Comparative outcomes of Forte versus Delta ceramic bearings in total hip arthroplasty using a national database

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). We identified 124,556 adult patients who underwent primary THA between 2003 and 2019. Among them, 75,475 patients who underwent ceramic-on-ceramic THA with either Forte-on-Forte or Delta-on-Delta bearings were ultimately included after applying the exclusion criteria. Dislocation, periprosthetic joint infection (PJI), and periprosthetic fracture within 30 days, 90 days, and 1 year were compared between the Forte and Delta groups. Survivorship was evaluated using stem revision, cup revision, and any revision as endpoints. 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 were associated with a higher risk of dislocation within 30 days compared with Delta bearings (aHR = 1.43; 95% CI = 1.21-1.69), and this association persisted at 1 year (aHR = 1.46; 95% CI = 1.34-1.60). The 10-year survival rates in the Delta group were higher for cup revision (98.6%, 95% CI = 98.4-98.8) and any revision (96.5%, 95% CI = 96.2-96.7) than those in the Forte group. Delta-on-Delta ceramic bearings were associated with lower risks of dislocation and revision compared with Forte-on-Forte bearings in this nationwide claims-based cohort.