Tribology and Wear of Metal-on-Metal Hip Prostheses: Influence of Cup Angle and Head Position

Williams, Sophie; Leslie, Ian; Isaac, Graham; Zhang, Jin; Ingham, Eileen; Fisher, John

doi:10.2106/jbjs.h.00485

Cited by 105 publications

(114 citation statements)

References 12 publications

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“…The steep position of the BHR cup resulted in the increase of wear rate by an order of magnitude compared with the optimal position. Similarly, in another MoM hip simulator study (28 mm head diameter), the increase of the cup inclination angle from 45° to 55° resulted in a fivefold increase of the wear rate [22]. With a 39 mm diameter MoM, the increase of the cup inclination angle from 45° to 60° resulted in a ninefold increase of the wear rate [20].…”

Section: Discussionmentioning

confidence: 84%

Adverse condition testing with hip simulators

Saikko

2015

Biotribology

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Recent clinical failures and abnormal sounds observed in certain prosthetic hip designs have directed attention to adverse condition hip simulator testing. In the present study, hip simulator wear and friction tests were made with a macroscopic separation of the bearing surfaces in the swing phase, steep acetabular cup position, increased load, poor or lacking lubrication, roughened bearing surfaces including titanium third bodies, and with combinations of these. The only conditions that resulted in squeaking were dry sliding with alumina-on-alumina and metal-on-metal, and an extreme peak load of 4 kN with serum lubricated metal-on-metal. The wear rate of metal-on-metal increased by an order of magnitude when the cup position was steep, 64 degrees, compared with the optimal position of 48 degrees. The increase of the peak load from 2 kN to 3 kN with the cup position of 48 degrees increased the running-in wear of metal-on-metal, but the steady state wear rates were equally low, of the order of 1 mg per one million cycles. Crosslinked polyethylene was the superior cup material under adverse conditions, including dry sliding and roughened femoral head.

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Section: Discussionmentioning

confidence: 84%

Adverse condition testing with hip simulators

Saikko

2015

Biotribology

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“…Elevated chromium and cobalt levels have been found in both the serum and remote organs of patients with metal-on-metal bearings [1,2,10]. Studies have also demonstrated excessive wear with onepiece metal shells in women with smaller diameter components as well as in hips in which the shell is oriented more vertically in the pelvis (a higher abduction angle) [5,11,13,16,19]. Occasionally, more dramatic local reactions to metal-on-metal articulations occur with a wide spectrum of presentations; excessive metal wear can lead to asymptomatic effusions, pseudotumors, and wide zones of soft tissue necrosis with loss of abductors and bone death [8,17].…”

Section: Introductionmentioning

confidence: 99%

Reduced Articular Surface of One-piece Cups: A Cause of Runaway Wear and Early Failure

Griffin

Nanson

Springer

et al. 2010

Clinical Orthopaedics &Amp; Related Research

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Background Despite the clinical success of modern metal-on-metal articulations, concerns with wear-related release of metal ions persist. Evidence suggests metal ion release is related to the effective coverage of the head in the metal shell (the cup's functional articular arc). A recent study suggests a reduced functional articular arc is associated with increased ion release and the arc is a function of component design, size, and the abduction angle. Questions/purposes The purposes of this study were to (1) measure the functional articular arc in different sizes of currently available one-piece metal shells from several different manufacturers; and (2) compare the functional articular arc of these one-piece metal shells with the 1808 arc of conventional hip arthroplasty acetabular components.Methods We calculated the available articular surface arc for 33 one-piece metal cups using measurements of cup depth and internal cup radius. Results The arc of the articular surface varied among manufacturers and generally decreased with decreasing shell diameter. The mean functional articular arc was 160.5°± 3.6°(range, 151.8°-165.8°), which was less than the 180°arc of a conventional acetabular component. Conclusions Our data show certain cup designs are at higher risk for failure as a result of the decreased articular surface arc. This, along with analysis of abduction angles, supports the recent findings of bearing failure with vertically placed implants. Care must be taken when implanting these shells to ensure they are placed in less abduction to avoid edge loading and the potential for early bearing failure.

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“…It appears likely hip arthroplasty based on large metal-onmetal bearings will have increased metal ion levels and higher rates of wear-related failure with higher acetabular inclination angles [20,21,31]. Previously, a few studies were directed at proper femoral component stem orientation in HRA [19,26,27].…”

Section: Discussionmentioning

confidence: 99%

“…Even though femoral neck fracture and femoral loosening were formerly reported as the most common failure modes in these studies [2,4,21], revision related to the acetabular component is being recognized more frequently in recent reports [8,11]. Previously, higher dislocation rates and increased wear rates were well-documented in standard THA with improper acetabular inclination angles [12,20,22,31]. Although large metal bearings are resistant to dislocation even with relatively high angles of inclination, several clinical studies have implicated high cup inclination angles in wear-related failures after HRA [4,13,33].…”

Section: Introductionmentioning

confidence: 99%

“…P. Gross, F. Liu (&), L. Webb Midlands Orthopaedics, p. a., 1910 Blanding Street, Columbia, SC 29201-3520, USA e-mail: grossortho@yahoo.com; feilresearch@gmail.com angles were greater than 55°in 39-mm metal-on-metal bearing hip implants [31]. Also, while several studies [3,8] suggest the upper limit for ideal inclination angle for large metal bearings is approximately 55°, we found no data suggesting a lower limit.…”

Section: Introductionmentioning

confidence: 99%

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Intraoperative Radiographs for Placing Acetabular Components in Hip Resurfacing Arthroplasty

Gross

Liu

Webb

2011

Clinical Orthopaedics &Amp; Related Research

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Background Various clinical and biomechanical studies suggest certain acetabular positions may be associated with higher wear and failure rates in modern metal-on-metal hip resurfacing arthroplasties. However, there are no widely available, reliable, and cost-effective surgical techniques that ensure surgeons are able to place an acetabular component within the safe range of inclination angles after hip resurfacing surgeries. Questions/purposes We investigated the accuracy of intraoperative radiographs to determine the acetabular inclination angle in resurfacing arthroplasty procedures. Patients and Methods The study group included the first 100 resurfacing arthroplasties performed after we started routinely checking the intraoperative acetabular inclination angles. The acetabular component was repositioned if the intraoperative acetabular inclination angle was out of the target range of 30°to 50°. The control group included the previous 100 resurfacing arthroplasties performed without the benefit of intraoperative radiographs. A posterior minimally invasive surgical approach was used in both groups. Demographics and diagnoses were similar in both groups. ResultsThe average (± SD) difference between the intraoperative and 6-week radiographs was 2.7°± 2.5°. The acetabular inclination angles at 6-week followup were within the targeted range more frequently in the study group than in the control group (outliers: 4% versus 29%). Conclusions These data suggest a single intraoperative radiograph is a quick, reliable, and cost-effective method for ensuring the acetabular inclination angle is within the targeted range. Level of Evidence Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

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Tribology and Wear of Metal-on-Metal Hip Prostheses: Influence of Cup Angle and Head Position

Abstract: These studies support the hypothesis that both an increased cup angle and a lateral head position increase wear in metal-on-metal hip prostheses.

Cited by 105 publications

References 12 publications

Adverse condition testing with hip simulators

Adverse condition testing with hip simulators

Reduced Articular Surface of One-piece Cups: A Cause of Runaway Wear and Early Failure

Intraoperative Radiographs for Placing Acetabular Components in Hip Resurfacing Arthroplasty

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