Screws are not needed when secure interference fit of uncemented acetabular components is adequate: a 5- to 15-year follow-up with clinical and radiological analysis.
OBJECTIVE
Even with good surgical preparation, adequate primary stability of the acetabular component is not always achieved after primary total hip replacement (THR). We hypothesise that adequate bone preparation for appropriate cortical loading would allow us to avoid screw use.


METHODS
A total of 791 uncemented cups were analysed to compare the need for screws to obtain primary fixation in 5 different designs. Arthritic hips with inflammatory arthritis or severe congenital hip disease were excluded. A press-fit technique was first tried in all hips and screws were only used when strictly needed. Radiological acetabular shape and postoperative cup position were assessed in all hips. The mean follow-up was 9.6 (5-15) years.


RESULTS
Screws were required in 155 hips (19.6%). We could not detect any difference in the percentage of screw use between designs. We found that female patients (odds ratio [OR] 2.06; 95% confidence interval [CI], 1.41-3.02) and cups with a greater distance to the hip rotation centre on the postoperative radiograph (OR 1.69; 95% CI, 1.17-2.45) had a higher risk for screw use. A greater anteversion of the cup had a lower risk for screw use (OR 0.96; 95% CI, 0.94-0.99). At latest follow-up no hips had needed revision for aseptic loosening.


CONCLUSIONS
Good intraoperative technique is not enough to avoid screw use since more accurate cup position and reconstruction of the hip rotation centre are required for an adequate interference fit. A press-fit technique can provide similar mid-term results to screw use in hips without severe deformities.
Department of Orthopaedic Surgery and Traumatology, Hospital La Paz-IdiPAZ, Madrid - Spain.
Eduardo
E
García-Rey
D000077:Acetabulum / Q000000981:diagnostic imaging / Q000601:surgery*; D000368:Aged; D019644:Arthroplasty, Replacement, Hip / Q000379:methods*; D001863:Bone Screws / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D005544:Forecasting; D006621:Hip Joint / Q000601:surgery; D006622:Hip Prosthesis; D006801:Humans; D008297:Male; D011474:Prosthesis Design; D011859:Radiography / Q000379:methods*; D012086:Reoperation; D012189:Retrospective Studies