Ceramic-on-ceramic versus polyethylene-based bearings in total hip arthroplasty: a meta-analysis

Area of Science:

• Orthopedic surgery
• Biomaterials science
• Clinical outcomes research

Background:

• Bearing surface selection is crucial for total hip arthroplasty (THA) longevity.
• Comparative evidence for modern ceramic and polyethylene bearings is inconsistent.
• This meta-analysis evaluates ceramic-on-ceramic (CoC) vs. various polyethylene-based bearings.

Purpose of the Study:

• To comprehensively compare the long-term performance of CoC bearings against alternative articulations in primary THA.
• To synthesize evidence on implant survivorship, revision rates, dislocation, wear, osteolysis, and functional outcomes.
• To inform individualized bearing selection in THA.

Main Methods:

• Systematic search of four databases for randomized controlled trials and comparative observational studies.
• Inclusion of 33 studies encompassing over 120,000 THAs.
• Pooled analyses using fixed-effect or random-effects models based on heterogeneity.

Main Results:

• Revision rates, aseptic loosening, and fractures were similar across bearing types; PJI was lower for CoC vs. MoHXLPE.
• CoC showed reduced dislocation and osteolysis compared to MoP and MoHXLPE.
• Squeaking was more frequent with CoC, while functional outcomes were generally equivalent, with slight advantages for CoC in some metrics.

Conclusions:

• Modern THA bearing surfaces offer comparable safety and survivorship.
• CoC bearings provide benefits like reduced dislocation and osteolysis, offset by increased squeaking.
• Individualized bearing selection is recommended based on patient factors and complication tolerance.