title: Ceramic on Ceramic or Ceramic-on-polyethylene for Total Hip Arthroplasty: A Systemic Review and Meta-analysis of Prospective Randomized Studies.
abstract: BACKGROUND
  Wear debris of polyethylene has become a restraining factor of the durability for total hip arthroplasty (THA). Ceramic on ceramic (COC) has better wear resistance while the squeaking sound and prosthesis fracture are of concern. It is still a controversy that bearing couples are better for THA.
  
  
  METHODS
  We performed a systematic review of all English articles identiﬁed from PubMed (1966-), Embase (1980-) and the Cochrane Library. Clinical outcomes, complications, revision rates, and radiographic outcomes of COC-THA and ceramic on polyethylene (COP)-THA were compared and evaluated.
  
  
  RESULTS
  Eight prospective randomized trials enrolling a total of 1508 patients and 1702 THA surgeries were identiﬁed. Our results demonstrated the prosthesis fracture and the squeaking sound is significantly higher in COC group and higher wear rate of the COP. Hip function, loosening rate, dislocation rate, revision rate, and the osteolysis rate were comparable between two groups. According to Grading of Recommendations Assessment, Development and Evaluation system assessment, the strength of evidence was high for prosthesis fracture, dislocation, osteolysis, and moderate for radiolucent line or loosening, hip noise, and revision.
  
  
  CONCLUSIONS
  Up to now, there is insufﬁcient evidence to identify any clinical advantage of COC compared with COP. Longer follow-up of larger randomized trial is needed to clarify the outcomes.
authors.forename: Yu-Lei
authors.initials: YL
authors.lastname: Dong
authors.forename: Tao
authors.initials: T
authors.lastname: Li
authors.forename: Ke
authors.initials: K
authors.lastname: Xiao
authors.forename: Yan-Yan
authors.initials: YY
authors.lastname: Bian
authors.affiliation: Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China.
authors.forename: Xi-Sheng
authors.initials: XS
authors.lastname: Weng
mesh_terms: D019644:Arthroplasty, Replacement, Hip / Q000379:methods*; D002516:Ceramics / Q000627:therapeutic use*; D006622:Hip Prosthesis; D006801:Humans; D020959:Polyethylene / Q000627:therapeutic use*
chemical_list: D020959:Polyethylene