Is a Ceramic-on-Ceramic Bearing Really Superior to Ceramic-on-Polyethylene for Primary Total Hip Arthroplasty? A Systematic Review and Meta-Analysis of Randomised Controlled Trials
Restricted accessReview articleFirst published online May, 2015
Is a Ceramic-on-Ceramic Bearing Really Superior to Ceramic-on-Polyethylene for Primary Total Hip Arthroplasty? A Systematic Review and Meta-Analysis of Randomised Controlled Trials
The outcomes of using a ceramic-on-ceramic (CoC) vs ceramic-on-polyethylene (CoP) bearing surface for primary total hip arthroplasty (THA) are much debated. We performed a systematic review and meta-analysis of randomised controlled trials (RCTs) to compare and evaluate the outcomes of these 2 bearing surfaces.
Materials and Methods
Electronic databases (PubMed/Medline, CENTRAL, Embase and Web of Science) were systematically searched for RCTs investigating the association between bearing surfaces and outcomes following primary THA. Two investigators independently reviewed studies for eligibility, assessed the risk of bias, extracted and analysed the data.
Results
In total, 13 RCTs including a total of 2,488 THAs were identified. The Harris Hip Score appeared to be similar between CoC and CoP THAs. The acetabular liner wear rate was lower in CoC than CoP THA, but the meta-analysis showed that the incidence of component-related noise and overall ceramic fracture in CoC group were 14.73 times and 6.02 times higher than CoP THA, respectively. There were no statistically significant differences in rates of radiolucent line formation (>1 mm), osteolysis, loosening, revision with follow-up ≥ 5 years, intraoperative femoral fracture, dislocation, deep infection, deep venous thrombosis and leg length discrepancy between CoC and CoP THAs.
Conclusions
There appears to be no clear evidence favouring the use of either a CoC or CoP bearing surfaces in primary THA, further studies with high-quality and longer term follow-up to provide more evidence on this topic are still required.
KawaiTTanakaCKanoeHTotal hip arthroplasty for Crowe IV hip without subtrochanteric shortening osteotomy -a long term follow up study.BMC Musculoskelet Disord201415172
2.
IssaKJohnsonAJNaziriQKhanujaHSDelanoisREMontMAHip osteonecrosis: does prior hip surgery alter outcomes compared to an initial primary total hip arthroplasty?J Arthroplasty2014291162–166
3.
TezukaTInabaYKobayashiNSatoMMitsugiNSaitoTLong-term results of porous-coated anatomic total hip arthroplasty for patients with osteoarthritis of the hip.J Arthroplasty201429122251–2255
4.
ShettyVShitoleBShettyGThakurHBhandariMOptimal bearing surfaces for total hip replacement in the young patient: a meta-analysis.Int Orthop20113591281–1287
5.
HarrisWHOsteolysis and particle disease in hip replacement.A reviewActa Orthop Scand1994651113–123
6.
ZagraLMaccarioCMondiniABianchiLTreatment of failures related to articulation material in THA.A comprehensive algorithm of surgical options and open questionsHip Int201424Suppl 10S48–S57
PiconiCStreicherRMForty years of ceramic-on-ceramic THR bearings.Semin Arthroplasty2013244188–192
9.
KimYHParkJWKulkarniSSKimYHA randomised prospective evaluation of ceramic-on-ceramic and ceramic-on-highly cross-linked polyethylene bearings in the same patients with primary cementless total hip arthroplasty.Int Orthop201337112131–2137
10.
KressAMSchmidtRHolzwarthUForstRMuellerLAExcellent results with cementless total hip arthroplasty and alumina-on-alumina pairing: minimum ten-year follow-up.Int Orthop2011352195–200
11.
StanatSJCapozziJDSqueaking in third- and fourth-generation ceramic-on-ceramic total hip arthroplasty: meta-analysis and systematic review.J Arthroplasty2012273445–453
12.
KooKHHaYCJungWHKimSRYooJJKimHJIsolated fracture of the ceramic head after third-generation alumina-on-alumina total hip arthroplasty.J Bone Joint Surg Am2008902329–336
13.
ParkYSHwangSKChoyWSKimYSMoonYWLimSJCeramic failure after total hip arthroplasty with an alumina-on-alumina bearing.J Bone Joint Surg Am2006884780–787
14.
CashDJKhandujaVThe case for ceramic-on-polyethylene as the preferred bearing for a young adult hip replacement.Hip Int2014245421–427
15.
BeaupreLAManolescuAJohnstonDWA randomized trial of ceramic-on-ceramic bearing versus ceramic-on-crossfire-polyethylene bearing in total hip arthroplasty: five-year outcomes.J Arthroplasty2013283485–489
16.
CaiPHuYXieJLarge-diameter Delta ceramic-on-ceramic versus common-sized ceramic-on-polyethylene bearings in THA.Orthopedics2012359e1307–e1313
17.
LewisPMAl-BelooshiAOlsenMSchemitchEHWaddellJPProspective randomized trial comparing alumina ceramic-on-ceramic with ceramic-on-conventional polyethylene bearings in total hip arthroplasty.J Arthroplasty2010253392–397
18.
LundhAGøtzschePCRecommendations by Cochrane Review Groups for assessment of the risk of bias in studies.BMC Med Res Methodol20088122
19.
AmanatullahDFLandaJStraussEJGarinoJPKimSHDi CesarePEComparison of surgical outcomes and implant wear between ceramic-ceramic and ceramic-polyethylene articulations in total hip arthroplasty.J Arthroplasty2011266)(Suppl72–77
20.
LombardiAVJrBerendKRSengBEClarkeICAdamsJBDelta ceramic-on-alumina ceramic articulation in primary THA: prospective, randomized FDA-IDE study and retrieval analysis.Clin Orthop Relat Res20104682367–374
21.
HamiltonWGMcAuleyJPDennisDAMurphyJABlumenfeldTJPolitiJTHA with Delta ceramic on ceramic: results of a multicenter investigational device exemption trial.Clin Orthop Relat Res20104682358–366
22.
PoggieRATurgeonTRCouttsRDFailure analysis of a ceramic bearing acetabular component.J Bone Joint Surg Am2007892367–375
23.
KimYHYoonSHKimJSChanges in the bone mineral density in the acetabulum and proximal femur after cementless total hip replacement: alumina-on-alumina versus alumina-on-polyethylene articulation.J Bone Joint Surg Br2007892174–179
24.
BalBSAletoTJGarinoJPToniAHendricksKJCeramic-on-ceramic versus ceramic-on-polyethylene bearings in total hip arthroplasty: Results of a multicenter prospective randomized study and update of modern ceramic total hip trials in the United States.Hip Int2005153129–135
25.
NygaardMZerahnBBruceCSøballeKBorgwardtAEarly periprosthetic femoral bone remodelling using different bearing material combinations in total hip arthroplasties: a prospective randomised study.Eur Cell Mater2004865–72discussion 72-73
26.
PittoRPSchikoraNWillmannGGraefBSchmidtRRadiostereoanalysis of press-fit cups with alumina liner.A randomized clinical trialKey Eng Mater2003240-2817–822
27.
PittoRPSchwammleinDSchrammMOutcome of modular press-fit acetabular components in total hip arthroplasty - A comparative clinical trial using polyethylene and alumina liners.Key Eng Mater2000192-195979–982
28.
HavelinLIEngesaeterLBEspehaugBFurnesOLieSAVollsetSEThe Norwegian Arthroplasty Register: 11 years and 73,000 arthroplasties.Acta Orthop Scand2000714337–353
29.
HoltGMurnaghanCReillyJMeekRMThe biology of aseptic osteolysis.Clin Orthop Relat Res2007460460240–252
30.
UrbanJAGarvinKLBoeseCKCeramic-on-polyethylene bearing surfaces in total hip arthroplasty.Seventeen to twenty-one-year resultsJ Bone Joint Surg Am20013111688–1694
31.
EnghCAJrStepniewskiASGinnSDA randomized prospective evaluation of outcomes after total hip arthroplasty using cross-linked marathon and non-cross-linked Enduron polyethylene liners.J Arthroplasty2006216)(Suppl 217–25
32.
JacobsCAChristensenCPGreenwaldASMcKellopHClinical performance of highly cross-linked polyethylenes in total hip arthroplasty.J Bone Joint Surg Am200789122779–2786
33.
FisherJInghamEStoneMHAlternative bearing couples in total hip replacements: Solutions for young patients.Hip Int200313131–35
34.
PollardTCBakerRPEastaugh-WaringSJBannisterGCTreatment of the young active patient with osteoarthritis of the hip.A five- to seven-year comparison of hybrid total hip arthroplasty and metal-on-metal resurfacingJ Bone Joint Surg Br2006885592–600
35.
SteaSVisentinMGranchiDWear debris and cytokine production in the interface membrane of loosened prostheses.J Biomater Sci Polym Ed1999102247–257
36.
BonoJVSanfordLToussaintJTSevere polyethylene wear in total hip arthroplasty.Observations from retrieved AML PLUS hip implants with an ACS polyethylene linerJ Arthroplasty199492119–125
37.
JarrettCARanawatASBruzzoneMBlumYCRodriguezJARanawatCSThe squeaking hip: a phenomenon of ceramic-on-ceramic total hip arthroplasty.J Bone Joint Surg Am20099161344–1349
38.
WalterWLWatersTSGilliesMSqueaking hips.J Bone Joint Surg Am200890Suppl 4102–111
39.
KeurentjesJCKuipersRMWeverDJSchreursBWHigh incidence of squeaking in THAs with alumina ceramic-on-ceramic bearings.Clin Orthop Relat Res200846661438–1443
40.
YangCCKimRHDennisDAThe squeaking hip: a cause for concern-disagrees.Orthopedics2007309739–742
41.
ToniATrainaFSteaSEarly diagnosis of ceramic liner fracture.Guidelines based on a twelve-year clinical experienceJ Bone Joint Surg Am200688Suppl 455–63
42.
RestrepoCParviziJKurtzSMSharkeyPFHozackWJRothmanRHThe noisy ceramic hip: is component malpositioning the cause?J Arthroplasty2008235643–649
43.
SharmaVRanawatASRasquinhaVJWeiskopfJHowardHRanawatCSRevision total hip arthroplasty for ceramic head fracture: a long-term follow-up.J Arthroplasty2010253342–347
44.
BarrackRLBurakCSkinnerHBConcerns about ceramics in THA.Clin Orthop Relat Res200442973–79
45.
HaYCKimSYKimHJYooJJKooKHCeramic liner fracture after cementless alumina-on-alumina total hip arthroplasty.Clin Orthop Relat Res2007458458106–110
46.
WalterSDYaoXEffect sizes can be calculated for studies reporting ranges for outcome variables in systematic reviews.J Clin Epidemiol2007608849–852
