Mixing and matching in ceramic-on-metal hip arthroplasty: an in-vitro hip simulator study.

The clinical success of second-generation metal-on-metal hip replacement and the good tribological performance of alumina ceramic revived an interest in hip articulation as a solution to reduce wear. This study was aimed at characterizing the wear behaviour of new hybrid ceramic-on-metal bearings. In particular, this study investigated the wear behaviour of ceramic-on-metal hip components (three different diameters configurations: 28, 32 and 36 mm), not specifically proposed to be coupled, in order to compare them with ceramic-on-ceramic, which is considered to be the gold standard for wear resistance. For this purpose, the weight loss over a standard wear simulation was monitored. Moreover, scanning electronic microscope observations were used to verify if any carbides removal, for the metallic components, triggered wears debris production promoting abrasive third-body wear. After five million cycles, our results showed significantly greater wear-in ceramic-on-metal compared with ceramic-on-ceramic, and significant greater wear for the 32-mm diameter compared with the 36-mm one. Our findings showed an increase in wear for the proposed hybrid specimens with respect to that of the ceramic-on-ceramic ones confirming that even in the case of ceramic-on-metal bearings, mixing and matching could not prove effective wear behaviour, not even comparable with that of the ceramic-on-ceramic gold standard. Wear patterns and roundness tolerances certainly discourage the coupling of components not specifically intended to be coupled. Unsuitable geometrical conformity could, in fact, result in a poor dynamic behaviour and lead to clinical failure.

[1]  K Ikeuchi,et al.  Low wear rate of UHMWPE against zirconia ceramic (Y-PSZ) in comparison to alumina ceramic and SUS 316L alloy. , 1991, Journal of biomedical materials research.

[2]  Georg Heinze,et al.  Metal-on-metal hip implants: do they impair renal function in the long-term? A 10-year follow-up study , 2008, Archives of Orthopaedic and Trauma Surgery.

[3]  G. Willmann,et al.  Wear characteristics of sliding pairs of zirconia (Y-TZP) for hip endoprostheses. , 1996, Biomaterials.

[4]  S. Affatato,et al.  Comparative study on the wear behaviour of different conventional and cross-linked polyethylenes for total hip replacement , 2008 .

[5]  Juan Ramon Valentí,et al.  Catastrophic wear in a metal-on-ceramic total hip arthroplasty. , 2007, The Journal of arthroplasty.

[6]  L Sedel,et al.  Alumina-on-Alumina Hip Arthroplasty in Patients Younger Than 30 Years Old , 2008, Clinical orthopaedics and related research.

[7]  F Damie,et al.  Dosages sanguins de métaux chez 48 patients porteurs d'une prothèse totale de hanche en chrome-cobalt à couple métal-polyéthylène , 2004 .

[8]  David Backstein,et al.  Hemiarthroplasty of the hip for fracture-what is the appropriate sized femoral head? , 2008, Injury.

[9]  R. Wilcox.  Kolmogorov–Smirnov Test , 2005 .

[10]  J Fisher,et al.  A novel low wearing differential hardness, ceramic-on-metal hip joint prosthesis. , 2001, Journal of biomechanics.

[11]  J. Archard.  Contact and Rubbing of Flat Surfaces , 1953 .

[12]  Claire L. Brockett,et al.  The influence of clearance on friction, lubrication and squeaking in large diameter metal-on-metal hip replacements , 2008, Journal of materials science. Materials in medicine.

[13]  S Affatato,et al.  Larger Diameter Bearings Reduce Wear in Metal-on-Metal Hip Implants , 2007, Clinical orthopaedics and related research.

[14]  W. Steens,et al.  Severe cobalt poisoning with loss of sight after ceramic-metal pairing in a hip—a case report , 2006, Acta orthopaedica.

[15]  Hideki Yoshikawa,et al.  Serious metallosis of a metal head due to fragmented ceramic screws in a cemented THA , 2006, Archives of Orthopaedic and Trauma Surgery.

[16]  Zhongmin Jin,et al.  PRESIDENTIAL GUEST LECTURE: Tribology of Alternative Bearings , 2006, Clinical orthopaedics and related research.

[17]  G. Willmann.  Ceramics for total hip replacement--what a surgeon should know. , 1998, Orthopedics.

[18]  Michael Carroll,et al.  Wear performance of large-diameter differential-hardness hip bearings. , 2008, The Journal of arthroplasty.

[19]  H. L. Costa,et al.  On the abrasive wear of zirconias , 1997 .

[20]  J Fisher,et al.  Understanding the differences between the wear of metal-on-metal and ceramic-on-metal total hip replacements , 2008, Proceedings of the Institution of Mechanical Engineers. Part H, Journal of engineering in medicine.

[21]  S. Affatato,et al.  Mixed oxides prosthetic ceramic ball heads. Part 1: effect of the ZrO2 fraction on the wear of ceramic on polythylene joints. , 1999, Biomaterials.

[22]  Rina Sakai,et al.  Appropriate radial clearance of ceramic-on-ceramic total hip prostheses to realize squeeze-film lubrication. , 2004, Clinical biomechanics.

[23]  John Fisher,et al.  THE 2007 OTTO AUFRANC AWARD: Ceramic-on-Metal Hip Arthroplasties: A Comparative In Vitro and In Vivo Study , 2007, Clinical orthopaedics and related research.

[24]  J. Stiehl,et al.  Catastrophic failure of a modular revision total hip polyethylene insert. , 2007, The Journal of arthroplasty.

[25]  T Khan,et al.  Metal ion levels after metal-on-metal Ring total hip replacement: a 30-year follow-up study. , 2007, The Journal of bone and joint surgery. British volume.

[26]  Tarun Goswami,et al.  Hip implants – Paper VI – Ion concentrations , 2007 .

[27]  G. Willmann,et al.  The Evolution of Ceramics in Total Hip Replacement , 2000 .

[28]  I Nishimura,et al.  The sphericity of the bearing surface in total hip arthroplasty. , 2001, The Journal of arthroplasty.

[29]  R M Rose,et al.  On the true wear rate of ultra high-molecular-weight polyethylene in the total hip prosthesis. , 1980, The Journal of bone and joint surgery. American volume.

[30]  J Fisher,et al.  Quantitative analysis of wear and wear debris from metal-on-metal hip prostheses tested in a physiological hip joint simulator. , 2001, Bio-medical materials and engineering.

[31]  Duncan Dowson,et al.  A hip joint simulator study of the performance of metal-on-metal joints: Part II: design. , 2004, The Journal of arthroplasty.

[32]  A. Toni,et al.  First hip arthroplasty register in Italy: 55,000 cases and 7 year follow-up , 2009, International Orthopaedics.

[33]  H S Dobbs,et al.  Metal ion release after total hip replacement. , 1980, Biomaterials.

[34]  G Willmann,et al.  Mismatched wear couple zirconium oxide and aluminum oxide in total hip arthroplasty. , 2001, The Journal of arthroplasty.

[35]  I. Clarke,et al.  A Review of Lubrication Conditions for Wear Simulation in Artificial Hip Replacements , 2006 .

[36]  Zhongmin Jin,et al.  Friction of total hip replacements with different bearings and loading conditions. , 2007, Journal of biomedical materials research. Part B, Applied biomaterials.

[37]  Christian Heisel,et al.  Metal-on-metal total hip replacement. , 2005, Clinical orthopaedics and related research.

[38]  K. L. Dahm,et al.  Hard coatings for orthopedic implants , 1995 .

[39]  W J Maloney,et al.  Fibroblast response to metallic debris in vitro. Enzyme induction cell proliferation, and toxicity. , 1993, The Journal of bone and joint surgery. American volume.

[40]  Susanna Stea,et al.  Early diagnosis of ceramic liner fracture. Guidelines based on a twelve-year clinical experience. , 2006, The Journal of bone and joint surgery. American volume.

[41]  S. Affatato,et al.  Mixed oxides prosthetic ceramic ball heads. Part 3: effect of the ZrO2 fraction on the wear of ceramic on ceramic hip joint prostheses. A long-term in vitro wear study. , 2001, Biomaterials.

[42]  G. Willmann,et al.  Ceramic Femoral Head Retrieval Data , 2000, Clinical orthopaedics and related research.

[43]  J Fisher,et al.  Wear of surface engineered metal-on-metal hip prostheses , 2004, Journal of materials science. Materials in medicine.

[44]  R. Nelissen,et al.  Resurfacing hip prostheses revisited , 2005, International Orthopaedics.

[45]  Nicola Baldini,et al.  Serum ion levels after ceramic‐on‐ceramic and metal‐on‐metal total hip arthroplasty: 8‐year minimum follow‐up , 2008, Journal of orthopaedic research : official publication of the Orthopaedic Research Society.