“…It has been suggested that a direct communication pathway between the joint and osteolysis lesion must exist to define osteolysis [8,39] however we did not observe this in all cases of osteolysis identified in this cohort. A 2014 RCT comparing solid back versus cluster hole acetabular shells demonstrated no difference in incidence of osteolysis between groups supporting our suggestion that this is not a critical element of peri-prosthetic acetabular osteolysis generation [13]. In a similar study to ours Leung et al recalled 33% of patients (76 of 236) originally enrolled in an RCT comparing conventional and cross-linked polyethylene and used CT to investigate for osteolysis.…”
Section: Discussionsupporting
confidence: 79%
“…One mechanism for this failure results from the generation of wear particles that induce an inflammatory reaction mediated by proinflammatory cytokines and upregulation of macrophages [12]. This inflammatory reaction has been causally linked with periprosthetic osteolysis seen in aseptic implant loosening [13].…”
Background Polyethylene acetabular components are commonplace in hip arthroplasty. Highly cross-linked polyethylene (HXLPE) has lower wear than ultra-high molecular weight polyethylene (UHMWPE). Evidence suggests wear particles induce inflammation causing peri-prosthetic osteolysis contributing to implant loosening with wear rates of 0.05mm/yr considered safe. We aimed to compare incidence and volume of peri-acetabular osteolysis between HXLPE and UHMWPE using computed tomography (CT). Methods Initially 54 hips in 53 patients were randomized to HXLPE or UHMWPE acetabular liner. At 10 years 39 hips in 38 patients remained for radiostereometric analysis (RSA) demonstrating significantly lower wear in the HXLPE group. At 12 years 14 hips in 13 patients were lost to follow-up leaving 25 hips for CT assessment. Images were reconstructed to detect osteolysis and where identified, areas were segmented and volumised. Results Osteolysis was observed in eight patients, seven from the UHMWPE group and only one from the HXLPE group (Fisher's Exact p=0.042). There was no correlation between amount of polyethylene wear and osteolysis volume however, RSA measured wear rate in patients with osteolysis from both groups was significantly higher than overall average wear rate. Conclusion This data demonstrates lower incidence of peri-acetabular osteolysis in the HXLPE group of a small cohort. Whilst numbers are too low to estimate causation, in the context of lower wear in the HXLPE group this finding supports the hypothesis that HXLPE may not elevate osteolysis risk and hence does not suggest HXLPE wear particles are more biologically active than those generated by earlier generations of polyethylene.
“…It has been suggested that a direct communication pathway between the joint and osteolysis lesion must exist to define osteolysis [8,39] however we did not observe this in all cases of osteolysis identified in this cohort. A 2014 RCT comparing solid back versus cluster hole acetabular shells demonstrated no difference in incidence of osteolysis between groups supporting our suggestion that this is not a critical element of peri-prosthetic acetabular osteolysis generation [13]. In a similar study to ours Leung et al recalled 33% of patients (76 of 236) originally enrolled in an RCT comparing conventional and cross-linked polyethylene and used CT to investigate for osteolysis.…”
Section: Discussionsupporting
confidence: 79%
“…One mechanism for this failure results from the generation of wear particles that induce an inflammatory reaction mediated by proinflammatory cytokines and upregulation of macrophages [12]. This inflammatory reaction has been causally linked with periprosthetic osteolysis seen in aseptic implant loosening [13].…”
Background Polyethylene acetabular components are commonplace in hip arthroplasty. Highly cross-linked polyethylene (HXLPE) has lower wear than ultra-high molecular weight polyethylene (UHMWPE). Evidence suggests wear particles induce inflammation causing peri-prosthetic osteolysis contributing to implant loosening with wear rates of 0.05mm/yr considered safe. We aimed to compare incidence and volume of peri-acetabular osteolysis between HXLPE and UHMWPE using computed tomography (CT). Methods Initially 54 hips in 53 patients were randomized to HXLPE or UHMWPE acetabular liner. At 10 years 39 hips in 38 patients remained for radiostereometric analysis (RSA) demonstrating significantly lower wear in the HXLPE group. At 12 years 14 hips in 13 patients were lost to follow-up leaving 25 hips for CT assessment. Images were reconstructed to detect osteolysis and where identified, areas were segmented and volumised. Results Osteolysis was observed in eight patients, seven from the UHMWPE group and only one from the HXLPE group (Fisher's Exact p=0.042). There was no correlation between amount of polyethylene wear and osteolysis volume however, RSA measured wear rate in patients with osteolysis from both groups was significantly higher than overall average wear rate. Conclusion This data demonstrates lower incidence of peri-acetabular osteolysis in the HXLPE group of a small cohort. Whilst numbers are too low to estimate causation, in the context of lower wear in the HXLPE group this finding supports the hypothesis that HXLPE may not elevate osteolysis risk and hence does not suggest HXLPE wear particles are more biologically active than those generated by earlier generations of polyethylene.
“…After a preliminary review, 3928 studies were excluded because of overlapping records or obviously irrelevant studies; 1209 articles were excluded because they were case reports, reviews, were not human studies, or were in a language other than English; and 17 articles were excluded because there was no comparison, the improper acetabular cup was used, or there was no available data. Therefore, a total of 19 articles [ 4 , 7 – 11 , 15 , 17 – 19 , 23 – 31 ] with 21 studies comparing the cementless press-fit acetabular cup with and without screws were included. Fig.…”
Section: Resultsmentioning
confidence: 99%
“…A magnetic resonance imaging study has shown that obvious osteolysis occurred around acetabular screws [ 3 ]. However, some studies suggested that osteolysis is not necessarily related to screws [ 23 , 37 ]. In our study, eight RCTs and seven cohort studies about osteolysis were included.…”
Background
Press-fit cementless acetabular cup is widely used in total hip arthroplasty (THA). However, the use of additional screws for the acetabular cup has been extensively debated. The purpose of this review is to compare the stability, revision rate, wear rate, and clinical scores of cementless acetabular cups with and without screws in THA.
Materials and Methods
Comprehensive literature searches of the following databases were performed: Cochrane Library, Pubmed, Web of Science, OVID, Elsevier ClinicalKey, Clinicaltrials.gov, and EMBASE. We searched for trials that compared cementless acetabular cups with screws or without screws, and were published in the English language. We evaluated the stability of the prosthesis by osteolysis and migration. The clinical scores included Harris hip scores (HHS) and pain scores.
Results
Nineteen articles involving 4046 THAs met the inclusion criteria. Our analysis revealed that additional screws did not increase the stability of acetabular cups, and there was no statistical significance between the groups with and without screws in osteolysis and clinically relevant migration. Revision rates showed no significant difference between the groups with and without screws. There was no difference in wear between the two groups. Our analysis showed no difference in pain scores and HHS between groups.
Conclusion
Press-fit without screws could achieve sufficient acetabular cup stability. Acetabular cups without screws showed no difference from acetabular cups with screws in many outcomes. Additional screws are not required for cementless acetabular cups.
Level of evidence: Level III.
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