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Manufacturers Affect Clinical Results of THA with Zirconia Heads: A Systematic Review

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Clinical Orthopaedics and Related Research®

Abstract

In the 1980s, zirconia was introduced for THA with the expectation of lower polyethylene wear and better clinical results. However, several studies have reported poor survivorship of zirconia-polyethylene THA. We performed a systematic review and meta-analysis of zirconia-polyethylene THA to confirm or refute the theoretical advantages of this combination. Of 163 studies identified by a comprehensive search, seven met our selection criteria. These involved 769 hips of 586 patients with a mean age of 56.8 years and a minimum followup of 60 months (mean, 89.2 months; range, 60–155 months). The consolidated revision rate of zirconia-polyethylene THA at 89.2 months was higher than that of nonzirconia-polyethylene THA by 5% (risk difference, 0.05; 95% confidence interval, 0.02–0.08). Subgroup meta-analysis suggested THAs with zirconia heads from Ceraver had more revision surgery than nonzirconia heads (risk difference, 0.08; 95% confidence interval, 0.03–0.14), whereas zirconia heads from DePuy did not (risk difference, 0.02; 95% confidence interval, −0.01–0.06). The meta-analysis for annual linear polyethylene wear (which did not involve zirconia heads from Ceraver because of insufficient descriptions) showed no difference between zirconia and control groups. Collectively, THAs with high-quality zirconia heads appear to have prosthesis survivorship and polyethylene wear equivalent to those of THAs with traditional materials, but differing quality among zirconia heads could lead to poor survivorship of prostheses.

Level of Evidence: Level III, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

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Acknowledgments

We thank Keiichi Kawanabe for discussion and Koji Asaumi and Young-Hoo Kim for providing information about polyethylene.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan

    Hiroyuki Yoshitomi MD, PhD, Hiromu Ito MD, PhD & Takashi Nakamura MD, PhD

  2. Department of Surgery, Soseikai General Hospital, Kyoto, Japan

    Satoru Shikata MD, PhD

  3. Department of Health Informatics, Kyoto University Graduate School of Medicine, Kyoto, Japan

    Takeo Nakayama MD, PhD

Authors
  1. Hiroyuki Yoshitomi MD, PhD
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  2. Satoru Shikata MD, PhD
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  3. Hiromu Ito MD, PhD
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  4. Takeo Nakayama MD, PhD
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  5. Takashi Nakamura MD, PhD
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Corresponding author

Correspondence to Hiroyuki Yoshitomi MD, PhD.

Additional information

One or more of the authors (HY, HI, TN, TN) have received funding from Health and Labour Sciences Research Grants.

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Yoshitomi, H., Shikata, S., Ito, H. et al. Manufacturers Affect Clinical Results of THA with Zirconia Heads: A Systematic Review. Clin Orthop Relat Res 467, 2349–2355 (2009). https://doi.org/10.1007/s11999-009-0709-x

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  • DOI: https://doi.org/10.1007/s11999-009-0709-x

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