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Comparisons of different bearing surfaces in cementless total hip arthroplasty: a systematic review and Bayesian network analysis

Published:October 17, 2022DOI:https://doi.org/10.1016/j.arth.2022.10.016

      Highlights

      • 1)Bearings containing HXP, HXPE and ceramic liners showed comparable survivorship and hip function in the mid-term and long-term follow-up.
      • 2)Hard-on-hard bearings containing metal had higher serum level of metal ions than others.
      • 3)Bearings containing conventional polyethylene had poor performance in implant survival, hip function and wear rates.

      Abstract

      Objectives

      We aimed to make comparisons of different bearing surfaces in patients after cementless total hip arthroplasty.

      Methods

      The network meta-analysis was guided by the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guideline. The primary outcomes were implant survival and Harris hip score (HHS). Secondary outcomes included linear wear rates and serum level of metal ions. Subgroup analyses were performed by: 1) classifying head sizes as small and large; 2) femoral heads as ceramic and metal; and 3) liners as metal, ceramic, polyethylene, highly cross-linked polyethylene (HXP), or vitamin E-infused highly cross-linked polyethylene (HXPE). A total of 64 eligible RCTs with different bearings were assessed. Overall inconsistency and heterogeneity were acceptable.

      Results

      In the 10 years follow-up, metal-on-polythene and ceramic-on-polythene bearings with small heads showed higher risk for revisions compared with metal-on-HXP and ceramic-on-HXP bearings with small heads. Similarly, only metal or ceramic-on-polythene bearings with small heads showed inferiority in HHS compared with other bearings. Conventional polyethylene liners showed higher linear wear rates compared with HXP, HXPE, and ceramic liners at 5 and 10 years after surgery, while metal-on-metal and ceramic-on-metal bearings showed higher serum level of cobalt and chromium.

      Conclusions

      Bearings containing HXP, HXPE, and ceramic liners showed comparable survivorship and hip function at follow-up of 5 and 10 years. Hard-on-hard bearings containing metal had higher serum level of metal ions than others. Bearings containing conventional polyethylene had worse performance in terms of implant survival, hip function, and wear rates.

      Keywords

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