Logout successfull!
To overview page

Ceramic-on-ceramic vs. polyethylene-bearings in THA: what can 120,000 hips tell us?

A new meta-analysis by Dr. Lee Rubin (Yale University) et al. in the European Journal of Orthopaedic Surgery & Traumatology pools 33 comparative studies (randomized controlled trials and observational cohorts) encompassing more than 120,000 primary THAs.

Infographic stating 120,000-plus primary THAs, 33 comparative studies, and the year 2026.
Ceramic liner and head beside text on selective CoC advantages in THA clinical outcomes.
Table comparing CoC and polyethylene-based THA bearings across revision, dislocation, infection and osteolysis.
Infographic reporting pooled relative risks for dislocation and osteolysis with CoC THA bearings.
Infographic reporting a lower pooled periprosthetic joint infection rate for CoC versus MoHXLPE.
Reference citation, regulatory information link, and scientific-publication disclaimer on a dark blue background.

Across all studies, ceramic-on-ceramic (CoC) bearing couples were compared to metal-on-polyethylene (MoP), metal-on-highly cross-linked-PE (MoHXLPE), ceramic-on-PE (CoP), and ceramic-on-HXLPE (CoHXLPE) couples. 

 

Note: The majority of studies in this meta-analysis reported on the performance of BIOLOX® advanced ceramic technologies manufactured by CeramTec.

 

That said, this is an inherently complex comparison, measuring short-term results against long-term through pooled fixed- and random-effects analyses and varying in scope, patient population, and follow-up duration. Therefore, it is difficult to draw wide-ranging objective conclusions from the data.

 

Survivorship & revision: Revision rates, aseptic loosening, and periprosthetic fracture were statistically comparable across all four comparisons. Survivorship remained consistent throughout, although Kaplan-Meier scores revealed a consistent numerical advantage favoring ceramic-on-ceramic: Vendittoli et al. (2021) reported 20-year survivorship of 96.9% for CoC versus 73.6% for MoP.

 

Dislocation: CoC significantly reduced late prosthetic dislocation versus MoP (RR 0.39, p = 0.05) and vs. MoHXLPE (RR 0.77, p = 0.004). No statistically significant difference between the CoC and CoHXLPE groups (p = 0.38).

 

Osteolysis: Lower incidence of osteolysis and radiolucent lines with CoC versus MoP (RR 0.26, p = 0.02) and MoHXLPE (RR 0.48, p = 0.004). This is consistent with the extremely low wear rates of modern ceramic couples. No statistically significant difference between the CoC and CoHXLPE groups (p = 0.54).

 

Infection: PJI was broadly comparable, with the notable exception of a significantly lower pooled PJI rate for CoC versus MoHXLPE (RR 0.42, p < 0.00001). CoC and CoHXLPE returned no statistically significant difference (p = 0.4).

 

Function:Broadly equivalent across bearings. In the CoC-versus-MoHXLPE subgroup, CoC showed a modest edge in Harris Hip Score (MD 1.78, p = 0.0009) and WOMAC (MD –6.16, p = 0.005).

 

Trade-off: Noises were most frequent with CoC, but were also detected with other bearings – MoP (RR 2.14), CoP (RR 8.60), and CoHXLPE (RR 5.98).

 

Ceramic bearings (CoC and CoHXLPE) present distinct advantages over metal bearings. The authors conclude that bearing selection remains part of the surgeon’s medical decision making and should be tailored to patient age, activity demands, and tolerance for ceramic-specific noise phenomena.

 

Please check for regulatory approval  in your country.

 

References: Boutros M, Awad G, Bou Hamdan K, Rubin L, Mansour E. Ceramic-on-ceramic versus polyethylene-based bearings in total hip arthroplasty: A meta-analysis. European Journal of Orthopaedic Surgery & Traumatology, 36, 239. doi: 10.1007/s00590-026-04825-8 

 

BIOLOX® LinkedIn