Topic Ceramic on Ceramic

Executive Summary

Mid-term results of the BIOLOX®delta ceramic-on-ceramic total hip arthroplasty

Lee, Y. K., Y. C. Ha, J. I. Yoo, W. L. Jo, K. C. Kim and K. H. Koo
Bone Joint J 2017; 99-b(6): 741-748.
Level of Evidence
None given. Prospective study.


Lee et al. conducted a prospective study to evaluate the mid-term results of a specific THA system (DePuy; Corail, Pinnacle) with BIOLOX®delta CoC bearings. Only patients with at least 5 years of follow-up were included in the analysis.

The cohort consisted of 252 patients (286 THA) with a mean age of 49.7 years. Primary diagnosis was mostly osteonecrosis. A 32 mm bearing was used in 247 hips (86 %) and 36mm in 39 hips (14 %). The mean follow-up was 5.5 years.

Clinical outcome scores (HHS, WOMAC, UCLA activity) improved significantly post-op. Only 21 patients reported thigh pain, however, without limitations to their activity level or requiring medication. Radiological assessment showed evidence of bone ingrowth for all THA components, no measurable wear and no evidence of osteolysis. Kaplan-Meier survival rate, with revision for any reason as endpoint, was 99.4 % at 6 years. Three patients needed revision surgery; one for periprosthetic fracture, one for infection, and one for fracture of a malseated (tilted) ceramic liner which was revised with a new ceramic head and a highly crosslinked PE liner. There was no fracture of a ceramic ball head during the study period. 34 patients reported noise from their hip implant: grinding (20 hips), non-reproducible squeaking (7), snapping (3), clicking (2), cracking and popping (1 each). Neither pain nor functional limitations were associated with noise.

According to the authors’ conclusions, the mid-term survivorship of 4th generation ceramic-on-ceramic bearing surfaces is encouraging. However, insert malseating might be a concern.

Study Limitations

Key Messages

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