Relationship between use of screws and acetabular cup stability in total hip arthroplasty: a meta-analysis

OBJECTIVE: The relationship between the use of screws and acetabular cup stability in total hip arthroplasty (THA) remains controversial. We evaluated cup stability in THA with and without the use of screws. METHODS: We performed a systematic literature search to identify studies on cup stability relative to the use of screws in patients undergoing THA before October 2018. Methodological quality assessment and data collection were performed by two individual reviewers. Meta-analysis was performed using Review Manager version 5.3.5. RESULTS: We included seven trials involving 1402 patients (1469 THAs): 767 patients (809 THAs) with screws and 635 patients (660 THAs) without screws. The findings of meta-analysis indicated that uncemented acetabular component fixation with the use of additional screws was not correlated with migration of the cup, migration on roentgen stereophotogrammetry, or reoperation after THA. Moreover, operation time was not significantly different according to whether screws were used. There was no relationship between use of additional screws and osteoporosis or Harris Hip Score; however, THA with or without the use of screws might be related to bone sclerosis in the C1 region. CONCLUSION: Currently, limited evidence shows that the use of screws during THA may not improve cup stability.