Aims. We conducted a prospective study of a delta ceramic total hip arthroplasty (THA) to determine the rate of ceramic fracture, to characterise post-operative noise, and to evaluate the mid-term results and survivorship. Patients and Methods. Between March 2009 and March 2011, 274 patients (310 hips) underwent cementless THA using a delta ceramic femoral head and liner. At each follow-up, clinical and radiological outcomes were recorded. A Kaplan-Meier analysis was undertaken to estimate survival. Results. Four patients (four hips) died and 18 patients (20 hips) were lost to follow-up within five years. The remaining 252 patients (286 hips) were followed for a mean of 66.5 months (60 to 84). There were 144 men (166 hips) and 108 women (120 hips) with a mean age of 49.7 years (16 to 83) at surgery. The mean pre-operative Harris Hip Score of 47.1 points improved to 93.8 points at final follow-up. Six patients reported squeaking in seven hips; however, none were audible. Radiolucent lines involving Gruen zones one and/or seven were seen in 52 hips (18.2%). No hip had detectable wear, focal osteolysis or signs of loosening. One hip was revised because of fracture of the ceramic liner, which occurred due to an undetected malseating of the ceramic liner at the time of surgery. One hip was revised for a periprosthetic fracture of the femur, and one hip was treated for periprosthetic joint infection. The six-year survivorship with re-operation for any reason as the endpoint was 99.0% (95% confidence interval 97.8% to 100%). Discussion. The rate of delta ceramic fracture was 0.3% (one of 286). While ceramic head fracture was dominant in previous ceramic-on-ceramic THA, fracture of the delta ceramic liner due to malseating is a concern. Cite this article: Bone Joint J 2017;99-B:741–8

Introduction. The continued improvement of ceramic materials for total hip arthroplasty led to the development of Zirconia and Zirconia toughened Alumina materials such as BIOLOX® delta. Zirconia exists in a tetragonal phase in new ceramic heads and can transform to a monoclinic phase in response to loading giving the material improved fracture toughness. It is known that surface transformation occurs in this material under hydrothermal conditions (i.e. in vivo condition), and ISO standards recommend parts are artificially aged prior to testing to include any effect of surface transformation on new designs. Accelerated aging procedures have been used to predict the amount of phase transformation that will occur in vivo, but validation of these models requires the study of retrieved hip joints. Here 26 BIOLOX® delta retrievals are analysed to determine the degree of phase transformation that occurs in vivo. The levels of phase transformation measured are compared with those predicted based on accelerated aging tests. Methods. Twenty-six retrieved BIOLOX® delta (CeramTec AG, Germany) femoral heads were investigated. Retrievals were obtained after implantation of between 1 month and 7 years with an average follow-up of 1.5 years. All retrievals were from ceramic-on-ceramic hip joints that were implanted between 2004 and 2012. Mean patient age was 69 years (range 48–87 years). Raman spectra were collected using a confocal Raman spectrometer (WITec Gmbh, Germany) a laser wavelength of 532nm, a 50× objective and a 100μm pinhole. Twenty-five measurements were made on each retrieval at random locations outside any visible wear scars and inside visible wear scars. The average monoclinic content was calculated based on the method of Clarke and Adar [1]. For comparison 5 new BIOLOX® delta femoral head resurfacings were measured using the same procedure. Results. The average monoclinic content of the new heads was 5%±2%. For unworn areas of the retrievals this increased to 23%±9% with the highest monoclinic content measured at 42%. There was no statistical correlation between implantation time and monoclinic content in the unworn areas. In worn areas of the retrievals the monoclinic content was higher and varied between 13% and 51%. Discussion. This is the largest set of retrieved BIOLOX® delta heads to be examined for changes in monoclinic content building on the work of Affatato et al. [2] who analysed 5 retrievals. All retrievals have a higher level of phase transformation than new heads in the unworn areas showing that hydrothermal aging does take place in the body. The results also show that on average there is more monoclinic transformation in worn areas and hence the material toughening effect of the Zirconia phase is utilised. The mean phase transformation found in vivo matched the 23%±5% reported as occurring under the conditions described in the ISO standard for hydrothermal aging [3]. However, the ISO standard is thought to be equivalent to 40 years in vivo whilst the retrievals measured had a mean follow-up of 1.5 years

The purpose of this study was to compare the effect of femoral head material (delta ceramic versus metal) on polyethylene wear in a consecutive prospective randomized series of low friction total hip arthroplasty. A total of 110 patients with a mean age of 60.6 ± 9.3 (34–75) years were randomized (power of 90%, alpha of 5%) to receive either a metal (55 hips) or a delta ceramic (55 hips) femoral head. The polyethylene socket was moderately cross-linked (3 Mrads of gamma radiation in nitrogen) and annealed at 130°C in all hips. All other parameters were identical in both groups. The primary criterion for evaluation was linear head penetration measurement using the Martell system, performed by an investigator blinded to the material of the femoral head. Creep and steady state wear values were calculated. At the minimum of 3-year follow-up, complete data were available for analysis in 38 hips at a median follow-up of 4.4 years (3.0 to 5.7), and in 42 hips at a median follow-up of 4.0 years (3.0 to 5.4) in the metal and delta ceramic groups, respectively. The mean creep, measured as the linear head penetration at one year follow-up, was 0.42 ± 1.0 mm in the metal group versus 0.30 ± 0.81 mm in the delta ceramic group (Mann and Whitney test, p = 0.56). The mean steady state penetration rate from one year onwards measured 0.17 ± 0.44 mm/year (median 0.072) in the metal group versus 0.074 ± 0.44 mm/year (median 0.072) in the delta ceramic group (Mann and Whitney test, p = 0.48). No case of delta ceramic femoral head fracture was recorded, and no hip had signs of periprosthetic osteolysis. This study demonstrated that up to 5-year follow-up, delta ceramic femoral head did not significantly influence creep neither wear of a contemporary annealed polyethylene. Longer follow-up is necessary to further evaluate the potential clinical benefits of delta ceramic

In 2020 almost 90% of femoral heads for total hip implants in Germany were made of ceramic. Nevertheless, the cellular interactions and abrasion mechanisms in vivo have not been fully understood until now. Metal transfer from the head-neck taper connection, occurring as smear or large-area deposit, negatively influences the surface quality of the articulating bearing. In order to prevent metal transfer, damage patterns of 40 Biolox delta ceramic retrievals with CoC and CoPE bearings were analysed. A classification of damage type and severity for each component (n=40) was done according to an established scoring system. To investigate the physical properties, the surface quality was measured using confocal microscopy, quantitative analysis of phase composition were performed by Raman spectroscopy and qualitative analysis of metal traces was done by scanning electron microscopy (SEM) with energy dispersive X-ray spectroscopy (EDX). The periprosthetic tissue was analysed for abrasion particles with SEM and EDX. Both bearing types show different damage patterns. Dotted/ drizzled metal smears were identified in 82 % of CoC (n=16) and 96 % of CoPE (n=24) bearings. Most traces on the ceramic heads were identified in the proximal area while they were observed predominantly in the distal area for the ceramic inlays. The identified marks are similar to those of metallic bearings. Metallic smears lead to an increase of up to 30 % in the monoclinic crystalline phase of the ceramic. The roughness increases by up to six times to Ra=48 nm. Ceramic and metallic wear particles from the articulating surfaces or head neck taper junctions were found in the periprosthetic tissue. Damage patterns on CoC hip implants seem to be similar to those of metallic implants. More detailed analysis of CoC implants are needed to understand the described damage patterns and provide advice for prevention

Two types of ceramic materials currently used in total hip replacements are third generation hot isostatic pressed (HIPed) alumina ceramic (commercially known as BIOLOX®forte, CeramTec) and an alumina matrix composite material consisting of 75% alumina, 24% zirconia, and 1% mixed oxides (BIOLOX®delta, CeramTec). The aim of this study is to compare BIOLOX delta femoral heads to BIOLOX forte femoral heads revised within 2 years in vivo. Ceramic bearings revised at one center from 1998 to 2010 were collected (61 bearings). BIOLOX delta heads (n=11) revised between 1–33 months were compared to BIOLOX forte femoral heads with less than 24 months in vivo (n=20). The surface topography of the femoral heads was measured using a chromatically encoded confocal measurement machine (Artificial Hip Profiler, RedLux Ltd.). The median time to revision for BIOLOX delta femoral heads was 12 months, compared to 13 months for BIOLOX forte femoral heads. Sixteen out of 20 BIOLOX forte femoral heads and 6 out of 11 BIOLOX delta femoral heads had edge loading wear. The average volumetric wear rate for BIOLOX forte was 0.96 mm3/yr (median 0.13 mm3/yr), and 0.06 mm3/yr (median 0.01 mm3/yr) for BIOLOX delta (p=0.03). There was no significant difference (p>0.05) in age, gender, time to revision or femoral head diameter between the two groups. Early results suggest less volumetric wear with BIOLOX delta femoral heads in comparison to BIOLOX forte femoral heads

Since 2006 we have started to implant modular stelus, ceramic articolar component and Delta cotilus (PF 2006.2007 and TT since 2008) in hip artroplastic of young patients. 53 implantations (4 cases bilateral). Association with conic stelus (14th different shapes from 13 to 26) with trocanterical modulus that permits a good compliance studing each cases (offset-AR-lever-arm). We have found a good resolution using ceramic as matherial in articolar joint because reaching a very high level of satisfaction both for surgeons and for patients outfits. The Delta TT Lima has a titanium trabecular surface that offers a very good primary stability and a very high level in bone integration. The dedicated instrumentary, the design and the matherial high quality are the bases for a good resistance and a good articolar stability. Medium age of patients was 51 y.o. (from 33 to 66 y.o); follow up has been made at the 1st year and the 6th year. Results were evaluated following HHS guide line. Main treated pathologies were: primary arthrosis (9 cases); DCA (21 cases), post thraumatic arthrosis (9 cases), OA (8 cases), hip fractures (6 cases)

“Delta fixation” was developed to treat low-grade L5 isthmic spondylolisthesis. It involves placement of pedicle screws into L5 and from S1 through the L5/S1 disc into L5 (Fig.1). A biomechanical comparison to standard Posterior Lumbar Interbody Fusion (PLIF) with two anterior cages and pedicle screws in L5 and S1 was made. Eight fresh frozen human specimens were instrumented with both fixations and tested. Delta fixation was significantly more stable in resisting rotation. It requires less manipulation of the nerve roots and spares the cost of the fusion cages. Our objective is to compare the stability of Delta versus PLIF fixation in the treatment of low grade isthmic spondylolisthesis. Delta fixation provides superior initial stability, and therefore is an acceptable alternative to PLIF for the treatment of low grade isthmic spondylolisthesis of L5-S1. Symptomatic low-grade isthmic spondylolisthesis of L5 is often managed with PLIF. This procedure requires extensive manipulation of the cauda equine, posterior resection of the disc and the placement of two inter-body cages as spacers in addition to pedicle screws in L5 and S1. Delta Fixation has been developed to provide stable fixation with less nerve root manipulation and without the use of inter-body cages. It is therefore a safer alternative method of fixation that spares the additional cost of the fusion cages. When comparing Delta fixation to PLIF fixation the only statistically significant difference was found in axial rotation. Delta fixation had 2.05 degrees less ROM and 0.90 degrees less NZ compared to PLIF fixation with P values of 0.0052 and 0.0104 respectively. This demonstrates that the delta fixation is more stable than PLIF fixation. Eight fresh frozen human spines were used. Matched pairs were created and block randomization used to create two groups: PLIF fixation and Delta fixation groups. The specimens were instrumented with a grade II spondylolisthesis of L5-S1, tested, and then re-instrumented with the alternative fixation and tested again. Vertical displacement, axial rotation, flexion– extension and side bending were tested using an MTS machine. Please contact author for tables and/or diagrams

Aims: The authors reported an original technique for proximal humerus reconstruction followed tumor resection using a delta composite prosthesis. Seven patients undergoing this technique Technique: Proximal humeral resection was conducted usually. The host tendons of rotator cuff were resected; the deltoid muscle must be preserved. The glenosphere was inserted with three screws. A long humeral stem was used to provide a distal anchorage of 10 cm; this stem was cemented into the allograft and into the humerus host. The patient was immobilized in 90¡ of abduction during 6 weeks. Results: 7 patients aged 38 to 56 years, who presented a chondro-sarcoma or an osteosarcoma of the proximal humerus were enrolled in this study. The mean follow-up was 20 months (6 to 24). None patient presented with pain and the mean of active abduction was 120¡. No local or general recurrence was detected. Discussion: The Delta prosthesis of Gramon is usually used for shoulder arthritis with rotator cuff rupture. In our experience, reconstruction of the proximal humerus with composite prosthesis provides good functional results but after 3 years, a graft resorption was observed and the functional results decrease. The delta prosthesis could provide good functional results without reconstruction of the rotator cuff. In our technique, we sutured the rotator cuff to avoid dislocation. However, the glenoid þxation is incertain for a long term because its a constrained prosthesis. This technique could be used when the deltoid muscle can be preserved

INTRODUCTION. Managing severe periacetabular bone loss during revision total hip arthroplasty (THA) is a challenging task. Multiple treatment options have been described. Delta Revision Trabecular Titanium™ (TT) cup is manufactured by Electron Beam Melting (EBM) technology that allows modulating cellular solid structures with an highly porous structure were conceived to rich the goals of high bone ingrowth and physiological load transfer. The caudal hook and fins ensure additional stability and the modular system allows the surgeon to treat bone defects in the most complex revisions. Entirely modular, the system can meet all intra-operative needs thanks to a customized implant construction. The aim of this prospective study is to evaluate the short to mid-term clinical and radiographic outcomes of this acetabular revision cups. MATERIALS AND METHODS. We prospectively assessed clinical and radiographic results of 31 cases of acetabular revisions that were performed from June 2007 and March 2012 by Delta TT Lima Revision system. The mean age of patients was 69.5 years (range 29–90). The causes of revision were aseptic loosening in 22 cases (71.0%), periprosthetic acetabular fractures in 4 cases (13.0%), multiple dislocation of the primary implant in 3 cases (9.6%) and outcome of infection in 2 cases (6.4%). Stem revision was performed in 11 cases (35,4%). In 24 cases bone impaction grafting was used to fill cavitary defects (Paprosky 2B-3A); in 7 cases TT augments were used with the same aim. The average follow-up was 32 months (range 12–69). RESULTS AND CONCLUSIONS. No major complications were observed. The mean HHS significantly increased from 39.9 (range 17–60) preoperatively to 86.5 (range 65–100) at the last follow-up examination. The implanted cups were radiographically stable at the last follow-up visit without radiolucent lines or periprosthetic osteolysis. Trabecular Titanium showed a high capacity of osseointegration, providing excellent results in short to mid-term follow-up. The impaction grafting has demonstrated effective restoration of bone stock and no radiographic evidence bone resorption (Fig. 1). DISCUSSION. Delta Revision TT is a good solution for acetabular revision surgery even when there are cavitary and segmental bone defects. It is possible to restore muscle tension and correct anatomical impairments, while enhancing implant stability and minimising the risk of dislocation

The fourth generation Delta ceramic, in which zirconia is incorporated into the alumina matrix, was developed to provide improved fracture toughness and wear characteristics. The purpose of this study was to evaluate the minimum 5-year outcomes and bearing-specific complications in a single surgeon series of Delta ceramic-on-ceramic total hip arthroplasties (THAs). We retrospectively analysed 667 patients (749 hips) who underwent cementless THAs using Delta ceramic-on-ceramic bearings by a single surgeon. There were 315 men and 352 women with mean age of 55 years (range, 16 to 88 years) at the time of index surgery. Acetabular and femoral components were cementless in all hips. A 36 mm head was used in 472 hips and a 32 mm head was used in 227 hips. The mean duration of follow-up was 6.3 years (range, 5 to 8 years). The mean Harris hip score improved from 47.6 points preoperatively to 91.1 points at the time of final follow-up. All but one acetabular components were well-fixed, and all but one femoral components were well-fixed. No radiographic evidence of osteolysis was identified at the time of final follow-up. There were 2 (0.27%) ceramic liner fractures and no ceramic head fracture. A total of 48 hips (6.4%) exhibited an audible noise (29 clickings and 19 squeakings), but no patient required revision. Kaplan-Meier survivorship with an end point of revision for any reason was 98.7% at 6.3 years. Delta ceramic-on-ceramic THAs provide excellent clinical outcomes without osteolysis at the minimum 5-year follow-up. However, we also found 0.27% ceramic liner fractures and 6.4% audible noises associated with the use of Delta ceramic-on-ceramic bearings

Purpose of the study: The purpose of this prospective study was to evaluated the risk of fracture of 22.2 mm Delta ceramic heads. Material and methods: A preclinical study was performed on twenty 22.2 mm Delta ceramic femoral heads with a medium neck with 20 22.2 mm Delta ceramic femoral heads with a short neck. A V40TM cone was used in all cases with a 5 40 angle. In vitro tests consisted in the assessment of the fracture force under static pressure before and after stress tests, and with a static force shock test (Charpy model) simulating a microseparation during subluxation phenomena. Between April 2007 and April 200, a consecutive series of 55 composite Delta heads were used in 55 patients undergoing cemented total hip arthroplasty (THA). A polyethylene cup was sterilised under vacuum at 3 Mrads with a post-radiation temper (Duration. ®. ), and a stainless steel femoral piece with a highly polished surface and a V40TM Morse cone (Legend. ®. ). This series issued from a randomised prospective study designed to compare wear with 22.2mm Delta ceramic heads with stainless steel heads with the same diameter. Inclusion criteria were age < 75 years, degenerative disease on naive hip and patient residing in France. Mean patient age was 59.2±6.9 years (range 44–70). Results: The resistance of the 22.2 mm heads was significantly less during the static tests before and after the stress tests. Nevertheless, the mean resistance was higher than the FDA recommendations of 46K. The tests simulating a microseparation showed a significantly superior resistance for the 22.2 mm heads. All patients had from 1 to 2 years follow-up (usual delay for 80% of in vivo ceramic fractures). There were no cases of femoral head fracture in this series. There were no cases of early wear at this same follow-up and no case of femoral or acetabular osteolysis. Discussion and Conclusion: The results of this study indicate that the resistance of the 22.2mm ceramic Delta heads is very much superior to the recommendations for in vitro tests. In this series, the risk of fracture in vivo remained nil to two years follow-up. The pertinence of this ceramic implant for decreasing polyethylene wear in vivo is under evaluation

Introduction. Insufficient arthroscopic cuff tear reconstruction leading to massive osteoarthritis and irreparable rotator cuff tears might be salvaged by implantation of an inverted total shoulder prosthesis Delta in the elderly. However, despite the generally high success rate and satisfying clinical results of inverted total shoulder arthroplasty, this treatment option has potential complications. Therefore, the objective of this study was a prospective evaluation of the clinical and radiological outcome after a minimum of 2 years follow-up of patients undergoing inverted shoulder replacement with or without prior rotator cuff repair. Patients and Methods. Sixty-eight shoulders in 66 patients (36 women and 30 men) operated between February 2002 and June 2007 with a mean age of 66 years (ranging from 53 to 84 years) were first assessed preoperatively and then at minimum 2 years follow-up, using the Constant score for pain, Constant Shoulder Score, Oxford Shoulder Score, UCLA Shoulder rating scale, DASH Score, Rowe Score for Instability and Oxford Instability Score. 29 patients (Group A) had undergone previous shoulder arthroscopy for cuff tear reconstruction at a mean of 29 months (range 12 to 48 months) before surgery and 39 patients (Group B) underwent primary implantation of an inverted total shoulder prosthesis Delta. Any complications in both groups were assessed according to Goslings and Gouma. Results. We report statistically significant improvements of all obtained scores at a mean follow-up of 42 months (ranging from 24 to 96 months) in both groups. Significant outcome differences between 29 patients with previous shoulder arthroscopy for cuff tear reconstruction and 39 without previous shoulder arthroscopy were not observed. Eight complications occurred altogether, in terms of a nerve lesion once, loosening of the humeral stem three times, and loosening or fracture of the glenoid component four times. Conclusion. We did not detect any statistically significant impact of previous insufficient shoulder arthroscopy for cuff tear reconstruction on the outcome and survival rate after the implantation of the inverted total shoulder prosthesis Delta. We conclude that reverse total shoulder arthroplasty with the Delta prosthesis is significantly beneficial in terms of less shoulder pain, higher stability and gain of range of motion without this beneficial effect being significantly weakened by previous insufficient shoulder arthroscopy for cuff tear reconstruction. We believe that previous arthroscopic cuff tear reconstruction should therefore be included in the treatment algorithm

The combination of an irreparable tear of the rotator cuff and destructive arthritis of the shoulder joint may cause severe pain, disability and loss of independence in the aged. Standard anatomical shoulder replacements depend on a functioning rotator cuff, and hence may fail in the presence of tears in the cuff. Many designs of non-anatomical constrained or semi-constrained prostheses have been developed for cuff tear arthropathy, but have proved unsatisfactory and were abandoned. The DePuy Delta III reverse prosthesis, designed by Grammont, medialises and stabilises the centre of rotation of the shoulder joint and has shown early promise. This study evaluated the mid-term clinical and radiological results of this arthroplasty in a consecutive series of 50 shoulders in 43 patients with a painful pseudoparalysis due to an irreparable cuff tear and destructive arthritis, performed over a period of seven years by a single surgeon. A follow-up of 98% was achieved, with a mean duration of 39 months (8 to 81). The mean age of the patients at the time of surgery was 81 years (59 to 95). The female to male ratio was 5:1. During the seven years, six patients died of natural causes. The clinical outcome was assessed using the American Shoulder and Elbow score, the Oxford Shoulder Score and the Short-form 36 score. A radiological review was performed using the Sirveaux score for scapular notching. The mean American Shoulder and Elbow score was 19 (95% confidence interval (CI) 14 to 23) pre-operatively, and 65 (95% CI 48 to 82) (paired t-test, p < 0.001) at final follow-up. The mean Oxford score was 44 (95% CI 40 to 51) pre-operatively and 23 (95% CI 18 to 28) (paired t-test, p < 0.001) at final follow-up. The mean maximum elevation improved from 55° pre-operatively to 105° at final follow-up. There were seven complications during the whole series, although only four patients required further surgery

Aim: To show that the Delta III Total Shoulder Replacement (TSR) Prosthesis is an alternate treatment for complex proximal humeral fracture sequelae (Type 3 & 4). Methods: This is a prospective outcome study involving 10 patients (mean age (71.5 yrs). All patients failed conservative treatment with a mean time to surgery of 10.5 (+/− 11.5) months and a mean follow up of 8.2 months (6–24mnths). All patients underwent a Delta III TSR via McKenzie approach by a single surgeon. Patients were assessed with constant and age adjusted Constant scores, radiographs and subjective questionnaire and whether they were satisfied at 6 weeks, 3, 6, 12, 24 months. Results: At 6 months, age adjusted Constant scores changed form a mean 8.9 (5.3) pre-op to 50.1 (20.9). Six patients were satisfied, 2 unsure and 2 unsatisfied; elevation improved the most, with external rotation the least affected. Age adjusted power increase by 40.4 %, with a subjective function (10 points) improving by 32.6 %. X-rays at 6 months showed two glenoid notches in contact with the inferior screws. Three patients underwent revision surgery (total 5 revisions) for acute post – operative dislocations – all had inserts changed. Intra-operative tension assessment (by means of anterior dislocation of the humerus) was found to be a useful test of stability. Revision surgery found to be a significant predictor of poorer function at 6 months. (p< 0.025). No stem failures noted. Significantly better constant scores achieved with shorter period of time from fracture to delta replacement (p< 0.045). A single wound infection was treated successfully with oral antibiotics. Conclusion: The results of the Delta III TSR in this difficult group of patients, appear satisfactory in terms of patient satisfaction, subjective and objective functional assessment and 6 months prosthesis survival (100%), and appear to offer a better functional outcome than hemiarthroplasty

1. Delta phalanx is a rare congenital abnormality not to be confused with other forms of angular deformity of the phalanges. 2. The deformity needs radical treatment by repeated surgery because there is no tendency to spontaneous correction and growth of the phalanx is prevented by the epiphysial deformity

The new technology using femoral heads with sleeves allows conservative procedures for revision hip arthroplasty. The implantation of classical ceramic heads on a previously used femoral taper is not recommanded. When there is no loosening of the femoral implant, the use of sleeves is a good solution for using an alumine on alumine couple, specially in young and active patients. Material and methods: 25 hips in 25 patients were included. In 12 cases the cause of revision was an acetabular osteolysis with or without loosening in metal on metal cimented THR. In 13 patients the revision was performed for a loosening and a wear of the PHE cup with osteolysis (4 zyrcon and 9 chrome-cobalt heads). The mean age was 49 years for the metal on metal revisions (36 to 75) and 54 years for the prosthesis using a polyethylen socket. Cementless cups were implanted using XLW delta alumina inserts. The 32 mm delta alumina sleeved heads were adjusted on the existing femoral 12–14 tapers. Patients were evaluated preoperatively and followed-up with clinical and radiological examinations. Results: At 2 years mean follow-up, average Harris Hip Score was significantly improved (97 vs 54, p< 0.05). We did not observe ceramic fracture or squeaking. The radiographic results did not demonstrate acetabular loosening, osteolysis, or femoral abnormalities. Concerning the metal on metal revisions, the aseptic loosening of the socket was combined with high rates of cobalt and chromium serum levels. Mean delay before revision was 4 years (2 to 11). Unipolar acetabular revisions were only decided after a carefull inspection of the remaining stems to detect any taper alteration or impingement lesions. Postoperative cobalt and chromium serum levels significantly decreased postoperatively. Concerning the metal on PHE and the zyrcon on PHE revisions, the mean delay before revison was 11 years (4 to 21). At this short follow up, we did not notice any parasitic impingement due to the additional sleeve or any ceramic fracture or squeaking. The radiographic results did not demonstrate acetabular loosening, osteolysis, or femoral abnormalities. Discussion: Failures of metal-on-metal or metal on PHE hip arthroplasties raise new technical problems. Conversion to ceramic on ceramic has been suggested in case of hypersensibility reactions or high rate of serum metal ions, and in case of osteolysis in young population. This prospective study evaluates a revision strategy using ceramic cups and delta ceramic heads with titanium adapter sleeves when a femoral revision is not required. Despite the limitation due to short follow-up, this technical option should be considered when wear surfaces exchange is decided

The condition known as delta phalanx (or longitudinally bracketed epiphysis) is a rare congenital anomaly first described in 1964. The deformity consists of a triangular bone with an epiphysis running along the shortened side of the phalanx in a proximal to distal direction, making longitudinal growth of the digit impossible. Isolated hallux varus congenitus due to a delta phalanx of the proximal phalanges of both great toes is extremely rare: there have been only three such cases reported, two of which were in one family--the only report of a familial occurrence of this deformity. This present report details the occurrence of isolated bilateral hallux varus congenitus in four members of one family, a father and his three eldest children. All three children show bilateral delta phalanx of the proximal phalanges of both great toes. There are associated thumb nail anomalies, but no suggestion of polydactylism

The degenerative processes of the glenohumeral joint can be derived from primitive glenohumeral arethrosis, post traumatic arthrosis, neurogenic arthropaty and rotator-cuff arthropaty with inveterate cuff tears. These conditions have shared characteristics but the arthropaty from an inveterate tear of the rotator cuff estabilishes a characteristic connected to the distinctive lesions that culminate in the well-known radiologic imaging of ace-tabularization. Our experience of prothesization of the shoulder referring to this final result, with wich we previously tented toward using a bipolar endoprothesis, often with comforting but at time also decidedly disappointing results. Overall, our dissatifaction was attributed to the insufficient mobility regained with modest remaining muscle-tendons available, and to the anterior instability of the implant if not contained in a valid coracoacromiale arch. For this reason we are tending toward ageo-metric inverse prothesis with the supposition of intrinsic stability and a lever arm favorable to the contraction of slight muscolar recruitment. The inverse Delta prothesis provide an innovative therapeutic option for many patients with serious glenohumerale arthrosis associated with massive tear of the rotator cuff with the rising up of the humeral head. Our work intends to show which are the advantages and the limits, including surgical ones, of using the result of the prothesization of eight specially selected patients treated with the Delta prothesis. Without doubt the innovative architecture and the recent modification ofthe prothesis become clear; it becomes possible to do certain manouvers very easily which in the past were more complicated; also highlighted is the immediate symptomatic benefit that the patient obtain from the joint-substitution operation with this type of prothesis. On the other hand, it is therefore fundamental to select the patients in a very precise way who can undergo this operation, to have a notable improvement in their lifestyle. The modest but significant esperience derived from these first cases treated with the geometri inverse prothesis have introduced us to a relative simple prosthetic system, but just a bit more invasive than the endoprosthetic surgery; it is stable and well-tolerated, able to adequately satisfy the modest functional request permitted by the residual anatomic substratum. The autors, based on this limited but significant experience, intented tomention same technological problems inherent to the various od the implantation including the dif-ficulties occasionally met and resolved

Aims: The purpose of this study was to evaluate the efficacy of the inverted Delta 3 prosthesis in nonreconstructable massive rotator cuff tear. Methods: 31 inverted Delta 3 prostheses were performed between October 1999 and February 2002. The average age was 72.8 years old (65–84) and the average follow-up was 17.8 months (3–36). A deltopectoral approach was performed in all cases. Rotator cuffs were found to be nonreconstructable in all 31 cases. Results: Functional results were assessed using the Constant score. Constant score was improved from 32.1 preoperatively to 59 postoperatively. Forward flexion increased from 52 degrees to 135 mean degrees. 85% of the patients were satisfied. Two complications occurred: a stupor of the radial nerve and a ditching of the cementless humeral component. Conclusions: Inverted Delta 3 prosthesis represents a successful choice for cases of irreparable rotator cuff and gleno-humeral lesions in old patients with an excellent deltoid and a good glenoid bone stock. It reduces pain and improved function in all patients. The loosening of glenoid component is not frequent with a short-term follow-up

Noise generation has been reported with ceramic-on-ceramic articulations in total hip replacement (THR). This study evaluated 208 consecutive Delta Motion THRs at a mean follow-up of 21 months (12 to 35). There were 141 women and 67 men with a mean age of 59 years (22 to 84). Patients were reviewed clinically and radiologically, and the incidence of noise was determined using a newly described assessment method. Noise production was examined against range of movement, ligamentous laxity, patient-reported outcome scores, activity level and orientation of the acetabular component. There were 143 silent hips (69%), 22 (11%) with noises other than squeaking, 17 (8%) with unreproducible squeaking and 26 (13%) with reproducible squeaking. Hips with reproducible squeaking had a greater mean range of movement (p < 0.001) and mean ligament laxity (p = 0.004), smaller median head size (p = 0.01) and decreased mean acetabular component inclination (p = 0.02) and anteversion angle (p = 0.02) compared with the other groups. There was no relationship between squeaking and age (p = 0.13), height (p = 0.263), weight (p = 0.333), body mass index (p = 0.643), gender (p = 0.07) or patient outcome score (p = 0.422). There were no revisions during follow-up. Despite the surprisingly high incidence of squeaking, all patients remain satisfied with their hip replacement. Cite this article: Bone Joint J 2013;95-B:160–5