New Insights into Wear and Biological Effects of Metal-on-Metal Bearings

Catelas, Isabelle; Wimmer, Markus A.

doi:10.2106/jbjs.j.01877

Cited by 81 publications

(45 citation statements)

References 75 publications

(96 reference statements)

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“…[11][12][13][14][15][16][17] Metal-on-metal bearings have therefore gotten an increasingly bad reputation, especially when used with large diameter heads. [18][19][20] Although ceramic-on-ceramic bearings offer the least discernible wear rate, this advantage is to some extent reduced by the danger of a rare but devastating fracture of the ceramic liner or head and the occurrence of squeaking. 21,22 It may well be that edge loading is the main culprit leading to chipping, stripe wear and/or squeaking.…”

Section: Introductionmentioning

confidence: 99%

Edge loading does not increase wear rates of ceramic‐on‐ceramic and metal‐on‐polyethylene articulations

et al. 2014

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The mal-positioning of total hip arthroplasty components can result in edge loading conditions. Purpose of this study was to determine if the wear rate of ceramic-on-ceramic and metal-on-polyethylene increases under edge loading conditions. The literature was reviewed to determine which of the commonly used hip bearings is the most forgiving to implant mal-orientation. Two 28-mm ceramic-on-ceramic articulations were tested in vitro: pure alumina (PAL) ceramic versus the new alumina-toughened zirconia (ATZ). Two 28-mm metal-on-polyethylene articulations were tested in vitro: conventional ultrahigh molecular weight polyethylene (UHMWPE) versus highly crosslinked polyethylene (HXLPE) stabilized with vitamin E. All bearings were tested at standard and at highest possible inclination angles. Hip simulator tests were run for five million cycles based on N = 3 tests per condition. The average wear rate of ATZ-on-ATZ is 0.024 mm(3) /Mcycles at 45° and 0.018 mm(3) /Mcycles at 65°. Wear rate of PAL-on-PAL is between 0.02 and 0.03 mm(3) /Mcycles at 45°, as well as 65°. The wear rate of UHMWPE was 31 ± 1 mm(3) /Mcycles at an inclination angle of 45° and 26 ± 1 mm(3) /Mcycles at 80°. The wear rate of vitamin E stabilized HXLPE was 5.9 ± 0.2 mm(3) /Mcycles at 45° and 5.8 ± 0.2 mm(3) /Mcycles at 80°. Edge loading does not increase the wear rate of ceramic-on-ceramic and metal-on-polyethylene articulations. The newest biomaterials showed markedly lower wear rates compared with their conventional counterparts. ATZ-on-ATZ showed the lowest wear rate of all tested pairings, but the vitamin E stabilized HXLPE seems to be the most forgiving material when it comes to implant mal-orientation.

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Section: Introductionmentioning

confidence: 99%

Edge loading does not increase wear rates of ceramic‐on‐ceramic and metal‐on‐polyethylene articulations

et al. 2014

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“…2,9,10 Adverse soft tissue reactions causing local tissue damage, 1 pain, 2,9,11-16 metallosis and metal ions potentially being carcinogenic were the main concerns (ARMD). [17][18][19][20][21][22][23][24] Implants such as the ASR system (DePuy Orthopaedics, Johnson & Johnson, Warsaw, IN, USA) experienced high failure rates and were recalled from the market.…”

mentioning

confidence: 99%

601 metal-on-metal total hip replacements with 36 mm heads a 5 minimum year follow up: Levels of ARMD remain low despite a comprehensive screening program

Atrey

Hart

Hussain

et al. 2017

Journal of Orthopaedics

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“…MoP implants generally produce a higher volume of wear particles than MoM implants, but the latter generate a larger number of particles, as metal particles are an order of magnitude smaller [55][56][57][58][59]. The adaptive immune system reacts differently to MoM and MoP implants: unlike MoM implants, a specific cell-mediated response to ultrahigh molecular weight polyethylene (UHMWP) does not appear to play a major role in MoP implant loosening.…”

Section: Orthopedic Implantsmentioning

confidence: 99%

Hypersensitivity Reactions to Implanted Metal Devices: Facts and Fictions

2016

J Investig Allergol Clin Immunol

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The use of metals in the medical field has become increasingly prevalent over the past few decades. Patients find themselves being exposed to metals in a variety of ways, ranging from external exposure to instruments such as the stainless steel in surgical blades to internal exposure via medical devices being implanted in their bodies. There has been growing interest in the possibility of developing hypersensitivity reactions to constituent metals in medical implant devices, both in cutaneous and systemic forms. Hypersensitivity reactions to metals are uncommon, but they are reported and require appropriate evaluation and management, particularly if they are symptomatic. In view of the lack of consensus in the field on the appropriate steps to evaluate and manage patients with suspected metal hypersensitivity reactions, this review aims to analyze current evidence on hypersensitivity reactions to metallic implants in orthopedic surgery, endovascular surgery, obstetrics and gynecology, and dental surgery. Key words: Metal hypersensitivity. Metallic implants. ResumenEl empleo de metales dentro de la medicina ha ido aumentando de forma progresiva en las últimas décadas. Los pacientes se exponen a metales de diferentes formas desde fuentes externas, como instrumental quirúrgico como el presente en las hojas de acero de los bisturíes, hasta implantes metálicos. Como consecuencia de ello se está produciendo un interés creciente por la posibilidad de desarrollar reacciones de hipersensibilidad a metales presentes en los materiales y objetos implantados, tanto en forma de reacciones cutáneas como sistémicas. Las reacciones de hipersensibilidad a metales no son frecuentes, pero pueden desarrollarse, y por ello, requieren de un diagnóstico y tratamiento adecuado, especialmente en aquellos pacientes que desarrollen síntomas. No existe un consenso en el proceso diagnóstico ni en el tratamiento de estas reacciones en los pacientes con sospecha de alergia a metales. Esta revisión tiene por objeto actualizar la evidencia existente sobre las reacciones de hipersensibilidad a implantes metálicos en cirugía ortopédica, cirugía endovascular, cirugía obstétrica y ginecológica (OB-GYN) así como la dental. Palabras clave: Hipersensibilidad a metales. Implantes metálicos.

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New Insights into Wear and Biological Effects of Metal-on-Metal Bearings

Abstract: Background: Despite the renewed interest in metal-on-metal implants in the past two decades, the underlying wear

Cited by 81 publications

References 75 publications

Edge loading does not increase wear rates of ceramic‐on‐ceramic and metal‐on‐polyethylene articulations

Edge loading does not increase wear rates of ceramic‐on‐ceramic and metal‐on‐polyethylene articulations

601 metal-on-metal total hip replacements with 36 mm heads a 5 minimum year follow up: Levels of ARMD remain low despite a comprehensive screening program

Hypersensitivity Reactions to Implanted Metal Devices: Facts and Fictions

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