Comprehensive outcomes of different prosthetic interfaces in total hip arthroplasty: A network meta-analysis and systematic review based on age and follow-up periods

Background: Total Hip Arthroplasty (THA) is a well-established intervention that improves the quality of life in patients with severe hip arthritis by relieving pain and restoring function. Long-term success of THA is heavily influenced by the choice of prosthetic interfaces, particularly the bearing surfaces. However, the effects of patient age and follow-up duration on the outcomes of different interfaces remain underexplored. Methods: This study performed a systematic review and network meta-analysis, gathering randomized controlled trials (RCTs) from PubMed, Embase, Cochrane Library, and Web of Science. Included studies compared outcomes of various prosthetic interfaces, focusing on patient age (≤60 years and > 60 years) and follow-up duration. Quality was assessed using the Cochrane risk of bias tool. Results: Fifty-nine RCTs were included. For younger patients (≤60 years), ceramic-on-ceramic (CoC), ceramic-on-polyethylene (CoP), and highly cross-linked polyethylene (CoXLPE) interfaces showed lower revision rates and superior radiographic outcomes compared to metal-on-metal (MoM) and metal-on-polyethylene (MoP). Older patients (>60 years) saw better outcomes with metal interfaces, particularly MoP, in short- and mid-term follow-ups. Across all ages, CoXLPE demonstrated excellent durability and reduced revision rates. Conclusion: This meta-analysis highlights the importance of age-specific prosthetic selection in THA. Younger patients benefit from CoC and CoXLPE due to superior wear resistance, while older patients may achieve better results with MoP. Further long-term studies are needed to validate these findings and reduce study heterogeneity.