Comparative assessment of implantable hip devices with different bearing surfaces: systematic appraisal of evidence

Abstract

Objective To determine comparative safety and effectiveness of combinations of bearing surfaces of hip implants.Design Systematic review of clinical trials, observational studies, and registries.Data sources Medline, Embase, Cochrane Controlled Trials Register, reference lists of articles, annual reports of major registries, summaries of safety and effectiveness for pre-market application and mandated post-market studies at the United States Food and Drug Administration.Study selection Criteria for inclusion were comparative studies in adults reporting information for various combinations of bearings (such as metal on metal and ceramic on ceramic). Data search, abstraction, and analyses were independently performed and confirmed by at least two authors. Qualitative data syntheses were performed.Results There were 3139 patients and 3404 hips enrolled in 18 comparative studies and over 830 000 operations in national registries. The mean age range in the trials was 42-71, and 26-88% were women. Disease specific functional outcomes and general quality of life scores were no different or they favoured patients receiving metal on polyethylene rather than metal on metal in the trials. While one clinical study reported fewer dislocations associated with metal on metal implants, in the three largest national registries there was evidence of higher rates of implant revision associated with metal on metal implants compared with metal on polyethylene. One trial reported fewer revisions with ceramic on ceramic compared with metal on polyethylene implants, but data from national registries did not support this finding. ConclusionsThere is limited evidence regarding comparative effectiveness of various hip implant bearings. Results do not indicate any advantage for metal on metal or ceramic on ceramic implants compared with traditional metal on polyethylene or ceramic on polyethylene bearings.

Modular sleeves with ceramic heads in isolated acetabular cup revision in younger patients—laboratory and experimental analysis of suitability and clinical outcomes

“…In a simulation, polyethylene wear when combined with a ceramic head is half that of polyethylene combined with metal [1]. Clinical studies have also yielded very good long-term outcomes for this articulating couple [2,3]. These findings show that an articulating couple with optimal wear properties is of crucial importance in revision hip surgery, especially in younger patients.…”

Surgical Total Hip Arthroplasty Options for Geriatric Patients

“…Studies have shown that there is no difference in functional outcomes, measured by the Harris Hip Score, between different types of hip implants 2 years after the total hip arthroplasty, although metal-on-polyethylene implants had slightly better functional scores within the fi rst 2 years after THA. 19 Conclusive evidence has not been reached for a general recommendation on material type. Here, we will discuss general characteristics of each type of implant material and the advantages and disadvantages associated with them.…”

“…The most common causes of implant failure are infection, dislocation, wear, instability, loosening, or other mechanical failure. 19 Differences in these implants are the materials used, sizing of the implant components, and fi xation of the implant. Each option has its own advantages and disadvantages that can infl uence the long-term function of the artifi cial hip and affect the risk of postprocedure complications.…”

Overview on Biocompatibilities of Implantable Biomaterials

“…The thermal oxidation behavior of Al ion implanted Ti nitride films has been studied in dry oxygen atmosphere and found that Al implantation caused the oxidation rate of TiN films to slow down at the initial stage of oxidation [222]. Until recently, there is limited evidence regarding comparative effectiveness of various hip implant bearings, especially metal on metal or ceramic on ceramic implants compared with traditional metal on polyethylene or ceramic on polyethylene bearings [223].…”