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Objectives and questions: Mixing implant components from different manufacturers in primary total hip arthroplasty (THA) is considered when the matching counterpart of a preferred component from the same manufacturer does not meet the patient's specific requirements or has shown inferior results compared to a compatible component from another manufacturer. However, this practice remains controversial due to liability concerns and uncertainty regarding its impact on revision rates. This meta-analysis compares brand-mixed and brand-unmixed primary THA concerning revision rates, complications, and functional outcomes.

Material and methods: A comprehensive search was conducted on PubMed, Medline, and Embase for randomized clinical trials (RCTs) and observational studies. Effect estimates were systematically pooled across studies using random-effects models and presented as weighted odds ratios (ORs) with their corresponding 95% confidence intervals (95% CIs).

Results: Four studies were included in the analysis with 128,548 patients (17.7%) receiving a brand-mixed THA and 596,986 patients (82.3%) receiving a brand-unmixed THA. The overall revision rate was comparable in both groups (2.3% for brand-mixed vs. 2.5% for brand-unmixed, OR 0.98, 95% CI 0.78–1.24). Furthermore, following the exclusion of components exhibiting substandard performance, such as metal-on-metal bearings and other combinations previously identified as contributing to elevated revision rates in both brand-mixed and brand-unmixed groups, no statistically significant difference was observed between the two groups (2.04% for brand-mixed vs. 1.95% for brand-unmixed, OR 1.03, 95% CI 0.84–1.26). Two studies reported on the reasons for revision. The most prevalent indication for revision in both treatment groups was due to dislocation (32% for brand-mixed vs. 29% for brand-unmixed). Other complications, including loosening of the femoral and acetabular component, periprosthetic fracture, cup/liner wear, and septic revision were comparable across the treatment groups. One study reported on functional outcomes and revealed no significant disparities in Oxford Hip Scores at the six-month follow-up.

Discussion and conclusions: The present meta-analysis demonstrates no significant difference in revision rates, complications, and functional outcomes between brand-mixed and brand-unmixed primary total hip arthroplasty. Scientifically, the evidence suggests that orthopedic surgeons should not hesitate to use compatible components from different manufacturers when clinically appropriate.