New UK study shows THR revision least likely with BIOLOX®delta ceramic bearings

Over 100,000 THA procedures are performed each year in the UK, where metal-on-polyethylene bearings have historically been the standard of care. The new registry study demonstrates distinct advantages to implants with BIOLOX^®delta bearings – strikingly,BIOLOX^®delta-on-delta (DoD) with pre-assembled cups return the lowest revision rates of all.

Categories assessed included all-cause and indication-specific risks of revision in primary THR with heads and monobloc cups (378,979), as well as in modular acetabular component THRs (647,052) with different combinations of head and shell/liner.

Compared to implants with CoCr heads and HXLPE cups, the all-cause risk of revision for monobloc acetabular-component primary THRs was lower for patients with a BIOLOX^®delta-ceramic-head/HXLPE-cup combination. In this study, the risks were generally higher with CoCr or stainless-steel heads and non-HXLPE cups.  

For modular acetabular components, the all-cause revision risk was markedly lower when delta ceramic or oxidized zirconium heads were used with HXLPE liners. Higher risks of revision – and indication-specific risks – were seen with alumina heads and liners, non-HXLPE liners, and CoCr or stainless-steel heads paired with non-HXLPE liners. Conversely, pre-assembled DoD bearings (the BIOLOX^®delta ceramic liner is assembled with the metal shell in the factory) returned the lowest revision rates.

Whitehouse et al. concludes that bearing materials influence the outcome of the primary procedure and that – due to their reduced incidence of wear, biofilm development, and fretting corrosion – BIOLOX^®delta bearings seem to lower the risk of revision in comparison with the standard of care in the UK. The team acknowledges the difficulty of accounting for all influencing factors given that the trial was neither randomized nor controlled. They also emphasize that more research is needed on the correlation between implant bearing materials and the risk of rehospitalization, other re-operation, mortality, and material cost-effectiveness.

Even taking these limitations into account, the results of this team’s analyses will empower hospitals, surgeons, and patients to choose femoral head-and-liner combinations that improve the chances of enjoying a long-lived hip implant.

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References:

Whitehouse, Michael R.; Patel, Rita; French, Jonathan M. R.; Beswick, Andrew D.; Navvuga, Patricia; Marques, Elsa M. R.; Blom, Ashley W.; Lenguerrand, Erik. “The association of bearing surface materials with the risk of revision following primary total hip replacement: A cohort analysis of 1,026,481 hip replacements from the National Joint Registry.” PLOS Medicine, November 2024. pmc.ncbi.nlm.nih.gov/articles/PMC11542800/