Preventing ceramic liner fracture after Delta ceramic-on-ceramic total hip arthroplasty

Young Kyun Lee, Jae Young Lim, Yong Chan Ha, Tae Young Kim, Woon Hwa Jung, Kyung Hoi Koo

Research output: Contribution to journalArticlepeer-review

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Background: The results of total hip arthroplasty (THA) with use of Delta ceramic articulation were successful at medium term follow-up. The use of this newest ceramic has markedly reduced the incidence of ceramic head fractures, but not the incidence of ceramic liner fractures. We tested a hypothesis that the ceramic fractures are prevented by use of a metal shell with 18° inner taper angle and a stem design with a reduced neck geometry. Methods: We conducted a prospective multicenter study of cementless THA with use of 32/36-mm Delta ceramic bearing, Exceed ABT metal shell and Taperloc stem. We evaluated ceramic fracture, noise, clinical results, radiological changes and survival rate at a minimum of 5-year follow-up. Results: From April 2010 to February 2012, 246 patients (274 THAs) were enrolled. Among them, 224 patients (130 men and 94 women, 250 hips) were followed-up for 5–8 years (mean 6.0 years). Ceramic malseating or fracture did not occur in any patient. Eight patients (8 hips, 3.2%) reported noise. Mean Harris hip score was 84 points at the latest follow-up. All acetabular and femoral components had bone-ingrown stability. Two hips were revised due to recurrent dislocation and periprosthetic fracture. The survival rate was 99.6% at 8 years postoperatively. Conclusion: Ceramic fractures can be prevented by a use of (1) 32/36-mm Delta ceramic bearing, (2) metal shell with 18° taper angle, and (2) stem with a reduced neck geometry. However, noise remains a concern of the Delta ceramic bearing. Level of evidence: Therapeutic level II.

Original languageEnglish
Pages (from-to)1155-1162
Number of pages8
JournalArchives of Orthopaedic and Trauma Surgery
Issue number7
StatePublished - Jul 2021


  • Ceramic fracture
  • Delta ceramic-on-ceramic total hip arthroplasty
  • Noise
  • Taper angle
  • Zimmer biomet


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