Incidence of Ceramic Fracture in Contemporary Ceramic-on-Ceramic Total Hip Arthroplasty: A Meta-analysis of Proportions

Byung Ho Yoon, Jung Wee Park, Yong Han Cha, Suk Hyung Won, Young Kyun Lee, Yong Chan Ha, Kyung Hoi Koo

Research output: Contribution to journalArticle


Background: We performed a proportion meta-analysis of currently available data to determine the prevalence of ceramic fracture for each generation. Methods: A total of 10,571 total hip arthroplasties from 45 studies were included. Proportion meta-analysis with a random-effects model was performed to estimate the prevalence of ceramic fracture. To determine whether the ceramic fractures have a fatigue nature and a risk or latent period for the development, postoperative time lapse, patient age, and body mass index were related with ceramic fracture by metaregression analysis. Results: As of postoperative 2.0 to 18.8 years, the rate of ceramic fracture was 0.5% (95% CI, 0.3%-0.8%) in the forte group and 0.2% (95% CI, 0.1%-0.4%) in the delta group (P = .059). The ceramic fracture rate for each component was 0.2% (95% CI, 0.1%-0.3%) for the forte head, 0.1% (95% CI, 0.0%-0.2%) for the delta head (P = .210), 0.2% (95% CI, 0.1%-0.3%) for the forte liner, and 0.2% (95% CI, 0.1%-0.4%) for the delta liner (P = .305). The rate of ceramic fracture per 1000 patient-years was 0.9 (95% CI, 0.5-0.13) in the forte group and 0.5 (95% CI, 0.2-0.8) in the delta group (P = .072). In metaregression analysis, no significant associations were found between prevalence of ceramic fracture and postoperative time lapse, patient age, or body mass index. Conclusions: The rate of ceramic fracture was 0.9/1000 patient-year in the forte group and 0.5/1000 patient-year in the delta group. The results of this study provide baseline data for further studies validating ceramic bearings. Level of Evidence: Level I, meta-analysis.

Original languageEnglish
Pages (from-to)1437-1443.e3
JournalJournal of Arthroplasty
Issue number5
StatePublished - May 2020



  • ceramic
  • fracture
  • meta-analysis
  • revision
  • total hip arthroplasty

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