COMPARATIVE ANALYSIS OF CERAMIC-ON-CERAMIC VERSUS CERAMIC-ON-POLYETHYLENE BEARINGS IN TOTAL HIP ARTHROPLASTY

Abstract

Background: Total hip arthroplasty (THA) is one of the most successful orthopedic procedures for relieving pain and restoring function in patients with end-stage hip diseases. Bearing surface selection plays a critical role in implant longevity, wear characteristics, osteolysis, and functional outcomes. Ceramic-on-ceramic (CoC) and ceramic-on-polyethylene (CoP) bearings are widely used modern options, each with distinct biomechanical properties and clinical implications. While CoC bearings offer excellent wear resistance and reduced osteolysis, concerns remain regarding squeaking and ceramic fracture. Conversely, CoP bearings have evolved with highly cross-linked polyethylene, potentially reducing wear-related complications. Comparative clinical evidence remains necessary to guide optimal bearing selection.

Objective: To compare clinical outcomes, complication rates, and implant performance between ceramic-on-ceramic and ceramic-on-polyethylene bearing surfaces in patients undergoing primary total hip arthroplasty.

Methodology: A comparative analytical study was conducted at Sughra Shafi Medical Complex Narowal from July 2024 to June 2025 as of one year time involving patients who underwent primary THA using either CoC or CoP bearing surfaces. Patients were allocated into two groups based on the bearing type. Demographic data, operative details, and postoperative follow-up outcomes were recorded. Clinical outcomes were assessed using standardized hip function scores, including pain relief, range of motion, and functional mobility. Radiographic evaluation was performed to assess component positioning, wear, and signs of osteolysis or loosening. Complications such as dislocation, squeaking, infection, and revision surgery were documented. Statistical analysis was performed to compare outcomes between the two groups, with significance set at p < 0.05.

Results: Both groups demonstrated significant improvement in postoperative functional scores compared to preoperative status. The CoC group showed lower radiographic wear and absence of polyethylene-related osteolysis, while the CoP group demonstrated comparable functional outcomes with fewer reports of audible phenomena. Complication rates were low in both groups, with no statistically significant difference in infection or dislocation rates. Squeaking was observed exclusively in the CoC group, whereas mild radiographic wear was noted in some CoP cases without clinical significance.

Conclusion: Both ceramic-on-ceramic and ceramic-on-polyethylene bearings provide excellent clinical and functional outcomes in total hip arthroplasty. CoC bearings offer superior wear resistance, while CoP bearings provide reliable performance with fewer bearing-specific complications. Bearing selection should be individualized based on patient factors, surgeon preference, and long-term outcome considerations.