移。
患者接受直接前入路（DA）或直接外侧入路（DL）初次全髋关节置换术。DA 医生常规在髋臼杯固定时补充使用 1 或 2 枚螺钉，而 DL 医生不使用螺钉。在术后 7 次随访中，直至术后 2 年，患者接受放射立体测量分析（RSA）影像学检查以跟踪植入物迁移。主要结局定义为基于模型的 RSA 测量的髋臼杯近端迁移。
68 例患者在术后 2 年时进行了评估，其中 43 例使用了螺钉，25 例未使用螺钉。使用螺钉对杯迁移有显著影响（ = 0.018）。从术后 2 周至 2 年，使用螺钉和不使用螺钉的髋臼杯总平均迁移分别为 0.403 ± 0.681 mm 和 0.129 ± 0.272 mm（ = 0.319）。使用的螺钉数量也有显著影响，使用 1 枚螺钉固定的髋臼杯比使用 2 枚螺钉固定的髋臼杯迁移更多（ = 0.013，平均差异 0.712 mm）。
仅使用 1 枚螺钉固定的髋臼杯比不使用螺钉或使用 2 枚螺钉固定的髋臼杯更容易发生迁移，但平均幅度远低于 1.0 mm 的不可接受迁移阈值。然而，在仅使用 1 枚螺钉的 24 例患者中，有 3 例超过了 1.0 mm 的不可接受迁移阈值。最终，本研究结果表明，使用 2 枚螺钉补充杯固定可提供良好的植入物稳定性，相当于无螺钉的牢固压配组件。
ClinicalTrials.gov（NCT03558217）。
