Ceramic-on-ceramic hip resurfacing can potentially offer the bone conserving advantages of resurfacing while eliminating metal ion release. Thin-walled ceramic resurfacing heads are conceivable following developments in strength and reliability of ceramic materials, but verification of new designs is required. This study aimed to develop a mechanical pre-clinical analysis verification process for ceramic resurfacing heads, using the DeltaSurf prosthesis design as a case study.Finite element analysis of a range of in-vivo scenarios was used to design a series of physiologically representative mechanical tests, which were conducted to verify the strength of the prosthesis. Tests were designed to simulate ideal and worst-case in-vivo loading and support, or to allow comparison to a clinically successful metallic device.In tests simulating ideal loading and support, the prosthesis sustained a minimum load of 39 kN before fracture, and survived 10, 000, 000 fatigue cycles of (0.534 kN -5.34 kN). In worst-case tests representing a complete lack of superior femoral head bone support or pure cantilever loading of the prosthesis stem, the design demonstrated strength comparable to that of the equivalent metal device.The developed mechanical verification test programme represents an improvement in the state of the art where international test standards refer largely to total hip replacement prostheses. The case study's novel prosthesis design performed with considerable safety margins compared to extreme in-vivo loads, providing evidence that the proposed ceramic resurfacing heads should have sufficient strength to perform safely in-vivo. Similar verification tests should be designed and conducted for novel ceramic prosthesis designs in the future, leading the way to clinical evaluation.3

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