Comparison of Ceramic-on-Ceramic vs. Ceramic-on-Polyethylene for Primary Total Hip Arthroplasty: A Meta-Analysis of
1Department of Orthopaedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Insights
Ceramic-on-ceramic and ceramic-on-polyethylene components show comparable outcomes in total hip arthroplasty. However, ceramic-on-ceramic implants had higher rates of audible noise and fracture, while polyethylene showed increased wear.
Area of Science:
- Orthopedic Surgery
- Biomaterials Science
- Clinical Trials
Background:
- Total hip arthroplasty (THA) utilizes various bearing surfaces, including ceramic-on-ceramic (COC) and ceramic-on-polyethylene (COP) components.
- Choosing the optimal bearing surface is crucial for long-term THA success and patient outcomes.
Approach:
- A meta-analysis of 15 randomized controlled trials (RCTs) involving 2,702 patients (2,813 hips) was conducted.
- Searches were performed up to March 2021, including English-language RCTs comparing COC and COP in primary THA.
- Statistical analysis was performed using Stata11.0 to evaluate primary and secondary outcome measures.
Key Points:
- The ceramic-on-ceramic group exhibited significantly higher rates of audible noise (OR = 5.919) and prosthesis fracture (OR = 35.768).
- Wear rates were higher in the ceramic-on-polyethylene group.
- Comparable outcomes were observed for hip function, revision rates, dislocation, deep infection, osteolysis, and prosthesis loosening between the two bearing surfaces.
Conclusions:
- Current evidence suggests comparable overall outcomes between COC and COP bearing surfaces in primary THA.
- Further high-quality RCTs with extended follow-up are necessary to definitively establish the optimal bearing surface for THA.
Abstract:
Objective: This meta-analysis aimed to compare ceramic-on-ceramic (COC) components and ceramic-on-polyethylene (COP) components during total hip arthroplasty (THA). Settings: A meta-analysis of randomized controlled trials (RCTs) comparing COC and COP during primary THA was conducted. Electronic searches were current to March 2021. Participants: Trials were included for meta-analysis if they compared at least the bearing surfaces of COC and COP for patients undergoing primary THA and if they reported the outcomes of THA after a certain period of follow-up and only RCTs in English were included. Primary and Secondary Outcome Measures: The primary endpoints consist of audible noise, prosthesis fracture, and revision. Secondary endpoints include dislocation, deep infection, osteolysis, and prosthesis loosening. Extracted data were statistically analyzed with the Stata11.0. Results: A total of 15 RCTs containing 2,702 patients (2,813 hips) were included in this study. The audible noise [odds ratio (OR) = 5.919; 95% CI: 2.043, 17.146; p ≤ 0.001] and prosthesis fracture (OR = 35.768; 95% CI: 8.957, 142.836; p = 0.001) were significantly higher in the COC group. Hip function, revision rate, dislocation rate, deep infection rate, osteolysis rate, and prosthesis loosening rate were comparable between these two groups, while the wear rate was higher in the COP group. Conclusion: This study indicated comparable outcomes of COC and COP bearing surfaces in primary THA; high-quality RCTs with a long-term follow-up are still urgently needed to provide more evidence on the optimal bearing surfaces in primary THA.
