Efficacy and Safety of Acetabular Cup without Screw Fixation in Total Hip Arthroplasty: A Systematic Review and Meta-Analysis
<i>Background and Objectives</i>: Adequate initial fixation of the uncemented acetabular component in total hip arthroplasty is necessary to achieve long-term survival. Although screw fixation contributes to improved cup stability, there is currently no consensus on the use of this metho...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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MDPI AG
2022-08-01
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| Series: | Medicina |
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| Online Access: | https://www.mdpi.com/1648-9144/58/8/1058 |
| _version_ | 1797431953219125248 |
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| author | Takanori Miura Hiroaki Kijima Ryota Kimura Jun Watanabe Yuji Okazaki Naohisa Miyakoshi |
| author_facet | Takanori Miura Hiroaki Kijima Ryota Kimura Jun Watanabe Yuji Okazaki Naohisa Miyakoshi |
| author_sort | Takanori Miura |
| collection | DOAJ |
| description | <i>Background and Objectives</i>: Adequate initial fixation of the uncemented acetabular component in total hip arthroplasty is necessary to achieve long-term survival. Although screw fixation contributes to improved cup stability, there is currently no consensus on the use of this method. This study aimed to assess the existing randomized controlled trials (RCTs) on the efficacy and safety of cup fixation in total hip arthroplasty without screws. <i>Materials and Methods</i>: We searched the EMBASE, MEDLINE, Cochrane Central Register of Controlled Trials, World Health Organization International Clinical Trials Registry Platform, and ClinicalTrials.gov databases to identify RCTs published before February 2022. Primary outcomes were reoperation, cup migration, and Harris Hip Score. Secondary outcomes were the presence of a radiolucent line in the acetabular region, translation and rotation movement, and polyethylene wear. We conducted meta-analyses using the random-effects models. The revised Cochrane risk-of-bias tool was used to assess the risk of bias for outcomes of interest; the Grading of Recommendations, Assessment, Development, and Evaluation approach was used to summarize the body of evidence. <i>Results</i>: We included six reports from four studies. Total hip arthroplasty without screw fixation to the acetabular cup had little to no effect on reoperation (pooled relative risk, 0.98; 95% confidence interval, 0.14–6.68; <i>I</i><sup>2</sup> = 0%), cup migration (pooled relative risk, 1.72; 95% confidence interval, 0.29–10.33; <i>I</i><sup>2</sup> = 1%), Harris Hip Score (mean difference, 1.19; 95% confidence interval, −1.31–3.70; <i>I</i><sup>2</sup> = 0%), radiolucent line (pooled relative risk, 5.91; 95% confidence interval, 0.32–109.35), translation and rotation of all axes, and polyethylene wear (mean difference, 0.01; 95% confidence interval, −0.01–0.04; <i>I</i><sup>2</sup> = 0%), with very low certainty of evidence on all measures. <i>Conclusions</i>: The efficacy of acetabular cups without screw fixation in total hip arthroplasty remains uncertain, suggesting the need for prudent clinical application. Further large-scale, well-designed studies with low risk of bias are required. |
| first_indexed | 2024-03-09T09:52:46Z |
| format | Article |
| id | doaj.art-4e96bc42d68740729a509d7ec9d87222 |
| institution | Directory Open Access Journal |
| issn | 1010-660X 1648-9144 |
| language | English |
| last_indexed | 2024-03-09T09:52:46Z |
| publishDate | 2022-08-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Medicina |
| spelling | doaj.art-4e96bc42d68740729a509d7ec9d872222023-12-01T23:58:38ZengMDPI AGMedicina1010-660X1648-91442022-08-01588105810.3390/medicina58081058Efficacy and Safety of Acetabular Cup without Screw Fixation in Total Hip Arthroplasty: A Systematic Review and Meta-AnalysisTakanori Miura0Hiroaki Kijima1Ryota Kimura2Jun Watanabe3Yuji Okazaki4Naohisa Miyakoshi5Department of Orthopedic Surgery, Tazawako Hospital 17-1 Ukiyozaka Obonai, Tazawako, Senboku 014-1201, Akita, JapanDepartment of Orthopedic Surgery, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita 010-8543, Akita, JapanDepartment of Orthopedic Surgery, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita 010-8543, Akita, JapanScientific Research Workshop Peer Support Group (SRWS-PSG), Osaka, Osaka, JapanScientific Research Workshop Peer Support Group (SRWS-PSG), Osaka, Osaka, JapanDepartment of Orthopedic Surgery, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita 010-8543, Akita, Japan<i>Background and Objectives</i>: Adequate initial fixation of the uncemented acetabular component in total hip arthroplasty is necessary to achieve long-term survival. Although screw fixation contributes to improved cup stability, there is currently no consensus on the use of this method. This study aimed to assess the existing randomized controlled trials (RCTs) on the efficacy and safety of cup fixation in total hip arthroplasty without screws. <i>Materials and Methods</i>: We searched the EMBASE, MEDLINE, Cochrane Central Register of Controlled Trials, World Health Organization International Clinical Trials Registry Platform, and ClinicalTrials.gov databases to identify RCTs published before February 2022. Primary outcomes were reoperation, cup migration, and Harris Hip Score. Secondary outcomes were the presence of a radiolucent line in the acetabular region, translation and rotation movement, and polyethylene wear. We conducted meta-analyses using the random-effects models. The revised Cochrane risk-of-bias tool was used to assess the risk of bias for outcomes of interest; the Grading of Recommendations, Assessment, Development, and Evaluation approach was used to summarize the body of evidence. <i>Results</i>: We included six reports from four studies. Total hip arthroplasty without screw fixation to the acetabular cup had little to no effect on reoperation (pooled relative risk, 0.98; 95% confidence interval, 0.14–6.68; <i>I</i><sup>2</sup> = 0%), cup migration (pooled relative risk, 1.72; 95% confidence interval, 0.29–10.33; <i>I</i><sup>2</sup> = 1%), Harris Hip Score (mean difference, 1.19; 95% confidence interval, −1.31–3.70; <i>I</i><sup>2</sup> = 0%), radiolucent line (pooled relative risk, 5.91; 95% confidence interval, 0.32–109.35), translation and rotation of all axes, and polyethylene wear (mean difference, 0.01; 95% confidence interval, −0.01–0.04; <i>I</i><sup>2</sup> = 0%), with very low certainty of evidence on all measures. <i>Conclusions</i>: The efficacy of acetabular cups without screw fixation in total hip arthroplasty remains uncertain, suggesting the need for prudent clinical application. Further large-scale, well-designed studies with low risk of bias are required.https://www.mdpi.com/1648-9144/58/8/1058bone screwscementless acetabular cuphip osteoarthritismeta-analysissystematic reviewtotal hip replacement |
| spellingShingle | Takanori Miura Hiroaki Kijima Ryota Kimura Jun Watanabe Yuji Okazaki Naohisa Miyakoshi Efficacy and Safety of Acetabular Cup without Screw Fixation in Total Hip Arthroplasty: A Systematic Review and Meta-Analysis Medicina bone screws cementless acetabular cup hip osteoarthritis meta-analysis systematic review total hip replacement |
| title | Efficacy and Safety of Acetabular Cup without Screw Fixation in Total Hip Arthroplasty: A Systematic Review and Meta-Analysis |
| title_full | Efficacy and Safety of Acetabular Cup without Screw Fixation in Total Hip Arthroplasty: A Systematic Review and Meta-Analysis |
| title_fullStr | Efficacy and Safety of Acetabular Cup without Screw Fixation in Total Hip Arthroplasty: A Systematic Review and Meta-Analysis |
| title_full_unstemmed | Efficacy and Safety of Acetabular Cup without Screw Fixation in Total Hip Arthroplasty: A Systematic Review and Meta-Analysis |
| title_short | Efficacy and Safety of Acetabular Cup without Screw Fixation in Total Hip Arthroplasty: A Systematic Review and Meta-Analysis |
| title_sort | efficacy and safety of acetabular cup without screw fixation in total hip arthroplasty a systematic review and meta analysis |
| topic | bone screws cementless acetabular cup hip osteoarthritis meta-analysis systematic review total hip replacement |
| url | https://www.mdpi.com/1648-9144/58/8/1058 |
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