By Monica Jaramillo
A meta-analysis of randomized, controlled trials found ceramic-on-ceramic bearing surfaces in total hip arthroplasty increased the risk of squeaking and total implant fracture significantly compared with ceramic-on-polyethylene bearing surfaces; however, no significant differences were observed between bearing surfaces with regard to revision, osteolysis and radiolucent lines, loosening, dislocation or deep infection, according to study results.
After reviewing the PubMed, Embase and Cochrane online databases, researchers identified 83 articles that initially met the inclusion criteria of involving patients who underwent primary total hip arthroplasty (THA); comparing ceramic-on-ceramic (COC) and ceramic-on-polyethylene (COP)bearing surfaces; reporting clinical and radiographic outcomes of THA, with at least one desirable outcome; having a randomized, controlled study design; and being published in English. 
The researchers performed a meta-analysis comparing clinical and radiographic outcomes achieved by the two bearing surfaces. Additionally, using the Physiotherapy Evidence Database scale, the researchers assessed the methodological quality of each study. Ultimately, nine randomized, controlled trials that encompassed 1,575 patients and 1,747 hips were selected for inclusion in the final study