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BIOLOX®delta - 4th-generation ceramic-on-ceramic bearings, stability, and low complication rates: a study of 10+ years

A new prospective multicenter study by Lee et al. (University of Gwangmyeong Hospital and others in South Korea) in the Journal of Arthroplasty reports minimum 10-year outcomes of cementless total hip arthroplasty (THA) using 32/36mm BIOLOX®delta CoC bearings (Zimmer Biomet stem/cup system).

BIOLOX®delta ceramic femoral head and liner beside the title Larger Ceramic Heads: A Decade of Clinical Confidence
Slide graphic stating zero ceramic fractures at 10+ years with thinner liners and larger femoral heads.
Chart slide showing 99.1% revision-free survivorship at 12 years, dislocation cases and Harris Hip Score results.
Slide with three icons: 5.5% articular noise, 0.5% new focal osteolysis, extended CT surveillance may be warranted.

The investigation specifically addresses concerns associated with the thinner liners required to accommodate larger femoral heads, namely liner fracture risk, late dislocation, noise, and long-term biological response.

 

From April 2010-February 2012, 246 patients (274 THAs) were enrolled. At final follow-up, 178 patients (201 hips; mean age 51 years; range 18.9-77.6) were assessed at a mean of 12.3 years (range 10-14.6), with CT scans performed in 47 hips (23%). Kaplan-Meier survival analysis used revision and reoperation as endpoints.

 

Findings to note

  • No ceramic fractures were observed in any patient across the cohort.

  • Survivorship at 12 years was 99.1% (95% CI) with revision as the endpoint and 98.7% (95% CI) for any reoperation.

  • Mean Harris Hip Score (HHS) improved from 43.5 to 87.4 points.

  • New focal osteolysis was detected in a single hip (0.5%) at 12 years post-op. Asymptomatic, no progression noted.

  • Articular noise was reported in 11 hips (5.5%), but no patients were revised.

  • Beyond three dislocations reported in the team’s previous midterm follow-up analysis (Lee et al., 2021), one new case of anterior instability occurred (patient age 82, 9 years post-op), associated with lumbar degenerative kyphosis (LDK) and posterior impingement.

  • One case of PJI.

 

Limitations, as noted by the authors: the study lacked a control cohort for comparison with other bearings, and the dropout rate was relatively high (26.7%, 73 of 274); only 23% of the cohort underwent CT at 10-year follow-up.

 

The authors conclude that large-head BIOLOX®delta CoC bearings can prevent early dislocation without incurring liner-fracture risk, even with the thinner liners that larger heads require. LDK-associated late instability and articular noise remain considerations in long-term follow-up.

 

📖 Lee DH, Park JW, Jung WH, Kim TY, Ha YC, Koo, KH, Lee, YK. Complications of ceramic-on-ceramic total hip arthroplasty with large heads: 10-year minimum follow-up. J Arthroplasty. 2026. doi: 10.1016/j.arth.2026.06.015

 

Please check for  regulatory approval in your country.

 

This text reflects CeramTec’s summary of a peer-reviewed scientific publication and does not constitute clinical guidance, risk prediction for individual patients, or product-related recommendations. For product, safety, and risk information, always refer to the labeling of the legal manufacturer. This post was drafted with AI assistance and approved by CeramTec. 

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