Comparison of ceramic-on-ceramic to metal-on-polyethylene bearing surfaces in total hip arthroplasty: a meta-analysis of randomized controlled trials

Abstract

BackgroundIn recent years, the choice of ceramic-on-ceramic (COC) and metal-on-polyethylene (MOP) in primary total hip arthroplasty (THA) remains controversial. The purpose of this study was to compare the reliability and durability of COC with that of MOP bearing surfaces in THA.MethodsBased on prospective randomized controlled trials (RCTs) searched from Pubmed, Embase, Web of Science, and Cochrane central database, we performed a meta-analysis for comparing clinical and radiographic outcomes of COC with those of MOP. Two investigators independently selected studies, extracted data, and assessed risk of bias. Relative risks and weighted mean differences from each trial were pooled using random-effect or fixed-effect models depending on the heterogeneity of the included studies.ResultsFive RCTs involving 897 patients with 974 hips met predetermined inclusion criteria. Our results demonstrated COC significantly decreased the risks of revision, osteolysis and radiolucent line, aseptic loosening, and dislocation and increased the risks of squeaking and intraoperative implant fracture compared with MOP. There was no significant difference between the two groups in postoperative hip function, deep infection, and heterotopic ossification.ConclusionsGenerally, despite more squeaking and intraoperative implant fracture, our findings support the use of COC bearing surface which has lower rates of revision, osteolysis and radiolucent line, aseptic loosening, and dislocation compared with MOP.

Outcomes of Ceramic Bearings After Primary Total Hip Arthroplasty in the Medicare Population

“…Previous studies have reported that COC bearings have lower risk of dislocation compared with M-PE in primary THA [11,12]. Hernigou and coworkers compared the risk of dislocation in C-PE and COC bearings implanted from 1978 to 1985.…”

Periprosthetic Joint Infection in Hip Arthroplasty: Is There an Association Between Infection and Bearing Surface Type?

“…Bozic et al [2] in a large Medicare database of 148,827 patients undergoing THA found that MoM bearings were associated with higher risk of PJI than MoP and CoC bearings. A recent meta-analysis of five randomized clinical trials involving 897 patients with 974 hips and comparing reliability and durability of CoC (601) versus MoP (373) THAs showed that ceramic hips had decreased risks of revision for any reasons, but no difference was found between the two groups in regard to postoperative deep infection rate [7]. The total number of THAs included in the meta-analysis was relatively small considering the rate of revision for PJI is expected to be approximately 1%.…”

Ceramic-on-Ceramic in Total Hip Replacement Revision

“…1, Gruppe 2). Die Revisionen wurden in 53 Im Gegensatz zur MoP-Gleitpaarung zeigt die CoC-Gleitpaarung einen erhöhten Abriebwiderstand, ein geringeres Taper-Korrosionsrisiko und die Fähigkeit, das Luxationsrisiko zu reduzieren [6,40,41]. Das Risiko einer Luxation ist nach Revisionseingriffen deutlich höher als in der Primärendoprothetik [2,42].…”