Head, acetabular liner composition, and rate of revision and wear in total hip arthroplasty: a Bayesian network meta-analysis

Abstract

Total hip arthroplasty (THA) is a common procedure for patients suffering from hip pain e.g. from osteoarthritis, osteonecrosis, or hip fractures. The satisfaction of patients undergoing THA is influenced by the choice of implant type and material, with one key factor being the selection of the appropriate material combination for the bearing surface. In this Bayesian network meta-analysis, we investigated the impact of material combinations for the bearing surface on the longevity of hip implants. The wear penetration rate per year and the total wear penetration in the liner resulting from different material combinations, as well as the survival rate at last follow-up, were examined. We analyzed a total of 663,038 THAs, with 55% of patients being women. Mean patient age was 59.0 ± 8.1 years and mean BMI 27.6 ± 2.6 kg/m2. The combination of an aluminium oxide (Al2O3) head and an Al2O3 liner demonstrated the lowest wear penetration at last follow-up and the lowest rate of wear penetration per year. Additionally, the combination of a crosslinked polyethylene (XLPE) liner and a zircon oxide (ZrO2) head demonstrated the lowest rate of revision at last follow-up. These findings underscore the importance of careful material selection for hip implant bearing surfaces to optimize their longevity and patient satisfaction after THA.

A review on manufacturing processes of cobalt‐chromium alloy implants and its impact on corrosion resistance and biocompatibility

“…The acetabular components contain a cup (made of titanium or CoCr alloy) that is implanted in the patient's acetabulum. Inside the acetabular cup, a liner made of polyethylene (PE) or ceramic is placed as an interface between the acetabular cup and femoral head for a smooth gliding surface 62 . The PE liners can be made of conventional ultra‐high‐molecular‐weight PE (UHMWPE), cross‐linked PE (XLPE), moderately cross‐linked PE (MXLPE), highly cross‐linked PE (HXLPE), or vitamin E‐infused HXLPE 62 .…”

“…Inside the acetabular cup, a liner made of polyethylene (PE) or ceramic is placed as an interface between the acetabular cup and femoral head for a smooth gliding surface 62 . The PE liners can be made of conventional ultra‐high‐molecular‐weight PE (UHMWPE), cross‐linked PE (XLPE), moderately cross‐linked PE (MXLPE), highly cross‐linked PE (HXLPE), or vitamin E‐infused HXLPE 62 . The interaction between the femoral head and the liner in the acetabular cup is referred to as the bearing surface (i.e.)…”

“…The interaction between the femoral head and the liner in the acetabular cup is referred to as the bearing surface (i.e.) where the movement of new joint occurs 62 . For the bearing surfaces, different combinations of materials have been investigated: (a) metal‐on‐polymer; (b) metal‐on‐metal; (c) ceramic‐on‐ceramic; and (d) ceramic‐on‐polymer.…”

“…For the bearing surfaces, different combinations of materials have been investigated: (a) metal‐on‐polymer; (b) metal‐on‐metal; (c) ceramic‐on‐ceramic; and (d) ceramic‐on‐polymer. The movement in the bearing surfaces creates friction to cause wear of the acetabular liner over a period of time and release particles (debris) 62 . The wear particles cause adverse biological responses, such as an inflammatory reaction, that can ultimately result in periprosthetic osteolysis and aseptic loosening 63 .…”

Plasma-Sprayed Osseoconductive Hydroxylapatite Coatings for Endoprosthetic Hip Implants: Phase Composition, Microstructure, Properties, and Biomedical Functions

“…The stem will be anchored in the femur, and an acetabular cup with an alumina inset anchored in the hip bone. During the absence of synovial fluid that lubricates the joints, this type of ceramic-on-ceramic (CoC) bearing couple is highly effective and reliable, even though it may produce a disturbing squeaking noise during walking and a high risk of fracture [4]. In addition, its comparatively high cost puts a severe strain on the healthcare systems of many countries.…”