Meta-Analysis of Brand-Mixed Versus Brand-Unmixed Primary Total Hip Arthroplasty
- 1Department of Orthopedic and Trauma Surgery, Lucerne Cantonal Hospital, 6004 Lucerne, Switzerland
- 2Department of Health Science and Medicine, University of Lucerne, 6005 Lucerne, Switzerland
Abstract
Background/Objectives: Mixing implant components from different manufacturers in primary total hip arthroplasty (THA) remains controversial because of concerns regarding implant compatibility and revision risk. This systematic review and meta-analysis aimed to compare revision outcomes between brand-mixed and brand-unmixed primary THA. Methods: A PRISMA-compliant systematic review of PubMed/MEDLINE and Embase identified studies comparing brand-mixed and brand-unmixed primary THA. Reported time-to-event estimates were pooled as hazard ratios (HRs), and revision-event counts as odds ratios (ORs), using random-effects models. Results: Six retrospective observational studies comprising 1,185,948 primary THAs were included. The time-to-event analysis did not identify a statistically significant difference in all-cause revision between brand-mixed and brand-unmixed THA (HR 1.03; 95% CI 0.97–1.08; I2 = 0%). The complementary crude revision-event analysis likewise did not identify a statistically significant difference (OR 1.01; 95% CI 0.83–1.24), although substantial heterogeneity was present (I2 = 93%). A post hoc exploratory sensitivity analysis excluding metal-on-metal and ceramic-on-metal bearings and brand-mixed stem–head constructs was based on two studies and yielded an OR of 0.97 (95% CI 0.79–1.20; I2 = 95%). Certainty of evidence was low for the time-to-event analysis and very low for the event-based analyses. Conclusions: Available observational evidence did not identify a statistically significant association between brand mixing and all-cause revision following primary THA. However, these findings do not establish equivalence, universal component compatibility, or the safety of specific brand-mixed combinations and should be interpreted in light of the observational study designs, residual confounding, and heterogeneity in implant constructs.
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BibTeX
@article{elias2026metaanalysis,
title = {{Meta-Analysis of Brand-Mixed Versus Brand-Unmixed Primary Total Hip Arthroplasty}},
author = {Daniel Elias and Bryan J. M. van de Wall and Jörg Bucher and Björn-Christian Link and Pascal C. Haefeli},
journal = {Journal of Clinical Medicine},
year = {2026},
month = oct,
doi = {10.3390/jcm15207904},
url = {https://www.mdpi.com/2077-0383/15/20/7904},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Meta-Analysis of Brand-Mixed Versus Brand-Unmixed Primary Total Hip Arthroplasty
AU - Daniel Elias
AU - Bryan J. M. van de Wall
AU - Jörg Bucher
AU - Björn-Christian Link
AU - Pascal C. Haefeli
PY - 2026
DA - 2026/10/01
JO - Journal of Clinical Medicine
DO - 10.3390/jcm15207904
UR - https://www.mdpi.com/2077-0383/15/20/7904
AB - Background/Objectives: Mixing implant components from different manufacturers in primary total hip arthroplasty (THA) remains controversial because of concerns regarding implant compatibility and revision risk. This systematic review and meta-analysis aimed to compare revision outcomes between brand-mixed and brand-unmixed primary THA. Methods: A PRISMA-compliant systematic review of PubMed/MEDLINE and Embase identified studies comparing brand-mixed and brand-unmixed primary THA. Reported time-to-event estimates were pooled as hazard ratios (HRs), and revision-event counts as odds ratios (ORs), using random-effects models. Results: Six retrospective observational studies comprising 1,185,948 primary THAs were included. The time-to-event analysis did not identify a statistically significant difference in all-cause revision between brand-mixed and brand-unmixed THA (HR 1.03; 95% CI 0.97–1.08; I2 = 0%). The complementary crude revision-event analysis likewise did not identify a statistically significant difference (OR 1.01; 95% CI 0.83–1.24), although substantial heterogeneity was present (I2 = 93%). A post hoc exploratory sensitivity analysis excluding metal-on-metal and ceramic-on-metal bearings and brand-mixed stem–head constructs was based on two studies and yielded an OR of 0.97 (95% CI 0.79–1.20; I2 = 95%). Certainty of evidence was low for the time-to-event analysis and very low for the event-based analyses. Conclusions: Available observational evidence did not identify a statistically significant association between brand mixing and all-cause revision following primary THA. However, these findings do not establish equivalence, universal component compatibility, or the safety of specific brand-mixed combinations and should be interpreted in light of the observational study designs, residual confounding, and heterogeneity in implant constructs.
SN - 2077-0383
ER -