Topic Ceramic on Ceramic

Executive Summary

Alumina Delta-on-Alumina Delta Bearings in Cementless Total Hip Arthroplasty in Patients < 50 Years.

Y-H. Kim, J-W. Park, J-S. Kim; The Joint Replacement Center, SeoNam Hospital, Ewha Womans University School of Medicine, Seoul, Republic of Korea.
J Arthroplasty 32(3), 2016: 1048-1053.
Level of Evidence:
Level IV, case series.


Kim et al. evaluated the mid-term clinical and radiographic outcomes of cementless THA with 36mm (283 hips) or 32mm BIOLOX®delta ceramic-on-ceramic bearings in patients younger than 50 years of age. Included in the study were 277 patients (347 hips).

Reasons for primary surgery were mostly osteonecrosis and osteoarthritis secondary to developmental dysplasia. All surgeries were performed by a single surgeon using the posterolateral approach. The patients were followed up after 3 months, 1 year, 3 years and every 2–3 years after. The mean follow-up was 7.8 years. At final follow up the preoperative scores (HHS, WOMAC, UCL activity) had improved significantly. 99.3% of the patients were satisfied with the outcome of the operation; 2 patients had thigh pain due to stem loosening. No osteolysis could be identified on radiographs or CT scans. When patients were asked about noise from their THA, 10% reported clicking sounds and 0.6% reported squeaking sounds. There were 5 dislocations, 4 were managed with closed reduction without recurrence. There were no ceramic fractures. Kaplan-Meier survivorship was 99.7% for the acetabular component and 99.3% for the femoral component with revision or aseptic loosening as the endpoint at 7.8 years.

The authors conclude that cementless THA with BIOLOX®delta ceramic-on-ceramic provides high survivorship without osteolysis or ceramic fracture in the mid-term. They believe that there are several factors for their good results in this cohort of young patients: the improved stem design, their surgical technique, good bone quality in young patients, and the use of BIOLOX®delta ceramic-on-ceramic articulation.

Study limitations

Key Messages


Mid-term results of BIOLOX®delta ceramic THA in patients younger than 50 with DDH and AVN appears very promising. Fractures are absent and joint noise generation is not unfrequent, but clinically irrelevant.

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