Metal-On-Metal or Ceramic-On-Ceramic for Cementless Total Hip Arthroplasty: A Meta-Analysis

• Published in: The Journal of arthroplasty Vol. 31; no. 11; pp. 2637 - 2645.e1
• Main Authors: Lee, Young-Kyun, Yoon, Byung-Ho, Choi, Yun Seong, MD, Jo, Woo-Lam, MD, Ha, Yong-Chan, Koo, Kyung-Hoi
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.11.2016
• Subjects: Arthroplasty, Replacement, Hip - instrumentation; ceramic; Ceramics; Hip Prosthesis - adverse effects; Hip Prosthesis - statistics & numerical data; Humans; meta-analysis; metal; Metal-on-Metal Joint Prostheses - adverse effects; Metal-on-Metal Joint Prostheses - statistics & numerical data; Metals; Odds Ratio; Orthopedics; Prosthesis Failure - etiology; Prosthesis-Related Infections - etiology; Reoperation - statistics & numerical data; revision; total hip arthroplasty; ceramic; metal; meta-analysis; total hip arthroplasty; Level I; revision
• ISSN: 0883-5403; 1532-8406
• DOI: 10.1016/j.arth.2016.04.014

Abstract Background Hard bearings, metal-on-metal (MOM) and ceramic-on-ceramic (COC) have been developed to overcome polyethylene wear-related osteolysis, but comparisons between these two hard bearings are limited. We performed a meta-analysis to determine revision rates for (1) any reason, (2) aseptic loosening, (3) periprosthetic joint infection (PJI), and (4) recurrent dislocation between MOM and COC bearings in cementless THA. Methods This analysis included 3 studies comparing COC and MOM bearings and 56 studies reporting outcomes of MOM or COC bearings. We conducted a comparison meta-analysis (with a fixed-effects model) on the three comparative studies, and a proportional meta-analysis on the data from the 59 articles in order to determine a consensus. Results In the comparison meta-analysis, MOM showed higher revision rate than COC for any reason (OR = 2.39, p = 0.046) and PJI (OR = 6.21, p = 0.015). In the proportion meta-analysis, the MOM group showed significantly higher revision rate than COC group for any reason, aseptic loosening, and PJI. Conclusions MOM bearings were associated with a higher risk of revision for any reason and PJI than COC bearings after cementless THA.