Sheridan Gerard A, Lowe Lyndon Y H, Hughes Andrew J, Courtney P Maxwell, Sidhu Arsh, MacDonell Tanya, Howard Lisa C, Neufeld Michael E, Garbuz Donald S, Masri Bassam A
Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada; Department of Orthopaedics, University of Galway, Galway, Ireland.
Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada.
J Arthroplasty. 2025 Aug;40(8S1):S186-S189. doi: 10.1016/j.arth.2025.03.034. Epub 2025 Mar 17.
The aim of this study was to assess if selective screw insertion can achieve low rates of acetabular component loosening and whether this approach to screw usage is noninferior to habitual screw insertion.
This was a retrospective international multicenter cohort study assessing 4,707 acetabular components for primary total hip arthroplasties at mean follow-up of 6.5 years. There were 3,855 acetabular components in the selective no-screw (SNS) group, 734 in the selective with-screw (SWS) group, and 118 in the habitual (H) group. The primary outcome was all-cause aseptic revision. Secondary outcomes were all-cause revision and revision for aseptic acetabular loosening.
The rate of aseptic revision in the selective user group was 0.89% (41 of 4,589) and 1.7% (two of 118) in the H user group (P = 0.467). The aseptic revision rate for SNS, SWS, and H groups was 0.7, 1.5, and 1.6%, respectively (P = 0.71). The all-cause revision rate for SNS, SWS, and H groups was 0.7, 1.5, and 4.2%, respectively (P = 0.001). The revision rate for cup loosening was 0.02% (one of 3,855) in the SNS group, 0.2% (two of 734) in the SWS group, and 0.8% (one of 118) in the H group (P = 0.002). The cumulative screw length had no effect on the aseptic revision rate (P = 0.52).
Acetabular components with no screws had the lowest rate of all-cause revision, aseptic revision, and revision for acetabular loosening. If screws are inserted, there is no significant difference in results depending on the number of screws inserted or the cumulative screw length. A selective approach to screw insertion is noninferior to habitual screw insertion and may achieve superior rates of aseptic revision and acetabular loosening.
本研究旨在评估选择性螺钉置入是否能实现较低的髋臼组件松动率，以及这种螺钉使用方法是否不劣于常规螺钉置入。
这是一项回顾性国际多中心队列研究，评估了4707例初次全髋关节置换术的髋臼组件，平均随访6.5年。选择性无螺钉（SNS）组有3855个髋臼组件，选择性有螺钉（SWS）组有734个，常规（H）组有118个。主要结局是全因无菌性翻修。次要结局是全因翻修和无菌性髋臼松动翻修。
选择性使用者组的无菌性翻修率为0.89%（4589例中的41例），H使用者组为1.7%（118例中的2例）（P = 0.467）。SNS、SWS和H组的无菌性翻修率分别为0.7%、1.5%和1.6%（P = 0.71）。SNS、SWS和H组的全因翻修率分别为0.7%、1.5%和4.2%（P = 0.001）。SNS组髋臼杯松动翻修率为0.02%（3855例中的1例），SWS组为0.2%（734例中的2例），H组为0.8%（118例中的1例）（P = 0.002）。累计螺钉长度对无菌性翻修率无影响（P = 0.52）。
无螺钉的髋臼组件全因翻修、无菌性翻修和髋臼松动翻修率最低。如果置入螺钉，根据置入螺钉的数量或累计螺钉长度，结果无显著差异。选择性螺钉置入方法不劣于常规螺钉置入，且可能实现更高的无菌性翻修率和更低的髋臼松动率。
