title: Comparison of ceramic-on-ceramic to metal-on-polyethylene bearing surfaces in total hip arthroplasty: a meta-analysis of randomized controlled trials.
abstract: BACKGROUND
  In recent years, the choice of ceramic-on-ceramic (COC) and metal-on-polyethylene (MOP) in primary total hip arthroplasty (THA) remains controversial. The purpose of this study was to compare the reliability and durability of COC with that of MOP bearing surfaces in THA.
  
  
  METHODS
  Based on prospective randomized controlled trials (RCTs) searched from Pubmed, Embase, Web of Science, and Cochrane central database, we performed a meta-analysis for comparing clinical and radiographic outcomes of COC with those of MOP. Two investigators independently selected studies, extracted data, and assessed risk of bias. Relative risks and weighted mean differences from each trial were pooled using random-effect or fixed-effect models depending on the heterogeneity of the included studies.
  
  
  RESULTS
  Five RCTs involving 897 patients with 974 hips met predetermined inclusion criteria. Our results demonstrated COC significantly decreased the risks of revision, osteolysis and radiolucent line, aseptic loosening, and dislocation and increased the risks of squeaking and intraoperative implant fracture compared with MOP. There was no significant difference between the two groups in postoperative hip function, deep infection, and heterotopic ossification.
  
  
  CONCLUSIONS
  Generally, despite more squeaking and intraoperative implant fracture, our findings support the use of COC bearing surface which has lower rates of revision, osteolysis and radiolucent line, aseptic loosening, and dislocation compared with MOP.
authors: Department of Orthopaedic Surgery, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, 430071, China. hudongcai@whu.edu.cn.
authors: Dongcai
authors: D
authors: Hu
authors: Department of Orthopaedic Surgery, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, 430071, China. saintdiego2001@sina.com.
authors: Kai
authors: K
authors: Tie
authors: Department of Intensive Care Unit, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, 430071, China. yangxiao88@whu.edu.cn.
authors: Xiao
authors: X
authors: Yang
authors: Department of Orthopaedic Surgery, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, 430071, China. tanyang515@163.com.
authors: Yang
authors: Y
authors: Tan
authors: Department of Orthopaedic Surgery, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, 430071, China. sheher@hotmail.com.
authors: Mohammed
authors: M
authors: Alaidaros
authors: Department of Orthopaedic Surgery, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, 430071, China. lbchen@whu.edu.cn.
authors: Liaobin
authors: L
authors: Chen
mesh_terms: D019644:Arthroplasty, Replacement, Hip; D002516:Ceramics; D006622:Hip Prosthesis / Q000706:statistics & numerical data*; D006801:Humans; D020959:Polyethylene; D011183:Postoperative Complications / Q000453:epidemiology; D016032:Randomized Controlled Trials as Topic; D020127:Recovery of Function; D012086:Reoperation
chemical_list: D020959:Polyethylene
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