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

IF 1.3 4区 医学 Q3 ORTHOPEDICS
HIP International Pub Date : 2024-01-01 Epub Date: 2023-04-05 DOI:10.1177/11207000231164711
Jennifer S Polus, Edward M Vasarhelyi, Brent A Lanting, Matthew G Teeter
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引用次数: 0

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).

初级全髋关节置换术后使用和不使用螺钉固定髋臼杯:通过放射立体分析评估迁移情况。
背景:全髋关节置换术(THA)后的早期髋臼杯移位与无菌性松动导致的后期翻修有关。然而,使用螺钉来增加髋臼杯的稳定性仍不明确并存在争议。本研究旨在评估使用螺钉固定和未使用螺钉固定的髋臼杯之间的髋臼移位情况:患者采用直接前方(DA)或直接侧方(DL)入路进行初次 THA。DA外科医生常规使用1或2枚螺钉进行髋臼杯固定,而DL外科医生则不使用螺钉。在术后 2 年的 7 次随访中,患者接受了放射性立体计量分析(RSA)成像,以跟踪植入物的迁移情况。主要结果是通过基于模型的 RSA 测量的近端杯移位:68名患者接受了术后2年的评估,其中43人使用了螺钉,25人未使用。使用螺钉对骨杯移位有显著影响(p = 0.018)。从术后 2 周到 2 年,使用螺钉和未使用螺钉的牙杯的总平均移位量分别为 0.403 ± 0.681 毫米和 0.129 ± 0.272 毫米(p = 0.319)。使用的螺钉数量也有显著影响,使用1颗螺钉固定的髋臼杯比使用2颗螺钉固定的髋臼杯移位更多(p = 0.013,平均差异为0.712毫米):结论:仅使用1颗螺钉固定的髋臼杯比未使用螺钉或使用2颗螺钉固定的髋臼杯移位更严重,但平均移位幅度远低于1.0毫米的不可接受移位阈值。不过,在仅使用 1 颗螺钉固定的 24 位患者中,有 3 位患者的移位超过了 1.0 毫米的不可接受阈值。最终,这项研究结果表明,使用2颗螺钉来补充杯状固定可以提供良好的植入稳定性,其效果与不使用螺钉的安全压入式组件相当:临床试验注册:ClinicalTrials.gov (NCT03558217)。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
HIP International
HIP International 医学-整形外科
CiteScore
4.20
自引率
0.00%
发文量
70
审稿时长
2 months
期刊介绍: HIP International is the official journal of the European Hip Society. It is the only international, peer-reviewed, bi-monthly journal dedicated to diseases of the hip. HIP International considers contributions relating to hip surgery, traumatology of the hip, prosthetic surgery, biomechanics, and basic sciences relating to the hip. HIP International invites reviews from leading specialists with the aim of informing its readers of current evidence-based best practice. The journal also publishes supplements containing proceedings of symposia, special meetings or articles of special educational merit. HIP International is divided into six independent sections led by editors of the highest scientific merit. These sections are: • Biomaterials • Biomechanics • Conservative Hip Surgery • Paediatrics • Primary and Revision Hip Arthroplasty • Traumatology
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