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Additional evidence for BIOLOX® delta bearings: nationwide Korean data on 15,299 total hip arthroplasties

In Archives of Orthopaedic and Trauma Surgery, Lee et al. (2026) analyzed the Korean National Health Insurance database. They compared two bearing options: BIOLOX®delta ceramic-on Ceramic (DoD) vs. BIOLOX® delta ceramic-on-highly cross-linked polyethylene (DoHXLPE).

Table: 10-year survivorship for cup, stem and any revision, CoC vs. CoHXLPE; any revision 96.5% vs. 95.3%
Table: 1-year incidence of PJI, dislocation, periprosthetic fracture and adjusted hazard ratios, DoD vs. DoHXLPE
Study design
  • Primary THAs with a BIOLOX®delta ceramic bearing, 2003–2013 (n = 15,299)
  • DoD: 14,255 patients (93.2%).
  • DoHXLPE: 1,044 patients (6.8%)
  • Multivariable Cox regression, competing-risk analysis, and 1:3 propensity score matching as a sensitivity analysis
  • Mean follow-up: 9.3 ± 3.7 years (DoD) vs. 8.7 ± 2.9 years (DoHXLPE)

 

Key findings for BIOLOX®delta-on-BIOLOX®delta
  • Periprosthetic joint infection within 1 year: 0.9% with DoD vs. 1.9% with DoHXLPE (aHR 2.10, 95% CI 1.29–3.41). The difference remained significant after matching (aHR 2.23, 95% CI 1.22–4.05).
  • Dislocation within 1 year: 2.3% with DoD vs. 3.0% with DoHXLPE. This was not significant in the primary analysis, but significant after propensity score matching (HR 1.68, 95% CI 1.08–2.63).
  • Periprosthetic fracture within 1 year: 0.7% vs. 0.6%no significant difference between the groups.
  • Any revision at 10 years: 3.5% with DoD vs. 4.8% with DoHXLPE (aHR 1.32). Ten-year survivorship free of any revision was 96.5% with DoD vs. 95.3% with DoHXLPE.
  • Cup + stem revision: 10-year survivorship was 98.6% with DoXLPE? and 98.8% with DoD.
  • Adoption: use of BIOLOX®delta liners has risen markedly in Korea since 2007.

 

This was a retrospective claims-based cohort, so the findings show associations, not causation. The authors state the study does not demonstrate the superiority of either bearing. That said, in this large national cohort, BIOLOX® delta ceramic on ceramic bearings had consistently low complication and revision rates over ≤10 years. They were also associated with a lower risk of early periprosthetic joint infection than BIOLOX® delta ceramic on HXLPE.

 

They also note some limitations: the any-revision difference lost statistical significance after propensity score matching; the smaller DoHXLPE group limited statistical precision; and ceramic-specific complications such as squeaking, fracture, and liner malseating could not be captured in claims data.

Head size, surgical approach and implant position were not available. Ceramic-specific events such as squeaking or liner fracture could not be captured. 

 

Other national registries, including the NJR, have reported different revision patterns.

 

The authors stress that prospective studies with detailed clinical and procedural data are still needed.

 

📖 Lee YK, Kang D, Kim H, Kang E, Cho J, Park JW. Comparative outcomes of delta-on-delta and delta-on-highly cross-linked polyethylene bearings in total hip arthroplasty: A nationwide cohort study. Archives of Orthopaedic and Trauma Surgery, 146, 338. 2026. doi: 10.1007/s00402-026-06502-1

 

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.

 

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