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    2. Deutscher Kongress für Orthopädie und Unfallchirurgie 2025 (DKOU 2025)
    3. Comparison between metal, alumina, and delta head on highly cross-linked polyethylene liner
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German Congress of Orthopaedics and Traumatology (DKOU 2025)

Deutsche Gesellschaft für Orthopädie und Unfallchirurgie (DGOU), Deutsche Gesellschaft für Orthopädie und Orthopädische Chirurgie (DGOOC), Deutsche Gesellschaft für Unfallchirurgie (DGU), Berufsverband für Orthopädie und Unfallchirurgie (BVOU)
28.-31.10.2025
Berlin


Meeting Abstract

Comparison between metal, alumina, and delta head on highly cross-linked polyethylene liner

Young-Kyun Lee 1
Jung-Wee Park 1
Ki-Tae Park 1
Dong-Hoon Lee 1
1Seoul National University Bundang Hospital, Seongnam, Republik Korea (Südkorea)

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Objectives and questions: To evaluate (1) the national trends of metal and ceramic head in THA, and (2) survivorship of metal versus ceramic femoral heads when used with an HXLPE liner.

Material and methods: We conducted a retrospective cohort(registry) study using the Korean NHIS (National Health Insurance Service) database. Primary THAs using HXLPE liner in the South Korea between 2003 and 2019 were included. Difference in bearing types of THA: metal-on-HXLPE(MoHXLPE), forte ceramic-on-HXLPE(FoHXLPE), and delta ceramic-on-HXLPE(DoHXLPE) were compared. Main outcomes were cumulative incidences of dislocation, periprosthetic joint infection (PJI), periprosthetic fracture and survivorship for revisions according to bearing types.

Results: Among a total of 14,137 THA with HXLPE, Delta head was the most frequently utilized femoral head in 6,294 hips (45%), followed by metal head in 4,656 (33%), and Forte head in 3,184 (22%). Delta head had a lower risk of dislocation compared to metal head (aHR=0.30; 95% CI=0.11, 0.78). Forte head had a lower risk of PJI compared to the metal head (aHR=0.35; 95% CI=0.19, 0.66) within 1 year. Delta head had a lower risk of periprosthetic fracture within 30 days compared to metal head (aHR=0.53; 95% CI=0.43, 0.67), which persisted at 1-year (aHR=0.52; 95% CI=0.32, 0.85) and 10-year follow-up (aHR=0.67; 95% CI=0.79, 0.90). After 10 years, Delta head showed lower cumulative incidences of cup revision (aHR=0.44; 95% CI=0.31, 0.62), stem revision (aHR=0.55; 95% CI=0.38, 0.79), and any revision (aHR=0.48; 95% CI=0.38, 0.59) compared with metal head. Forte head showed a lower cumulative incidence of any revision compared with metal head (aHR=0.73; 95% CI=0.59, 0.90). The 10-year survival rates for Delta head were highest for cup revision (98.7%, 95% CI=98.2, 99.3), stem revision (98.7%, 95% CI=98.2, 99.2), and any revision (96.2%, 95% CI=95.1, 97.2), compared with Forte and metal head.

Discussion and conclusions: We found a lower risk of complications and revision for FoHXLPE and DoHXLPE bearings compared with MoHXLPE-bearing surfaces. Our findings suggested that we can recommend Delta ceramic head when used with HXLPE liner in THA.