Ceramic Femoral Heads Exhibit Lower Wear Rates Compared to Cobalt Chrome: A Meta-Analysis

source extracted confidence: high 2026-04-09
#humans #femur-head #prosthesis-design #arthroplasty-replacement-hip #hip-prosthesis

Ceramic Femoral Heads Exhibit Lower Wear Rates Compared to Cobalt Chrome: A Meta-Analysis

Mertz et al., 2023 | J Arthroplasty | Meta Analysis

Citation

Mertz Kevin C, Yang JaeWon, ... Heckmann Nathanael D. Ceramic Femoral Heads Exhibit Lower Wear Rates Compared to Cobalt Chrome: A Meta-Analysis. J Arthroplasty. 2023-Feb;38(2):397-405. doi:10.1016/j.arth.2022.09.008

Abstract

BACKGROUND: 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. METHODS: 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. RESULTS: 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; P < .01) for ceramic (P < .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, P = .306). Mean wear for 32-mm heads was significantly higher for ceramic (P < .01), while mean wear for 36-mm heads was significantly higher for CoCr (P < .01). CONCLUSION: 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.

Key Findings

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; P < .01) for ceramic (P < .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, P = .306). Mean wear for 32-mm heads

Outcomes Measured

  • Requires manual extraction

Population

Field Value
Population See abstract
Sample Size 36
Age Range See abstract
Condition See abstract

MeSH Terms

  • Humans
  • Femur Head
  • Prosthesis Design
  • Arthroplasty, Replacement, Hip
  • Hip Prosthesis
  • Polyethylene
  • Chromium Alloys
  • Ceramics
  • Prosthesis Failure
  • Cobalt

Evidence Classification

  • Level: Meta Analysis
  • Publication Types: Systematic Review, Meta-Analysis, Journal Article
  • Vertical: chromium

Provenance

Source extracted via PubMed E-utilities API on 2026-04-09