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EVIDENCE YOU CAN COUNT ON.

Trust is not built overnight. Since 1974, CeramTec has been advancing ceramic solutions for joint replacement. What began with a commitment to ceramic excellence has become a trusted foundation for innovative, cost-effective medical products.

Today, surgeons who choose BIOLOX® can count on more than 23 years of clinical evidence1, over 25 million surgeries worldwide2, and more than 50 years of ceramics experience3. These numbers represent more than milestones – they reflect decades of proven performance, continuous innovation, and confidence earned in clinical practice.

BIOLOX®delta ceramic technology has set benchmarks for implant material performance, supporting reliable outcomes across joint replacement and hip resurfacing applications. Its clinical evidence is a recurring focus at influential international congresses, where surgeons, researchers, and industry leaders exchange perspectives on the future of joint replacement.

From hip bearings to breakthrough developments in resurfacing and knee replacement, each innovation builds on the same principle: trust must be earned through evidence.

 

Explore the evidence behind TRUST.

Five BIOLOX® ceramic implant components on dark background, with key figures: 23+ years clinical evidence, 25+ million surgeries, 50+ years ceramics experience

BIOLOX® Product Lineup

BIOLOX® ceramic femoral head with ceramic liner and with cross-linked polyethylene liner - two bearing couple options for total hip arthroplasty.
BIOLOX® Ceramic Hip Components

The benchmark in joint replacement: BIOLOX®delta femoral heads and cup inserts for hip replacement can be combined with ceramic components from the BIOLOX® family as well as with inserts made from conventional and highly cross-linked polyethylene.

BIOLOX® Hip Product Portfolio

BIOLOX® option ceramic femoral head with titanium taper sleeve for secure fixation in total hip arthroplasty.
Sleeved Revision Femoral Head

BIOLOX®OPTION offers the possibility of revising a femoral head implant while retaining a well-fixed femoral stem with minor damage on the taper surface. The adapter sleeve is designed to recreate a pristine taper interface for the ceramic head before it is placed on a stem which remains in situ. BIOLOX®OPTION also offers the possibility of adjusting the offset intraoperatively in primary hip replacement.

More info on our sleeved femoral head as PDF

H1® by Zimmer Biomet and ReCerf® by Matortho Ltd - BIOLOX® ceramic hip resurfacing components with porous coating
Ceramic-on-Ceramic Resurfacing

On display: the H1® BIOLOX®delta ceramic-on-ceramic resurfacing device by Embody Orthopaedic Ltd. and the ReCerf® BIOLOX®delta ceramic-on-ceramic resurfacing device by Matortho Limited.

  • Cementless or cemented fixation
  • Vacuum-plasma-coating
  • Both devices granted Breakthrough Device Designation by FDA

Hip Resurfacing with BIOLOX®delta material

BIOLOX® ceramic total knee arthroplasty implant showing femoral and tibial components with polyethylene insert on dark background.
Metal Free Ceramic Knee

The BPK-S ceramic knee from Peter Brehm.

  • First full ceramic knee system11
  • No known risk of allergy11
  • Lower wear of PE against ceramic (compared to metal)11

Biocompatible and Hypoallergenic

BIOLOX®delta is a highly biocompatible and hypoallergenic ceramic material. It shows superior physico-chemical properties that result in excellent wettability and a very high wear resistance. BIOLOX®delta is safe in terms of metal ion release and pathogenic reactions to ceramic particles are highly unlikely. Citations for all statements can be found here.

Biocompatibility

BIOLOX®delta ceramics show excellent biocompatibility. Pathogenic reactions to BIOLOX® ceramic particles are highly unlikely. BIOLOX®delta ceramic has proven its ability/capability to perform its desired function and generates the most appropriate tissue response, but without eliciting undesirable local or systemic effects.

 

More about our implant materials

Clinical Outcomes

The use of ceramic bearings in hip arthroplasty has increased over the last few years. Today, ceramic such as BIOLOX®delta is the preferred femoral head material in hip replacements. Most arthroplasty registries worldwide confirm that ceramic bearings are associated with best clinical outcomes and are associated with lower rates of revision for infection.

 

Impact on the clinical outcome

Cost-Effectiveness in THA

Studies examining the cost effectiveness of different bearing-materials and analyzing the relation between initial cost and long-term benefit of the bearing have shown that ceramic bearings show a high potential for cost effectiveness in THA.

 

More about Health Economics

Skin Allergy Patch Test on Back of Patient

Metal Sensitivity

BIOLOX®delta material is hypoallergenic and safe in terms of metal ion release. Due to the nature and strength of the covalent and ionic bonds of its structure, BIOLOX®delta ceramic is chemically stable in a physiological environment.

 

More about our ceramic materials

Infection

BIOLOX®delta ceramic has the highest wettability of all bearing materials used in TJA. It elicits a reduced biofilm formation compared to other bearing materials (Metal, XLPE). The most recent registry data show that (mixed) ceramic bearings are associated with a lower risk of revision for periprosthetic joint infection (PJI) compared to metal bearings.

 

BIOLOX® option ceramic femoral head with titanium taper sleeve for secure fixation in total hip arthroplasty.

Use in Revisions

Sleeved ceramic heads such as BIOLOX®OPTION offer the possibility of revising a femoral head implant while retaining a well-fixed femoral stem with minor damage on the taper surface. The BIOLOX®OPTION system has proven to be safe and is reliable in revisions for adverse local tissue reaction (ALTR). Extensive tests and retrieval studies show that the use of an adapter sleeve has no significant effect on the corrosion of modular taper connections.

 

The Evolution of BIOLOX®

At CeramTec, we can proudly look back to more than 50 years of experience in the development and manufacturing of innovative ceramic solutions for medical applications.
Our material has developed from BIOLOX® alumina, established in 1974, to BIOLOX®delta introduced in 2003.

 

1BIOLOX®2Autophor Liners made of BIOLOX® ceramics3BIOLOX®forte ceramic-on-ceramic bearing4BIOLOX®DUO5BIOLOX®delta6BIOLOX®OPTION7BIOLOX®delta Ceramic Knee8BIOLOX®delta Ceramic Knee9BIOLOX®delta Ceramic-on-Ceramic Hip Resurfacing10BIOLOX®delta Ceramic-on-Ceramic Hip Resurfacing11BIOLOX CONTOURA®12BIOLOX®delta Core for Cervical Disc13BIOLOX®delta ceramic insert for Modular Dual Mobility System14BIOLOX® CERAMIC KNEE

Alumina skirted heads made of BIOLOX®

Alumina Ceramic: hipped, lasered, proofed

Bipolar Shell and Head

Zirconia, Platelet-Toughened Alumina Ceramic Composite

Sleeved Ceramic Head made of BIOLOX®delta

Multigen Plus Ceramic Knee, LIMA Corporate S.p.A.

BPK-S Ceramic Knee, Peter Brehm GmbH

H1® Ceramic Hip Resurfacing, Embody Orthopaedic Ltd.

ReCerf® Ceramic Hip Resurfacing, MatOrtho Limited

Anatomically Contoured Femoral Head

For cervical artificial discs

Breakthrough Device Designation granted to CeramTec by the FDA

BIOLOX®

Alumina skirted heads made of BIOLOX®

BIOLOX®
Autophor Liners made of BIOLOX® ceramics
Autophor Liners made of BIOLOX® ceramics
BIOLOX®forte ceramic-on-ceramic bearing

Alumina Ceramic: hipped, lasered, proofed

BIOLOX®forte ceramic-on-ceramic bearing
BIOLOX®DUO

Bipolar Shell and Head

BIOLOX®DUO
BIOLOX®delta

Zirconia, Platelet-Toughened Alumina Ceramic Composite

BIOLOX®delta
BIOLOX®OPTION

Sleeved Ceramic Head made of BIOLOX®delta

BIOLOX®OPTION
BIOLOX®delta Ceramic Knee

Multigen Plus Ceramic Knee, LIMA Corporate S.p.A.

BIOLOX®delta Ceramic Knee
BIOLOX®delta Ceramic Knee

BPK-S Ceramic Knee, Peter Brehm GmbH

BIOLOX®delta Ceramic Knee
BIOLOX®delta Ceramic-on-Ceramic Hip Resurfacing

H1® Ceramic Hip Resurfacing, Embody Orthopaedic Ltd.

BIOLOX®delta Ceramic-on-Ceramic Hip Resurfacing
BIOLOX®delta Ceramic-on-Ceramic Hip Resurfacing

ReCerf® Ceramic Hip Resurfacing, MatOrtho Limited

BIOLOX®delta Ceramic-on-Ceramic Hip Resurfacing
BIOLOX CONTOURA®

Anatomically Contoured Femoral Head

BIOLOX CONTOURA®
BIOLOX®delta Core for Cervical Disc

For cervical artificial discs

BIOLOX®delta Core for Cervical Disc
BIOLOX®delta ceramic insert for Modular Dual Mobility System
BIOLOX®delta ceramic insert for Modular Dual Mobility System
BIOLOX® CERAMIC KNEE

Breakthrough Device Designation granted to CeramTec by the FDA

BIOLOX® CERAMIC KNEE

BIOLOX® ACADEMY

The new knowledge hub on the topic of bioceramics

Read more

The Future of Orthopaedics:
News, Trends and Insights from the World of Hip Replacement and Beyond


Show all top stories

CoP ceramic liner and MoP metal femoral head in polyethylene cups; labeled Clinical Results comparing bearing surfaces in primary THA.

Bearing choice and PJI risk: Evidence from a 10,602-patient THA cohort (Rothman Orthopaedics)

Periprosthetic joint infection (PJI) remains a devastating potential complication following total hip arthroplasty (THA). While bearing surface selection has traditionally been discussed in the context of wear and long-term survivorship, a growing body of research suggests that implant material may influence the local immune environment – and even pose the risk of infection.

Read more
BIOLOX®delta CoC monoblock acetabular cup with titanium mesh shell alongside a ceramic-on-polyethylene modular cup; labeled Clinical Results.

BIOLOX®delta ceramic-on-ceramic monoblock vs. ceramic-on-polyethylene modular: what 5 years of radiostereometric analysis reveal for ceramic hip replacement

Drs. Caner Içli and Nina M. C. Mathijssen, together with colleagues at the Reinier Haga Orthopaedic Centre and Reinier de Graaf Gasthuis (Netherlands), have published a new randomized controlled trial in Acta Orthopaedica.

Read more
Pink BIOLOX delta ceramic femoral head and acetabular liner on black background, labelled Clinical Results.

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).

Read more

What does the best available evidence tell us about BIOLOX®delta 4th-generation ceramic bearings in total hip arthroplasty?

Profs Carsten Perka, Luigi Zagra, Maziar Mohaddes, Niklas Keller, Axel Ekkenkamp, and Dirk Stengel – hailing from institutions including Berlin’s Charité Medical University Center and Milan’s IRCCS Istituto Ortopedico Galeazzi – are the authors of one of the most comprehensive best-evidence synthesis to date. It draws on eight national registries, 20 systematic reviews, and over two decades of clinical use and real-world data to provide unbiased estimates of advantages and potential risks of 4th-generation ceramic bearings in THA, with a focus on BIOLOX®delta.

Read more
3D render of a BIOLOX® ceramic femoral head and acetabular insert as a ceramic-on-ceramic bearing pair, labeled Clinical Results

Ceramic-on-ceramic tribology is a system & technology question – not a material question alone.

CoC bearings have proven their long-term stability and performance in total hip arthroplasty. But what do we know about the mechanisms behind frictional instability, lubrication transitions, and microstructural damage? A research team at China’s Zhejiang Institute of Medical Device Testing set out to consolidate the current evidence.

Read more
3D render of a BIOLOX®delta ceramic-on-ceramic hip resurfacing implant with clinical results headline.

BIOLOX®delta Ceramic-on-Ceramic Hip Resurfacing: Wear Performance Under Daily Activities

A new wear simulation study jointly published by Prof. Louise Jennings and Raelene Cowie (University of Leeds) and MatOrtho Ltd’s engineering team Danielle de Villiers, Colin Fisher, et al. evaluates the tribological performance of MatOrtho’s ReCerf® ceramic-on-ceramic hip resurfacing (BIOLOX®𝘥𝘦𝘭𝘵𝘢) over a range of daily activities (e.g. walking, jogging). The study moves beyond the standard ISO 14242-1 gait cycle to bearing behavior under more patient-realistic conditions.

Read more

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Issue # 12025

CeraNews

CeraNews to the Point delivers an overview of relevant current research – brief and to the Point!
In medicine, staying informed about trends and advancements is not just an obligation, but a necessity to ensure the highest standard of patient care. This issue focuses on metal hypersensitivity in joint arthroplasty. We examine its clinical impact, the implant-related factors that may trigger immune responses, and its possible role in implant failure. We also highlight current diagnostic approaches and explore strategies to help mitigate risk in sensitive patients.

Read more
William M. Mihalko MD, PhD

Campbell Clinic Orthopaedics
Memphis TN USA

Health Economics & Policy

A patient-centered allergy testing model

Dr. Burkhard Summer of Ludwig-Maximilans-Universität in Munich explains how the LMU’s multidisciplinary testing strategy integrates genetic testing, patch testing, lymphocyte transformation assay (LTT), and the IL-1α/IL-1β...

Read More Here
Implant Material

Metal hypersensitivity & implant failure

Dr. Marco Calcedo of Orthopedic Analysis/Rush University asserts that metal hypersensitivity is an underrecognized factor in implant failure, articulates the pathophysiological process of a metal-hypersensitivity reaction,...

Read More Here
Outcomes Research

Ni, Co, and Cr allergies in orthopedics

Dr. David Langton, Managing Director of ExplantLab, argues that aseptic lymphocyte-dominated vasculitis-associated lesions (ALVAL) is the true clinical manifestation of metal hypersensitivity and describes how ExplantLab’s...

Read More Here
Information to Download

Read now or save for later - our compact PDF files provide you with the most important facts:

CeraNews
Issue 1/2025
Metal Hypersensitivity: Pathophysiology and Diagnostic Tools
4 MB, pdf
download
EN
Product Information, Top Downloads
BIOLOX®delta Quick Reference Guide
6 MB, pdf
download
EN
Product Information, Top Downloads
BIOLOX® Hip Product Portfolio
2 MB, pdf
download
EN
Product Information, Top Downloads
BIOLOX® Generations of Ceramic Materials
847 KB, pdf
download
EN

References

1. BIOLOX®delta registered and in clinical use since 2003. CeramTec data on file.

2. Cumulative BIOLOX® delta components delivered worldwide as of 09/22/2026. CeramTec internal data; data on file.

3. Refers to CeramTec's experience in the development and manufacture of medical-grade ceramics since 1974.

4. Sharplin P, Wyatt MC, Rothwell A, Frampton C, Hooper G. Which is the best bearing surface for primary total hip replacement? A New Zealand Joint Registry study. Hip Int. 2018;28(4):352-362. doi:10.5301/hipint.5000585.

5. Peters RM, Van Steenbergen LN, Stevens M, Rijk PC, Bulstra SK, Zijlstra WP. The effect of bearing type on the outcome of total hip arthroplasty. Acta Orthop. 2018;89(2):163-169. doi:10.1080/17453674.2017.1405669.

6. Maccauro G, Cittadini A, Magnani G, Sangiorgi S, Muratori F, Manicone PF, Rossi Iommetti P, Marotta D, Chierichini A, Raffaelli L, Sgambato A. In vivo characterization of Zirconia Toughened Alumina material: a comparative animal study. Int J Immunopathol Pharmacol. 2010;23(3):841-846. doi:10.1177/039463201002300319.

7. Cunningham BW, Hallab NJ, Hu N, McAfee PC. Epidural application of spinal instrumentation particulate wear debris: a comprehensive evaluation of neurotoxicity using an in vivo animal mode. J Neurosurg Spine. 2013;19:336-350. doi:10.3171/2013.5.SPINE13166.

8. Asif I M. Characterisation and Biological Impact of Wear Particles from Composite Ceramic Hip Replacements. [PhD thesis]. Leeds, UK: University of Leeds; 2018. etheses.whiterose.ac.uk/20563. Accessed March 6, 2020.

9. Beraudi A, Stea S, De Pasquale D, et al. Metal ion release: also a concern for ceramic-on-ceramic couplings? Hip Int. 2014;24(4):321-326. doi:10.5301/hipint.5000132.

10. Kretzer JP, Mueller U, Streit MR, et al. Ion release in ceramic bearings for total hip replacement: Results from an in vitro and an in vivo study. Int Orthop. 2018;42(1):65-70. doi:10.1007/s00264-017-3568-1.

11. Thomas P, Stea S. Metal Implant Allergy and Immuno-Allergological Compatibility Aspects of Ceramic Materials. Heidelberg, Germany:  Springer-Verlag Berlin Heidelberg; 2015.

12. Tsaousi A, Jones E, Case CP. The in vitro genotoxicity of orthopaedic ceramic (Al2O3) and metal (CoCr alloy) particles. Mutat Res. 2010;697(1-2):1-9. doi:10.1016/j.mrgentox.2010.01.012.

13. Esposito C, Maclean F, Campbell P, Walter WL, Walter WK, Bonar SF. Periprosthetic tissues from third generation alumina-on-alumina total hip arthroplasties. J Arthroplasty. 2013;28(5):860-866. doi:10.1016/j.arth.2012.10.021.

14. Trieb K, Ullmann D, Metzinger K, et al. Prospective Comparison of a Metal-Free Ceramic Total Knee Arthroplasty with an Identical Metal System. Z Orthop Unfall. 2018;156(1):46-52. doi:10.1055/s-0043-118600.

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