<![CDATA[Background: Supplemental acetabular screw fixation is commonly used in cementless total hip arthroplasty (THA) to enhance initial cup stability; however, its routine necessity remains debated, particularly in populations with distinct anatomical and bone quality characteristics.Methods: A prospective observational cohort study was conducted at a tertiary care center in India from January 2023 to July 2024 to evaluate the effects of supplemental screws in primary cementless THA. Based on intraoperative assessment of press-fit stability, 80 consecutive patients were allocated into two groups: Group A (with supplemental screws, n = 40) and Group B (without screws, n = 40). Primary outcomes included functional improvement (Harris Hip Score (HHS) and WOMAC) and radiographic cup stability at 12 months. Secondary outcomes included complications and operative parameters.Results: Baseline characteristics were comparable between groups. Both groups showed significant improvement in HHS and WOMAC scores at 12 months, with no statistically significant intergroup differences (p > 0.05). Mean acetabular cup migration was minimal (0.20 ± 0.21 mm with screws vs 0.21 ± 0.22 mm without screws; p = 0.86). No cup demonstrated migration greater than 1 mm. No screw-related complications or revisions were observed.Conclusion: In primary cementless THA with adequate intraoperative press-fit stability, supplemental acetabular screws did not provide additional short-term clinical or radiographic benefit in this cohort. These findings suggest that routine screw fixation may not be necessary and should be used selectively.]]>
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