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

Study Summary

33 comparative studies including over 120 000 primary total hip arthroplasties (THAs) were included in this systematic review and meta-analysis comparing ceramic-on-ceramic (CoC) bearings with metal-on-polyethylene (MoP), metal-on–highly cross-linked polyethylene (MoHXLPE), ceramic-on-polyethylene (CoP), and ceramic-on–highly cross-linked polyethylene (CoHXLPE). Pooled outcomes included implant survivorship, revision, prosthetic hip dislocation, periprosthetic joint infection, osteolysis, wear, functional outcomes, radiographic findings, and postoperative complications. CoC bearings demonstrated lower rates of dislocation and osteolysis than MoP and MoHXLPE, lower wear and modestly improved functional scores compared with MoHXLPE, but higher rates of squeaking than most polyethylene-based bearings, while revision rates, implant survivorship, aseptic loosening, fractures, and most other complications were comparable across bearing surfaces. Overall, the findings suggest that modern bearing surfaces provide similar long-term safety and survivorship in primary THA, although CoC bearings may offer advantages in wear-related outcomes and implant stability at the expense of increased ceramic-specific noise phenomena.