Lim SJ, et al. - In a single-surgeon series, the minimum 5-year outcomes and bearing-specific complications after fourth-generation alumina ceramic-on-ceramic total hip arthroplasties (THAs) were assessed. At 6.5-year follow-up, delta ceramic-on-ceramic THAs presented with a high rate of survivorship without radiographic evidence of osteolysis. However, 0.3% ceramic liner fractures and 6.4% audible noises associated with the use of Delta ceramics were found.