title: Is there any difference in survivorship of total hip arthroplasty with different bearing surfaces? A systematic review and network meta-analysis.
abstract: OBJECTIVE
  Although many total hip bearing implants are widely used all over the world, simultaneous comparisons across the numerous available bearing surfaces are rare. The purpose of this study was to compare the survivorship of total hip arthroplasty (THA) with six available bearing implants.
  
  
  METHODS
  We conducted a systematic review of randomized controlled trials (RCTs) reporting survivorship or revision of ceramic-on-ceramic (CoC), ceramic-on-conventional polyethylene (CoPc), ceramic-on-highly-crosslinked polyethylene (CoPxl), metal-on-conventional polyethylene (MoPc), metal-on-highly-crosslinked polyethylene (MoPxl), or metal-on-metal (MoM) bearing implants. The synthesis of present evidence was performed by both the traditional direct-comparison meta-analysis and network meta-analysis.
  
  
  RESULTS
  In total, 40 RCTs involving a total of 5321 THAs were identified. The pooled data of network meta-analysis showed no difference in relative risk (RR) of revision across CoC, CoPc, CoPxl and MoPxl bearings. However, the MoM bearing was demonstrated with a significant higher risk of revision compared with CoC (RR 5.10; 95% CI=1.62 to 16.81), CoPc (RR 4.80; 95% CI=1.29 to 17.09), or MoPxl (RR 3.85; 95% CI=1.16 to 14.29), and the MoPc bearing was indicated with a higher risk of revision compared with CoC (RR 2.83; 95% CI=1.20 to 6.63). The ranking probabilities of the effective interventions also revealed the inferiority of the MoM and MoPc implants in survivorship (both 0%, 95% CI=0% to 0%) compared with CoC (39%, 95% CI=0% to 100%), CoPc (33%, 95% CI=0% to 100%), CoPxl (7%, 95% CI=0% to 100%) or MoPxl (21%, 95% CI=0% to 100%).
  
  
  CONCLUSIONS
  The present evidence indicated the similar performance in survivorship among CoC, CoPc, CoPxl and MoPxl bearing implants, and that all likely have superiority compared with the MoM and MoPc bearing implants in THA procedures. Long-term RCT data are required to confirm these conclusions and better inform clinical decisions.
authors.affiliation: Department of Orthopaedic Surgery, First Affiliated Hospital of Xi'an Jiaotong university Xi'an, China.
authors.forename: Si
authors.initials: S
authors.lastname: Yin
authors.affiliation: Department of Orthopaedic Surgery, First Affiliated Hospital of Xi'an Jiaotong university Xi'an, China.
authors.forename: Dangfeng
authors.initials: D
authors.lastname: Zhang
authors.affiliation: Department of Network Coordination, Shaanxi Radio and TV University Xi'an, China.
authors.forename: Hui
authors.initials: H
authors.lastname: Du
authors.affiliation: Department of Orthopaedic Surgery, First Affiliated Hospital of Xi'an Jiaotong university Xi'an, China.
authors.forename: Heng
authors.initials: H
authors.lastname: Du
authors.affiliation: Department of Orthopaedic Surgery, First Affiliated Hospital of Xi'an Jiaotong university Xi'an, China.
authors.forename: Zhanhai
authors.initials: Z
authors.lastname: Yin
authors.affiliation: Department of Orthopaedic Surgery, First Affiliated Hospital of Xi'an Jiaotong university Xi'an, China.
authors.forename: Yusheng
authors.initials: Y
authors.lastname: Qiu
keywords: Total hip arthroplasty; bearing surface; network meta-analysis; randomized controlled trial; survivorship