Department of Joint Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China.
Department of Oral Implantology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China.
PeerJ. 2024 Sep 25;12:e18139. doi: 10.7717/peerj.18139. eCollection 2024.
To compare the clinical outcomes between ceramic-on-ceramic (CoC) and ceramic-on-polyethylene (CoP) bearing surfaces in patients undergoing total hip arthroplasty (THA) through a pooled analysis and evidence update.
We performed a systematic literature search using PubMed, Embase, Cochrane Library and Web of Science up to March 2023 for studies that compared the bearing surfaces of CoC and CoP in patients undergoing THA. The primary outcomes were the incidence of common postoperative complications and the rate of postoperative revision. The secondary outcome was the Harris Hip Score.
A total of 10 eligible studies involving 1,946 patients (1.192 CoC-THA 906 CoP-THA) were included in the evidence synthesis. Pooled analysis showed no significant difference in the rates of common postoperative complications (dislocation, deep vein thrombosis, infection, wear debris or osteolysis) and of revision. After eliminating heterogeneity, the postoperative Harris Hip Score was higher in the CoC group than in the CoP group. However, the strength of evidence was moderate for the Harris Hip Score.
CoC articulations are more commonly used in younger, healthier, and more active patients. While the performance of conventional polyethylene is indeed inferior to highly cross-linked polyethylene, there is currently a lack of sufficient research comparing the outcomes between highly cross-linked polyethylene and CoC bearing surfaces. This area should be a focal point for future research, and it is hoped that more relevant articles will emerge. Given the limited number of studies included, the heterogeneity and potential bias of those included in the analysis, orthopaedic surgeons should select a THA material based on their experience and patient-specific factors, and large multicentre clinical trials with >15 years of follow-up are needed to provide more evidence on the optimal bearing surface for initial THA.
通过汇总分析和证据更新，比较全髋关节置换术（THA）中陶瓷对陶瓷（CoC）和陶瓷对聚乙烯（CoP）两种不同关节面的临床结果。
我们对 PubMed、Embase、Cochrane 图书馆和 Web of Science 进行了系统的文献检索，检索截至 2023 年 3 月，纳入比较 CoC 和 CoP 在接受 THA 治疗的患者中的关节面的研究。主要结果为常见术后并发症的发生率和术后翻修率。次要结果为 Harris 髋关节评分。
共有 10 项符合条件的研究，共纳入 1946 例患者（1192 例 CoC-THA 和 906 例 CoP-THA），纳入证据综合。汇总分析显示，常见术后并发症（脱位、深静脉血栓形成、感染、磨损碎屑或骨溶解）和翻修率的发生率无显著差异。消除异质性后，CoC 组的术后 Harris 髋关节评分高于 CoP 组。然而，对于 Harris 髋关节评分，证据强度为中等。
CoC 关节在年轻、健康和活跃的患者中更常使用。虽然传统聚乙烯的性能确实不如高交联聚乙烯，但目前缺乏足够的研究比较高交联聚乙烯和 CoC 关节面的结果。这一领域应该是未来研究的重点，希望能有更多相关文章出现。鉴于纳入的研究数量有限，分析中纳入的研究的异质性和潜在偏倚，骨科医生应根据自己的经验和患者的具体因素选择 THA 材料，需要进行 >15 年随访的大型多中心临床试验，以提供关于初始 THA 最佳关节面的更多证据。
