Fourth-generation ceramic-on-ceramic THA results in improvements in midterm outcomes compared to third-generation THA but does not resolve noise problems: a cohort study of a single-hip system

Abstract

Background Using data from the Korean Hip Registry, we aimed to investigate mid-term clinical and radiographic outcomes, including the prevalence of periprosthetic joint infection (PJI), osteolysis, and component loosening or dislocation, and to analyze the incidence of bearing-related complications following modern ceramic-on-ceramic (COC) total hip arthroplasty (THA) using a single cementless hip system. Methods Four hundred eighty-two patients (602 hips) who underwent Forte or Delta COC THAs with a single hip system and had a minimum 5-year follow-up were identified. The sample included 243 (50.4%) women and 239 (49.6%) men with a mean age of 50.6 years (range: 18–83 years). The Forte group comprised 310 hips, and the Delta group comprised 292 hips. The mean follow-up was 6.1 years (range: 5–10.2 years). Results Cup orientation did not differ between groups. No hip had a PJI or osteolysis in either group. All acetabular components and all but two femoral components (in the Delta group) were well fixed. Dislocations occurred in six (1.9%) hips in the Forte group and one (0.3%) hip in the Delta group ( p = 0.124). A total of nine (1.5%) revisions were performed. The 5-year survival rates for all-cause revisions were 98.4 and 98.6%, respectively. One (0.3%) ceramic head fracture occurred in the Forte group. Sixteen (5%) hips exhibited clicking and 6 (2%) hips had squeaking in the Forte group; 16 (6%) hips exhibited clicking and 5 (2%) hips had squeaking in the Delta group. Multiple regression analysis revealed that noise generation was unassociated with any factor. Conclusions From the Korean Hip Registry data, THA with modern ceramic bearings showed encouraging results, with lower risks of PJI, osteolysis, and component loosening. In particular, Delta COC THA resulted in no PJI or ceramic fracture and had a reduced dislocation risk. However, associated noise remains a concern.

Mid-term outcomes of the R3™ delta ceramic acetabular system in total hip arthroplasty

“…Clicking or squeaking occurred in 22 forte patients and 21 delta patients. There were 9 revisions, and survival rates were 98.4% and 98.6% at 5 years for the forte and delta groups, respectively [ 37 ].…”

Ceramic-on-ceramic vs ceramic-on-polyethylene, a comparative study with 10-year follow-up

“…A recent long-term meta-analysis showed that improvement of the ceramic over time led to lower fracture rates[ 32 ]. Additionally, in the literature, fourth-generation ceramic bearings showed no ceramic fracture when compared to third-generation CoC[ 33 ]. Since we used a fourth-generation ceramic bearing, this might be a reason that no head or liner fractures occurred in our study[ 32 , 33 ].…”

Mid-term Outcomes of the R3™ Delta Ceramic Acetabular System in Total Hip Arthroplasty

“…There were 9 revisions, and survival rates were 98.4% and 98.6% at 5 years for the forte and delta groups, respectively. [37) The reduction in wear rates of CoC bearings when compared to polyethylene have been well documented and the relatively bioinert debris produced from the CoC bearing when compared to polyethylene debris provides the advantage of reducing aseptic loosening due osteolysis [38]. The improvements in the manufacture of ceramic have also shown a reduction in the wear rates with the BIOLOX forte compound showing steady state wear rates of 1.2 mm 3 per million cycles, in contrast to the BIOLOX delta which demonstrated wear rates of only 0.12 mm 3 per million cycles [39].…”