Comparison of Ceramic-on-Ceramic and Ceramic-on-Highly-Crosslinked-Polyethylene in Primary Total Hip Arthroplasty: Findings of a Meta-Analysis

Abstract

Introduction An optimal hip implant is biocompatible, durable, and resistant to chemical and mechanical wear. This analysis aimed to compare failure (revision) and complication rates between ceramic-on-ceramic (CoC) and ceramic-on-highly-crosslinked-polyethylene (CoHXLPE) implants. Methods This review comprised of scientific literature published between 1995 and 2019. We included randomized controlled trials in adults (>18 years) that presented results of CoC and CoHXLPE total hip arthroplasty (THA) with more than two years of mean follow-up and drafted in English. The primary outcomes for this analysis were complications, revision rates, and loosening rates. Results Eight studies (1,689 hips) were included in this systematic review. There was no significant differences between COC and CoHXLPE for the risk of post-surgical complications (relative risk [RR]: 1.98, 95% confidence interval [CI]: 0.83-4.69, P = 0.12). Revision rates (RR: 1.25, 95% CI: 0.71-2.20, P = 0.43] and loosening rates between the two implants were not significantly different (RR: 1.17, 95% CI: 0.30-4.52, P = 0.82). Conclusion We report no significant differences between CoHXLPE and CoC in adults undergoing primary THA. Although introduced relatively recently, CoHXLPE is a cost-effective bearing that can be used for younger patients with no risk of increased complications in comparison to CoC. Further studies with longer follow-up periods are recommended to confirm the findings of this meta-analysis.

Updates on Biomaterials Used in Total Hip Arthroplasty (THA)

“…Multiple studies have shown a decrease in the release of polyethylene particles in the cases of XLPE and HXLPE compared to the case of UHMWPE [ 78 ] ( Figure 2 A,B). Kuzyk et al, in a systematic review, highlighted a much greater penetration of the prosthetic head in UHMWPE [0.137 mm/year] compared to XLPE [0.042 mm/year] [ 140 ]. Wear rates for UHMWPE of 0.1–0.2 mm/year were reported with large particles, compared to the wear rate for HXLPE of 0.051–0.25 mm/year with small particles [ 140 ].…”

“…Kuzyk et al, in a systematic review, highlighted a much greater penetration of the prosthetic head in UHMWPE [0.137 mm/year] compared to XLPE [0.042 mm/year] [ 140 ]. Wear rates for UHMWPE of 0.1–0.2 mm/year were reported with large particles, compared to the wear rate for HXLPE of 0.051–0.25 mm/year with small particles [ 140 ].…”