Text

Objectives and questions: Despite their widespread use, relatively little is known about the comparative survivorship of Forte-on-Forte (FoF) versus Delta-on-Delta (DoD) ceramic bearings with respect to risk of revision after total hip arthroplasty (THA). The purpose of this study was to evaluate (1) the national trends of FoF and DoD in THA, and (2) survivorship of THA with FoF versus DoD, using nationwide data from the NHIS (national health insurance service).

Material and methods: We identified all patients who underwent primary THA using ceramic bearings in the South Korea between 2003 and 2019 (N=124,556). Cumulative incidences of dislocation, periprosthetic joint infection (PJI), periprosthetic fracture were compared between Forte and Delta group. Survivorship for revisions was also calculated to determine differences. Multivariable Cox proportional hazard regression ratios (HRs) were used for comparisons.

Results: Among a total of 75,475 THA with CoC, DoD was utilized in 43,552 patients (57.7%) and FoF in 31,923 patients (42.3%). Utilization of DoD increased with a decrease of FoF since 2007. Forte bearings had a higher risk of dislocation within 30 days compared to Delta bearings (aHR=1.43; 95% CI=1.21, 1.69), which continued at 1-year (HR = 1.46; 95% CI=1.34, 1.60) Forte bearings showed higher risk of cup revision (aHR=1.43; 95% CI=1.25, 1.63), and any revision (aHR=1.36; 95% CI=1.25, 1.48) compared with Delta bearings at 10 years. The 10-year survival rates in Delta group were higher for cup revision (98.7%, 95% CI=98.2, 99.3), and any revision (96.2%, 95% CI=95.1, 97.2), compared with Forte group.

Discussion and conclusions: We found a lower risk of complications and overall revision for Delta bearings compared with Forte bearing surfaces. Our findings suggested that we can recommend Delta ceramic bearings in THA.