Wear between the femoral head and acetabular liners continues to limit the longevity of total hip arthroplasty implants despite advances in implant materials. The purpose of this meta-analysis was to compare linear wear rates of cobalt-chromium (CoCr) and fourth-generation ceramic femoral heads on highly cross-linked polyethylene (XLPE) liners. A systematic review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was conducted to identify all studies between 2003 and 2020 that examined in vivo wear rates of either fourth-generation ceramics or CoCr femoral heads on XLPE liners. Studies were analyzed in a weighted means analysis of wear rates and a random effects meta-analysis. A total of 36 studies met inclusion criteria (1,657 CoCr and 659 ceramic patients). The pooled, weighted mean wear rate was 0.063 mm/year (standard deviation [SD]: 0.061, confidence interval [CI]: 0.049-0.077) for CoCr and 0.047 mm/year (SD: 0.057, CI: 0.033-0.062; < .01) for ceramic ( < .01). A meta-analysis of 4 studies directly comparing ceramic and CoCr found that CoCr heads demonstrated 0.029 mm/year more wear than ceramic heads (95% CI: 0.026-0.059, = .306). Mean wear for 32-mm heads was significantly higher for ceramic ( < .01), while mean wear for 36-mm heads was significantly higher for CoCr ( < .01). Fourth-generation ceramic femoral heads were found to have significantly lower wear rates than CoCr heads. Unlike previous studies, this meta-analysis included only in vivo studies and those with the same generation of highly XLPE liners.

中文翻译：

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与钴铬合金股骨头相比，陶瓷股骨头的磨损率更低：荟萃分析

尽管植入材料取得了进步，但股骨头和髋臼衬垫之间的磨损继续限制全髋关节置换术植入物的寿命。本荟萃分析的目的是比较高交联聚乙烯 (XLPE) 内衬上的钴铬 (CoCr) 和第四代陶瓷股骨头的线性磨损率。按照系统评价和荟萃分析指南的首选报告项目进行了系统评价，以确定 2003 年至 2020 年期间检查 XLPE 内衬上第四代陶瓷或 CoCr 股骨头的体内磨损率的所有研究。研究通过磨损率加权平均值分析和随机效应荟萃分析进行分析。共有 36 项研究符合纳入标准（1,657 名钴铬患者和 659 名陶瓷患者）。 CoCr 的汇总加权平均磨损率为 0.063 毫米/年（标准差 [SD]：0.061，置信区间 [CI]：0.049-0.077），CoCr 为 0.047 毫米/年（SD：0.057，CI：0.033-0.062；< .01) 对于陶瓷 (< .01)。对直接比较陶瓷和 CoCr 的 4 项研究进行的荟萃分析发现，CoCr 刀头的磨损比陶瓷刀头多 0.029 毫米/年 (95% CI: 0.026-0.059, = .306)。陶瓷的 32 毫米刀头的平均磨损明显较高 ( < .01)，而钴铬的 36 毫米刀头的平均磨损明显较高 ( < .01)。研究发现第四代陶瓷股骨头的磨损率明显低于钴铬合金股骨头。与之前的研究不同，这项荟萃分析仅包括体内研究和使用同代高 XLPE 内衬的研究。