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Metal-on-metal or metal-on-polyethylene for total hip arthroplasty: a meta-analysis of prospective randomized studies

  • Hip Arthroplasty
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Background

There has been recent concern regarding the increased use of metal-on-metal total hip arthroplasty (MOM-THA) as an alternative to contemporary metal-on-polyethylene total hip arthroplasty (MOP-THA), and the choice remains controversial. We performed a meta-analysis to evaluate and compare metal ion concentrations, complications, reoperation rates, clinical outcomes and radiographic outcomes of MOM-THA and MOP-THA.

Methods

We performed a systematic review of English and non-English articles identified from MEDLINE, Embase, the Cochrane Central Register of Controlled Trials, PreMEDLINE and HealthSTAR. Metal ion concentrations, complications, reoperation rates and other outcomes of MOM bearings were compared with MOP bearings in THA based on relative risks, mean differences and standardized mean difference statistics.

Results

Eight prospective randomized trials were identified from 1,075 citations. Our results demonstrated significantly elevated erythrocyte, serum and urine levels of metal ions (cobalt and chromium) among patients who received MOM-THA. No significant differences in titanium concentrations or total complication or reoperation rates were found between MOM-THA and MOP-THA. Clinical function scores and radiographic evaluations were similar between the two groups.

Conclusions

This analysis found insufficient evidence to identify any clinical advantage of MOM-THA compared with MOP-THA. Although cobalt and chromium concentrations were elevated after MOM-THA, there were no significant differences in total complication rates (including all-case mortality) between the two groups in the short- to mid-term follow-up period. The MOM bearing option for THA should be used with caution.

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References

  1. Makela KT, Peltola M, Hakkinen U, Remes V (2010) Geographical variation in incidence of primary total hip arthroplasty: a population-based analysis of 34, 642 replacements. Arch Orthop Trauma Surg 130(5):633–639

    Article  PubMed  Google Scholar 

  2. Huo MH, Stockton KG, Mont MA, Parvizi J (2010) What’s new in total hip arthroplasty. J Bone Joint Surg Am 92(18):2959–2972

    Article  PubMed  Google Scholar 

  3. Courpied JP, Caton JH (2011) Total hip arthroplasty, state of the art for the 21st century. Int Orthop 35(2):149–150

    Article  PubMed  Google Scholar 

  4. Kurtz S, Ong K, Lau E, Mowat F, Halpern M (2007) Projections of primary, revision hip, knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am 89(4):780–785

    Article  PubMed  Google Scholar 

  5. Hallan G, Dybvik E, Furnes O, Havelin LI (2010) Metal-backed acetabular components with conventional polyethylene: a review of 9113 primary components with a follow-up of 20 years. J Bone Joint Surg Br 92(2):196–201

    Article  PubMed  CAS  Google Scholar 

  6. Maezawa K, Nozawa M, Hirose T et al (2002) Cobalt and chromium concentrations in patients with metal-on-metal and other cementless total hip arthroplasty. Arch Orthop Trauma Surg 122(5):283–287

    Article  PubMed  Google Scholar 

  7. Malviya A, Ramaskandhan J, Holland JP, Lingard EA (2010) Metal-on-metal total hip arthroplasty. J Bone Joint Surg Am 92(7):1675–1683

    Article  PubMed  Google Scholar 

  8. Crawford R, Ranawat CS, Rothman RH (2010) Metal on metal: is it worth the risk? J Arthroplasty 25:1–2

    Article  PubMed  Google Scholar 

  9. Macpherson GJ, Breusch SJ (2011) Metal-on-metal hip resurfacing: a critical review. Arch Orthop Trauma Surg 131(1):101–110

    Article  PubMed  Google Scholar 

  10. Imanishi T, Hasegawa M, Sudo A (2010) Serum metal ion levels after second-generation metal-on-metal total hip arthroplasty. Arch Orthop Trauma Surg 130(12):1447–1450

    Article  PubMed  Google Scholar 

  11. Marker M, Grubl A, Riedl O, Heinze G, Pohanka E, Kotz R (2008) Metal-on-metal hip implants: do they impair renal function in the long-term? A 10-year follow-up study. Arch Orthop Trauma Surg 128(9):915–919

    Article  PubMed  Google Scholar 

  12. Moroni A, Savarino L, Hoque M, Cadossi M, Baldini N (2011) Do ion levels in hip resurfacing differ from metal-on-metal THA at midterm? Clin Orthop Relat Res 469(1):180–187

    Article  PubMed  CAS  Google Scholar 

  13. Girard J, Bocquet D, Autissier G, Fouilleron N, Fron D, Migaud H (2010) Metal-on-metal hip arthroplasty in patients thirty years of age or younger. J Bone Joint Surg Am 92(14):2419–2426

    Article  PubMed  Google Scholar 

  14. Riley RD, Higgins JP, Deeks JJ (2011) Interpretation of random effects meta-analyses. BMJ 342:d549

    Article  PubMed  Google Scholar 

  15. Liberati A, Altman DG, Tetzlaff J et al (2009) The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ 339:b2700

    Article  PubMed  Google Scholar 

  16. Juni P, Egger M (2009) PRISMAtic reporting of systematic reviews and meta-analyses. Lancet 374(9697):1221–1223

    Article  PubMed  Google Scholar 

  17. Detsky AS, Naylor CD, O’Rourke K, McGeer AJ, L’Abbé KA (1992) Incorporating variations in the quality of individual randomized trials into meta-analysis. J Clin Epidemiol 45:255–265

    Article  PubMed  CAS  Google Scholar 

  18. Fleiss JL (1993) The statistical basis of meta-analysis. Stat Methods Med Res 2:121–145

    Article  PubMed  CAS  Google Scholar 

  19. Hozo SP, Djulbegovic B, Hozo I (2005) Estimating the mean and variance from the median, range, and the size of a sample. BMC Med Res Methodol 5:13

    Article  PubMed  Google Scholar 

  20. Deeks JJ, Higgins JPT, Altman DG (eds) Data extraction for continuous outcomes. In: Higgins JPT, Green S (eds) Cochrane Handbook for Systematic Reviews of Interventions 5.0.2; http://www.cochrane.org/training/cochrane-handbook Accessed Sept 2009

  21. Lombardi AV Jr, Mallory TH, Alexiades MM, Cuckler JM, Faris PM, Jaffe KA et al (2001) Short-term results of the M2a-taper metal-on-metal articulation. J Arthroplasty 16:122–128

    Article  PubMed  Google Scholar 

  22. Lombardi AV Jr, Mallory TH, Cuckler JM, Williams J, Berend KR, Smith TM (2004) Mid-term results of a polyethylene-free metal-on-metal articulation. J Arthroplasty 19:42–47

    Article  PubMed  Google Scholar 

  23. Zijlstra WP, Cheung J, Sietsma MS, van Raay JJ, Deutman R (2009) No superiority of cemented metal-on-metal vs metal-on-polyethylene THA at 5-year follow-up. Orthopedics 32:479

    Article  PubMed  Google Scholar 

  24. Zijlstra WP, Van Raay JJ, Bulstra SK, Deutman R (2010) No superiority of cemented metal-on-metal over metal-on-polyethylene THA in a randomized controlled trial at 10-year follow-up. Orthopedics 154–161. (Epub ahead of print)

  25. Engh CA Jr, MacDonald SJ, Sritulanondha S, Thompson A, Naudie D, Engh CA (2009) 2008 John Charnley award: metal ion levels after metal-on-metal total hip arthroplasty: a randomized trial. Clin Orthop Relat Res 467:101–111

    Article  PubMed  Google Scholar 

  26. Dahlstrand H, Stark A, Anissian L et al (2009) Elevated serum concentrations of cobalt, chromium, nickel, and manganese after metal-on-metal alloarthroplasty of the hip: a prospective randomized study. J Arthroplasty 24:837–845

    Article  PubMed  Google Scholar 

  27. Jacobs M, Gorab R, Mattingly D, Trick L, Southworth C (2004) Three- to six-year results with the Ultima metal-on-metal hip articulation for primary total hip arthroplasty. J Arthroplasty 19:48–53

    Article  PubMed  Google Scholar 

  28. MacDonald SJ, McCalden RW, Chess DG, Bourne RB, Rorabeck CH, Cleland D et al (2003) Metal-on-metal versus polyethylene in hip arthroplasty: a randomized clinical trial. Clin Orthop Relat Res 406:282–296

    Article  PubMed  Google Scholar 

  29. DeLee JG, Charnley J (1976) Radiological demarcation of cemented sockets in total hip replacement. Clin Orthop 121:20–32

    PubMed  Google Scholar 

  30. van der Weegen W, Hoekstra HJ, Sijbesma T, Bos E, Schemitsch EH, Poolman RW (2011) Survival of metal-on-metal hip resurfacing arthroplasty: a systematic review of the literature. J Bone Joint Surg Br 93(3):298–306

    Article  PubMed  Google Scholar 

  31. Moroni A, Savarino L, Cadossi M, Baldini N, Giannini S (2008) Does ion release differ between hip resurfacing and metal-on-metal THA? Clin Orthop Relat Res 466(3):700–707

    Article  PubMed  Google Scholar 

  32. Nunley RM, Della Valle CJ, Barrack RL (2009) Is patient selection important for hip resurfacing? Clin Orthop Relat Res 467(1):56–65

    Article  PubMed  Google Scholar 

  33. McGrory B, Barrack R, Lachiewicz PF et al (2010) Modern metal-on-metal hip resurfacing. J Am Acad Orthop Surg 18(5):306–314

    PubMed  Google Scholar 

  34. De Smet K, Campbell PA, Gill HS (2010) Metal-on-metal hip resurfacing: a consensus from the Advanced Hip Resurfacing Course, Ghent, June 2009. J Bone Joint Surg Br 92(3):335–336

    Article  PubMed  Google Scholar 

  35. Shetty VD, Villar RN (2006) Development and problems of metal-on-metal hip arthroplasty. Proc Inst Mech Eng H 220:371–377

    Article  PubMed  CAS  Google Scholar 

  36. Patntirapong S, Habibovic P, Hauschka PV (2009) Effects of soluble cobalt and cobalt incorporated into calcium phosphate layers on osteoclast differentiation and activation. Biomaterials 30(4):548–555

    Article  PubMed  CAS  Google Scholar 

  37. Ziaee H, Daniel J, Datta AK, Blunt S, McMinn DJ (2007) Transplacental transfer of cobalt and chromium in patients with metal-on-metal hip arthroplasty: a controlled study. J Bone Joint Surg Br 89:301–305

    PubMed  CAS  Google Scholar 

  38. Daniel J, Ziaee H, Pradhan C, Pynsent PB, McMinn DJ (2010) Renal clearance of cobalt in relation to the use of metal-on-metal bearings in hip arthroplasty. J Bone Joint Surg Am 92(4):840–845

    Article  PubMed  Google Scholar 

  39. Zeh A, Becker C, Planert M, Lattke P, Wohlrab D (2009) Time-dependent release of cobalt and chromium ions into the serum following implantation of the metal-on-metal Maverick type artificial lumbar disc (Medtronic Sofamor Danek. Arch Orthop Trauma Surg 129(6):741–746

    Article  PubMed  Google Scholar 

  40. Yang J, Shen B, Zhou Z, Pei F, Kang P (2011) Changes in cobalt and chromium levels after metal-on-metal hip resurfacing in young, active Chinese patients. J Arthroplast 26(1):65–70 (70 e61)

    Article  Google Scholar 

  41. Langton DJ, Joyce TJ, Mangat N et al (2011) Reducing metal ion release following hip resurfacing arthroplasty. Orthop Clin North Am 42(2):169–180

    Article  PubMed  Google Scholar 

  42. Nikolau VS, Petit A, Zukor D, et al (2010) Semen metal ion levels and sperm quality in patients with metal on metal total hip replacement. Paper #F501. Presented at the 2010 EFORT Congress. June 2–5, Madrid

  43. Khan M, Kuiper JH, Richardson JB (2008) The exercise-related rise in plasma cobalt levels after metal-on-metal hip resurfacing arthroplasty. J Bone Joint Surg Br 90(9):1152–1157

    Article  PubMed  CAS  Google Scholar 

  44. Savarino L, Granchi D, Ciapetti G et al (2003) Ion release in stable hip arthroplasties using metal-on-metal articulating surfaces: a comparison between short- and medium term results. J Biomed Mater Res A 66:450–456

    Article  PubMed  CAS  Google Scholar 

  45. deSouza RM, Parsons NR, Oni T, Dalton P, Costa M, Krikler S (2010) Metal ion levels following resurfacing arthroplasty of the hip: serial results over a ten-year period. J Bone Joint Surg Br 92(12):1642–1647

    Article  PubMed  CAS  Google Scholar 

  46. Antoniou J, Zukor DJ, Mwale F, Minarik W, Petit A, Huk OL (2008) Metal ion levels in the blood of patients after hip resurfacing: a comparison between twenty-eight and thirty-six-millimeter-head metal-on-metal prostheses. J Bone Joint Surg Am 90((Suppl 3)):142–148

    Article  PubMed  Google Scholar 

  47. Learmonth ID, Case CP (2007) Metallic debris from orthopaedic implants. Lancet 369(9561):542–544

    Article  PubMed  Google Scholar 

  48. Stellman JM (ed) (1998) Encyclopaedia of occupational health and safety, 4th edn. ILO, Geneva

    Google Scholar 

  49. Deutsche Forschungsgemeinschaft (1992) Expositionaquivalente für Krebserzeugende Arbeitsstoffe. Wiley-VCH, Weinheim

  50. Bhamra MS, Case CP (2006) Biological effects of metal-on-metal hip replacements. Proc Inst Mech Eng H 220(2):379–384

    Article  PubMed  CAS  Google Scholar 

  51. Ladon D, Doherty A, Newson R, Turner J, Bhamra M, Case CP (2004) Changes in metal levels and chromosome aberrations in the peripheral blood of patients after metal-on-metal hip arthroplasty. J Arthroplast 19((8 Suppl 3)):78–83

    Article  Google Scholar 

  52. Korovessis P, Petsinis G, Repanti M, Repantis T (2006) Metallosis after contemporary metal-on-metal total hip arthroplasty. Five to nine-year follow-up. J Bone Joint Surg Am 88(6):1183–1191

    Article  PubMed  CAS  Google Scholar 

  53. Davies AP, Willert HG, Campbell PA, Learmonth ID, Case CP (2005) An unusual lymphocytic perivascular infiltration in tissues around contemporary metal-on-metal joint replacements. J Bone Joint Surg Am 87(1):18–27

    Article  PubMed  CAS  Google Scholar 

  54. Hailer NP, Blaheta RA, Dahlstrand H, Stark A (2011) Elevation of circulating HLA DR(+) CD8(+) T-cells and correlation with chromium and cobalt concentrations 6 years after metal-on-metal hip arthroplasty. Acta Orthop 82(1):6–12

    Article  PubMed  Google Scholar 

  55. Hosman AH, van der Mei HC, Bulstra SK, Busscher HJ, Neut D (2010) Effects of metal-on-metal wear on the host immune system and infection in hip arthroplasty. Acta Orthop 81(5):526–534

    Article  PubMed  Google Scholar 

  56. Huk OL, Catelas I, Mwale F, Antoniou J, Zukor DJ, Petit A (2004) Induction of apoptosis and necrosis by metal ions in vitro. J Arthroplasty 19((8 Suppl 3)):84–87

    Article  PubMed  Google Scholar 

  57. Mabilleau G, Kwon YM, Pandit H, Murray DW, Sabokbar A (2008) Metal-on-metal hip resurfacing arthroplasty: a review of periprosthetic biological reactions. Acta Orthop 79(6):734–747

    Article  PubMed  Google Scholar 

  58. Dyer C (2010) UK law firm starts action on “metal on metal” hip implants. BMJ 340:c2394

    Article  PubMed  Google Scholar 

  59. Mahendra G, Pandit H, Kliskey K, Murray D, Gill HS, Athanasou N (2009) Necrotic and inflammatory changes in metal-on-metal resurfacing hip arthroplasties. Acta Orthop 80(6):653–659

    Article  PubMed  Google Scholar 

  60. Kwon YM, Thomas P, Summer B et al (2010) Lymphocyte proliferation responses in patients with pseudotumors following metal-on-metal hip resurfacing arthroplasty. J Orthop Res 28(4):444–450

    PubMed  CAS  Google Scholar 

  61. Singh C, Kaplan A, Pambuccian SE (2010) Necrotic granulomatous pseudotumor following metal-on-metal hip arthroplasty: a potential mimic of sarcoma on fine needle aspiration cytology. Diagn Cytopathol, Dec 30. (Epub ahead of print)

  62. Thomas P, Braathen LR, Dorig M et al (2009) Increased metal allergy in patients with failed metal-on-metal hip arthroplasty and peri-implant T-lymphocytic inflammation. Allergy 64(8):1157–1165

    Article  PubMed  CAS  Google Scholar 

  63. Thyssen JP, Jakobsen SS, Engkilde K, Johansen JD, Soballe K, Menne T (2009) The association between metal allergy, total hip arthroplasty, and revision. Acta Orthop 80(6):646–652

    Article  PubMed  Google Scholar 

  64. Kwon YM, Ostlere SJ, McLardy-Smith P, Athanasou NA, Gill HS, Murray DW (2010) “Asymptomatic” pseudotumors after metal-on-metal hip resurfacing arthroplasty prevalence and metal ion study. J Arthroplasty, Jun 28. (Epub ahead of print)

  65. Anderson H, Toms AP, Cahir JG, Goodwin RW, Wimhurst J, Nolan JF (2011) Grading the severity of soft tissue changes associated with metal-on-metal hip replacements: reliability of an MR grading system. Skeletal Radiol 40(3):303–307

    Article  PubMed  Google Scholar 

  66. Fujishiro T, Moojen DJ, Kobayashi N, Dhert WJ, Bauer TW (2011) Perivascular and diffuse lymphocytic inflammation are not specific for failed metal-on-metal hip implants. Clin Orthop Relat Res 469(4):1127–1133

    Article  PubMed  Google Scholar 

  67. Corradi M, Daniel J, Ziaee H, Alinovi R, Mutti A, McMinn DJ (2010) Early markers of nephrotoxicity in patients with metal-on-metal hip arthroplasty. Clin Orthop Relat Res, Nov 25. (Epub ahead of print)

  68. Visuri T, Borg H, Pulkkinen P, Paavolainen P, Pukkala E (2010) A retrospective comparative study of mortality and causes of death among patients with metal-on-metal and metal-on-polyethylene total hip prostheses in primary osteoarthritis after a long-term follow-up. BMC Musculoskelet Disord 11:78

    Article  PubMed  Google Scholar 

  69. Visuri TI, Pukkala E, Pulkkinen P, Paavolainen P (2006) Cancer incidence and causes of death among total hip replacement patients: a review based on Nordic cohorts with a special emphasis on metal-on-metal bearings. Proc Inst Mech Eng H 220:399–407

    PubMed  CAS  Google Scholar 

  70. Visuri T, Pukkala E, Paavolainen P, Pulkkinen P, Riska EB (1996) Cancer risk after metal on metal and polyethylene on metal total hip arthroplasty. Clin Orthop Relat Res (329 Suppl):S280–S289

  71. Amstutz HC, Wisk LE, Le DuV MJ. (2010) Sex as a patient selection criterion for metal-on-metal hip resurfacing arthroplasty. J Arthroplast. doi:10.1016/j.arth.2010.03.033

  72. Corten K, MacDonald SJ (2010) Hip resurfacing data from national joint registries. What do they tell us? What do they not tell us? Clin Orthop Relat Res 468:351–357

    Article  PubMed  Google Scholar 

  73. Mcbryde CW, Theivendran K, Thomas AM, Treacy RBC, Pynsent PB (2010) The influence of head size and sex on the outcome of Birmingham hip resurfacing. J Bone Joint Surg Am 92(1):105–112

    Article  PubMed  Google Scholar 

  74. Naudie D, Roeder CP, Parvizi J, Berry DJ, Eggli S, Busato A (2004) Metal-on-metal versus metal-on-polyethylene bearings in total hip arthroplasty: a matched casecontrol study. J Arthroplast 19((7 Suppl 2)):35–41

    Article  Google Scholar 

  75. Langton DJ, Jameson SS, Van Oursouw M, De Smet K, Nargol AVF. Suggested safe zone for cup placement for the reduction of blood metal ion concentrations following hip resurfacing. British Hip Society Annual scientific Meeting. 25th Feb 2010

  76. Brockenbrough G, orthopaedics today EUROPE 2010. Surgeons warn of performing metal-on-metal hip resurfacing on women younger than 40 years old:http://www.orthosupersite.com/view.aspx?rid=50327 Accessed Nov/Dec 2010

  77. Glyn-Jones S, Pandit H, Doll H, et al. The risk factors for developing an inflammatory pseudotumor following hip resurfacing: a survival analysis. British Orthopaedic Association Annual Congress. 15–18th Sept 2009

  78. Macpherson GJ, Hank C, Schneider M et al (2010) The posterior approach reduces the risk of thin cement mantles with a straight femoral stem design. Acta Orthop 81(3):292–295

    Article  PubMed  Google Scholar 

  79. Hank C, Schneider M, Achary CS, Smith L, Breusch SJ (2010) Anatomic stem design reduces risk of thin cement mantles in primary hip replacement. Arch Orthop Trauma Surg 130(1):17–22

    Article  PubMed  Google Scholar 

  80. Schneider M, Kawahara I, Ballantyne G et al (2009) Predictive factors influencing fast track rehabilitation following primary total hip and knee arthroplasty. Arch Orthop Trauma Surg 129(12):1585–1591

    Article  PubMed  Google Scholar 

  81. Witjes S, Smolders JM, Beaulé PE, Pasker P, Van Susante JL (2009) Learning from the learning curve in total hip resurfacing: a radiographic analysis. Arch Orthop Trauma Surg 129(10):1293–1299

    Article  PubMed  Google Scholar 

  82. Marker DR, Seyler TM, Jinnah RH, Delanois RE, Ulrich SD, Mont MA (2007) Femoral neck fractures after metal-on-metal total hip resurfacing: a prospective cohort study. J Arthroplasty 22((7 Suppl 3)):66–71

    Article  PubMed  Google Scholar 

  83. Myers GJ, Morgan D, McBryde CW, O’Dwyer K (2009) Does surgical approach influence component positioning with Birmingham hip resurfacing? Int Orthop 33(1):59–63

    Article  PubMed  CAS  Google Scholar 

  84. Bitsch RG, Loidolt T, Heisel C, Schmalzried TP (2010) Cementing techniques for hip resurfacing arthroplasty: in vitro study of pressure and temperature hip resurfacing: pressure and temperature. J Arthroplast. doi:10.1016/j.arth.2009.10.011

  85. Jenkins PJ, Teoh K, Simpson PM, Dave J, Simpson AH, Breusch S (2010) Clostridium difficile in patients undergoing primary hip and knee replacement. J Bone Joint Surg Br 92(7):994–998

    Article  PubMed  CAS  Google Scholar 

  86. Classen DC, Evans RS, Pestotnik SL, Horn SD, Menlove RL, Burke JP (1992) The timing of prophylactic administration of antibiotics and the risk of surgical-wound infection. N Engl J Med 326(5):281–286

    Article  PubMed  CAS  Google Scholar 

  87. Jenkins PJ, Clement ND, Gaston P, Breusch S, Simpson H, Dave J (2010) Invasive group B streptococcal disease in an orthopaedic unit. J Hosp Infect 76(3):231–233

    Article  PubMed  CAS  Google Scholar 

  88. Culver DH, Horan TC, Gaynes RP, et al. (1991) Surgical wound infection rates by wound class, operative procedure, and patient risk index. National Nosocomial Infections Surveillance System. Am J Med 91(3B):152S–157S

    Google Scholar 

  89. Dall GF, Huntley JS, Breusch SJ (2007) Managing wound problems following joint replacement. Practitioner 251(1691):45, 47–50

    Google Scholar 

  90. Hart AJ, Sabah S, Henckel J, Lewis A, Cobb J, Sampson B, Mitchell A, Skinner JA (2009) The painful metal-on-metal hip resurfacing. J Bone Joint Surg Br 91(6):738–744

    Article  PubMed  CAS  Google Scholar 

  91. Capello WN, D’Antonio JA, Feinberg JR, Manley MT, Naughton M (2008) Ceramic-on-ceramic total hip arthroplasty: update. J Arthroplasty 23((7 Suppl)):39–43

    Article  PubMed  Google Scholar 

  92. Schroder D, Bornstein L, Bostrom MP, Nestor BJ, Padgett DE, Westrich GH (2011) Ceramic-on-ceramic total hip arthroplasty: incidence of instability and noise. Clin Orthop Relat Res 469(2):437–442

    Article  PubMed  Google Scholar 

  93. Sexton SA, Walter WL, Jackson MP, De Steiger R, Stanford T (2009) Ceramic-on-ceramic bearing surface and risk of revision due to dislocation after primary total hip replacement. J Bone Joint Surg Br 91(11):1448–1453

    Article  PubMed  CAS  Google Scholar 

  94. Greene JW, Malkani AL, Kolisek FR, Jessup NM, Baker DL (2009) Ceramic-on-ceramic total hip arthroplasty. J Arthroplast 24(6 Suppl):15–18

    Article  Google Scholar 

  95. Mariconda M, Silvestro A, Mansueto G, Marino D (2010) Complete polyethylene wear-through and secondary breakage of the expansion cup in a ceramic-polyethylene total hip. Arch Orthop Trauma Surg 130(1):61–64

    Article  PubMed  Google Scholar 

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Acknowledgments

This work is supported by Program for Shanghai Key Laboratory of Orthopaedic Implant (Grant No. 08DZ2230330), New Medical Technology Development Program of Shanghai Hospital Developmental Center (Grant No. SHDC120066103) and Fund for Key Disciplines of Shanghai Municipal Education Commission (Grant No. J50206). We thank all corresponding authors from the studies we used in this meta-analysis for their assistance in obtaining additional data that contributed to our study. We also thank Dr. Weili Yan, Lianming Wu (Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, PRC) and Ning Yin (Department of Orthopaedics, Shanghai Ninth People’s Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, PRC) for the generosity in providing us with the statistical analysis and language editing.

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Authors and Affiliations

  1. Shanghai Key Laboratory of Orthopaedic Implant, Department of Orthopaedics, Shanghai Ninth People’s Hospital, Shanghai Jiaotong University School of Medicine, 639 Zhizaoju Road, Shanghai, 200011, People’s Republic of China

    Xinhua Qu & Kerong Dai

  2. Engineering Research Center of Digital Medicine, Ministry of Education PRC, 1954 Huashan Road, Shanghai, 200030, People’s Republic of China

    Kerong Dai

  3. Department of Plastic and Reconstructive Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiaotong University School of Medicine, 639 Zhizaoju Road, Shanghai, 200011, People’s Republic of China

    Xiaolu Huang

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  1. Xinhua Qu
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Correspondence to Kerong Dai.

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Qu, X., Huang, X. & Dai, K. Metal-on-metal or metal-on-polyethylene for total hip arthroplasty: a meta-analysis of prospective randomized studies. Arch Orthop Trauma Surg 131, 1573–1583 (2011). https://doi.org/10.1007/s00402-011-1325-2

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