| BackgroundTotal hip arthroplasty(THA) has been increasingly used in the young and active patients. Due to polyethylene wear particles generated lead to aseptic loosening is the most common reason for failure of THA, metal on ultra-high molecular-weight conventional polyethylene bearing(MoPc),once as a gold standard, in THA gradually decreased. With the implant design and materials science advances, new high wear-resistant materials were developed and applied, such as ceramic and highly cross-linked polyethylene material. In recent years, these new bearing surfaces consists of wear-resistant materials are widely used in THA, such as ceramic on ceramic bearing(CoC), metal on highly crosslinked polyethylene bearing(MoPxl) etc. In the past 20 years, although some system reviews and randomized controlled trials have made the analysis of different bearings with its clinical outcomes and postoperative complications, but as a result, some of the results are not entirely consistent, and lack of large sample statistical analysis. Compared with conventional polyethylene, although the wear resistance of ceramic and highly cross-linked polyethylene material better, But the safety of the COC, MoPc, MoPxl these three kinds of bearings is relatively small, especially the comparison of complications of linear wear rate, postoperation revision rate, osteolysis rate, aseptic loosening rate, squeaking rate, prosthesis fracture rate etc. At present the literature, large sample system analysis hasn't yet seen the safety of three different bearing surfaces of CoC, MoPc and MoPxl. ObjectiveBy meta analysis method of THA in CoC, MoPc, MoPxl three kinds of bearing surfaces of the postoperative complications were compared, evaluation the safety of the bearings, provide the basis for young and active patients with the selection of bearing surfaces. MethodBased on randomized controlled trials searched from PubMed, CNKI, Cochrane library, Web of Science, EMBase, Wanfang database, Chinese CJFD and related meetings, retrieval CoC, MoPc, MoPxl three kinds of bearing surfaces compared with each other. The retrieval period to 2016-01. The retrieval languages are English and Chinese. Two investigators independently selected studies, extracted data, assessed risk of bias and retrospective study of references. Three kinds of bearing surfaces compared with each other to form 3 comparison groups, CoC vs MoPc, CoC vs MoPxl, MoPc vs MoPxl. Use Revman 5.3 software for statistical analysis for each comparison group. ResultsThrough rigorous screening included 21 documents, a total of 3153 hips, the average age of 44~70.1 years, 9 CoC vs MoPc, 4 CoC vs MoPxl, 10 MoPc vs MoPxl. Wherein a comparison document contains three kinds of bearings, a literature own two bearings controlled twice.(1) CoC bearing's linear wear rate less than MoPc bearing[SMD=-2.56,95%CI(-3.31,-1.81);P<0.00001], CoC bearing's linear wear rate less than MoPxl bearing[SMD=-2.33,95%CI(-3.53,-1.13);P=0.0001], MoPxl bearing's linear wear rate less than MoPc bearing[SMD=1.19,95%CI(0.72,1.66);P<0.00001];(2) CoC bearing‘s revision rate is less than MoPc[RR=0.62,95%CI(0.41,0.94);P=0.02], MoPxl bearing's revision rate lower than MoPc bearing [RR=3.05,95%CI(1.27,7.32);P=0.01], CoC and MoPxl bearing's revision rate is no significant difference;(3) CoC bearing's osteolysis rate less than MoPc bearing [RR=0.18,95%CI(0.06,0.50);P=0.001], MoPxl bearing's osteolysis rate of less than MoPc bearing[RR=10.96,95%CI(3.46,34.75);P<0.001], MoPxl and CoC bearing's osteolysis rate is no significant difference;(4) CoC and MoPc bearing's squeaking rate, prosthesis fracture rate and postoperation infection rate are no significant difference. CoC and MoPxl bearing's squeaking rate, prosthesis fracture rate and heterotopic ossification rate are no significant difference. MoPc and MoPxl bearing's postoperation infection rate and heterotopic ossification rate are no significant difference;(5)Three kinds of bearings' aseptic loosening rate and postoperation dislocation rate are no statistical difference. ConclusionsIn the primary THA,(1) Compared with MoPc, CoC bearing has a lower linear wear rate, revision rate and osteolysis rate;(2) Compared with MoPxl, CoC bearing has a lower linear wear rate, but revision rate and osteolysis rate are no statistical difference;(3) Compared with MoPc, MoPxl bearing has a lower linear wear rate, revision rate and osteolysis rate;(4) In other postoperative complications, Three kinds of bearings' aseptic loosening rate and postoperation dislocation rate are no statistical difference. CoC and MoPc?CoC and MoPxl bearings' squeaking rate and prosthesis fracture rate are no statistical difference.Therefore, the CoC bearing is a better choice for young and active patients. |
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