Clinical Orthopaedics and Related Research®

, Volume 468, Issue 2, pp 358–366 | Cite as

THA With Delta Ceramic on Ceramic: Results of a Multicenter Investigational Device Exemption Trial

  • William G. HamiltonEmail author
  • James P. McAuley
  • Douglas A. Dennis
  • Jeffrey A. Murphy
  • Thomas J. Blumenfeld
  • Joel Politi
Symposium: Papers Presented at the Hip Society Meetings 2009


Although the published studies on the outcomes of total hip arthroplasty (THA) performed with currently available ceramic components show high survivorship and low bearing wear at midterm followup, concern over ceramic fracture and squeaking persist. For these reasons, the use of ceramic is limited. Recently, a new alumina matrix composite material (Delta ceramic) with improved material properties was developed to address these concerns. We report the early outcomes and complications of a prospective, randomized, multicenter trial of 263 patients (264 hips) at eight centers, comparing a Delta ceramic-on-ceramic (COC) articulation with a Delta ceramic head-crosslinked polyethylene bearing combination (COP). There were 177 COC hips and 87 COP hips. Complications were reported for all patients, whereas clinical and radiographic results were provided for the 233 patients with minimum 2-year followup (average, 31.2 months; range, 21–49 months). The Harris hip scores and clinical, radiographic, and survivorship outcomes were similar in both groups. There were four (2%) revisions in the COC group and two (2%) in the COP group. We encountered three intraoperative ceramic liner-related events. In addition, one patient receiving the COC underwent revision for chipping of the ceramic liner, and a second had ceramic fragmentation on followup radiographs but has not undergone revision. These liner related complications remain a concern. No patient reported squeaking in either group; this leaves us hopeful the new material will lessen the frequency of squeaking. In the short term, the Delta COC articulation provided similar functional scores and survivorship and complication rates with the ceramic head mated with crosslinked polyethylene.

Level of Evidence: Level I, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.


Alumina Matrix Composite Ceramic Head Femoral Head Fracture Ceramic Liner Ceramic Bearing 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



We thank additional surgeons and study coordinators (listed respectively by site) who were critical to the study design, enrollment, and followup of this patient cohort: William L. Bargar, MD, and Andrea Hankins (Sacramento, CA); C. Anderson Engh, Jr, MD, Charles A. Engh, Sr, MD, and Supatra Sritulanondha, MPH (Alexandria, VA); Theodore Firestone, MD, and Wayne McBride (Scottsdale, AZ); Robert Molloy, MD, and Lisa Hegemier (Cleveland, OH); Charles Nelson, MD, Craig Isrealite, MD, and Karunya Manikonda (Philadelphia, PA); and David Pollock, MD, and Charlene Cash (Winston-Salem, NC). Study coordinators affiliated with the authors include Donnis Rafferty, CCRC (Denver, CO) and Cheryl Seeley, RN, CCRC (Columbus, OH). Independent radiographic review was performed by Jonathan P. Garino, MD, and Denise Knox (Philadelphia, PA).


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Copyright information

© The Association of Bone and Joint Surgeons® 2009

Authors and Affiliations

  • William G. Hamilton
    • 1
    Email author
  • James P. McAuley
    • 2
  • Douglas A. Dennis
    • 3
    • 4
    • 5
  • Jeffrey A. Murphy
    • 6
  • Thomas J. Blumenfeld
    • 7
  • Joel Politi
    • 8
  1. 1.Anderson Orthopaedic Research InstituteAlexandriaUSA
  2. 2.Department of Orthopaedic SurgeryUniversity of Western Ontario, London Health Sciences CenterLondonCanada
  3. 3.Department of Biomedical EngineeringUniversity of TennesseeKnoxvilleUSA
  4. 4.University of Colorado Health Sciences CentersDenverUSA
  5. 5.Rocky Mountain Musculoskeletal Research LaboratoryDenverUSA
  6. 6.DePuy OrthopaedicsWarsawUSA
  7. 7.University of California Davis, Sutter General HospitalSacramentoUSA
  8. 8.Cardinal Orthopaedic InstituteColumbusUSA

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