There are a number of factors that determine the overall outcome of total hip replacement (THR) surgery, some of which appear to be related to the surgical procedure. In particular, the inclination angle at which the acetabular component is placed has been reported to influence the long-term successful performance of THR. The present study assessed the influence of cup orientation on the wear of 40 mm diameter metal-on-metal (MoM) hip bearings tested in a hip simulator. The bearings had a mean radial clearance of 150 μm; the cups oriented at 35°, 50°, and 60° to the horizontal were loaded for up to 6×106 cycles. In each test the wear rates during the run-in phase were higher than in the steady state phase; the wear rates during the run-in phase were not significantly different for each cup orientation. However, at cup angles of 50° and 60°, the steady state wear rates were 0.69 mm3/106 cycles and 1.7 mm3/106 cycles respectively, significantly higher than at 35° (0.24 mm3/106 cycles). The results indicated that larger cup inclination angles not only move the position of the wear scar but also, more significantly in MoM bearings, increase the wear rates and total wear volume generated.
DowsonD.JinZ. M.‘Metal-on-metal hip joint tribology.’Proc IMechE, Part H: J. Engineering in Medicine220 (2006): 107–118 DOI: 10.1243/095441105X69114.
2.
DoornP. F.CampbellP. A.AmstutzH. C.‘Metal versus polyethylene wear particles in total hip replacements. A review.’Clin. Orthop. Related Res.329 (Suppl.) (1996): S206–216.
3.
LombardiJ.AdolphV.MalloryT. H.AlexiadesM. M.CucklerJ. M.FarisP. M.JaffeK. A.KeatingE. M.NelsonJ.CarlL.‘Short-term results of the M2a-taper metal-on-metal articulation.’J. Arthroplasty16 (2001): 122–128
4.
LombardiJ.AdolphV.MalloryT. H.CucklerJ. M.WilliamsJ.BerendK. R.SmithT. M.‘Mid-term results of a polyethylene-free metal-on-metal articulation.’J. Arthroplasty19 (2004): 42–47
5.
DorrL. D.WanZ.LongjohnD. B.DuboisB.MurkenR.‘Total hip arthroplasty with use of the Metasul metal-on-metal articulation: Four to seven-year results.’J. Bone Jt Surg. Am.82 (2000): 789–798
6.
KimS. Y.KyungH. S.IhnJ. C.ChoM. R.KooK. H.KimC. Y.‘Cementless Metasul metal-on-metal total hip arthroplasty in patients less than fifty years old.’J. Bone Jt Surg. Am.86 (2004): 2475–2481
7.
DowsonD.‘Tribological principles in metal-on-metal hip joint design.’Proc. IMechE, Part H: J. Engineering in Medicine220 (2006): 161–171 DOI: 10.1243/09544110X63255.
8.
ChanF. W.BobynJ. D.MedleyJ. B.KrygierJ. J.TanzerM.‘The Otto Aufranc Award. Wear and lubrication of metal-on-metal hip implants.’Clin. Orthop. Related Res.369 (1999): 10–24
9.
CatelasI.BobynJ. D.MedleyJ. B.KrygierJ. J.ZukorD. J.HukO. L.‘Size, shape, and composition of wear particles from metal—metal hip simulator testing: Effects of alloy and number of loading cycles.’J. Biomed. Mater. Res.67 (2003): 312–327
10.
KeelJ. B.KusterM. S.‘Massive wear of an incompatible metal-on-metal articulation in total hip arthroplasty.’J. Arthroplasty19 (2004): 638–642
11.
CatelasI.CampbellP. A.DoreyF.FraustoA.MillsB. G.AmstutzH. C.‘Semi-quantitative analysis of cytokines in MM THR tissues and their relationship to metal particles.’Biomaterials24 (2003): 4785–4797
12.
JacobsJ. J.SkiporA. K.PattersonL. M.HallabN. J.PaproskyW. G.BlackJ.GalanteJ. O.‘Metal release in patients who have had a primary total hip arthroplasty. A prospective, controlled, longitudinal study.’J. Bone Jt Surg. Am.80 (1998): 1447–1458
13.
DobbsH. S.MinskiM. J.‘Metal ion release after total hip replacement.’Biomaterials1 (1980): 193–198
14.
HallabN. J.JacobsJ. J.BlackA. J.MikeczK.GalanteJ. O.‘Systemic metal—protein binding associated with total joint replacement arthroplasty.’J. Biomed. Mater. Res.49 (2000): 353–361
15.
CatelasI.PetitA.ZukorD. J.AntoniouJ.HukO. L.‘TNF-[alpha] secretion and macrophage mortality induced by cobalt and chromium ions in vitro: qualitative analysis of apoptosis.’Biomaterials24 (2003): 383–391
16.
SkiporA. K.CampbellP. A.PattersonL. M.AmstutzH. C.SchmalzriedT. P.JacobsJ. J.‘Serum and urine metal levels in patients with metal-on-metal surface arthroplasty.’J. Mater. Sci. Mater. Medicine13 (2002): 1227–1234
17.
VisuriT. I.PukkalaE.PulkkinenP.PaavolainenP.‘Cancer incidence and causes of death among total hip replacement patients: A review based on Nordic cohorts with a special emphasis on metal-on-metal bearings.’Proc. IMechE, Part H: J. Engineering in Medicine220 (2006): 399–407
18.
LewinnekG. E.LewisJ. L.TarrR.CompereC. L.ZimmermanJ. R.‘Dislocations after total hip replacement arthroplasties.’J. Bone Jt Surg. Am.60 (1978): 217–220
19.
MaistrelliG.GerundiniM.BombelliR.‘The inclination of the weight bearing surface in the hip joint. The clinical significance of abnormal force.’Orthop. Rev.15 (1986): 271–279
20.
KennedyJ. G.RogersW. B.SoffeK. E.SullivanR. J.GriffenD. G.SheehanL. J.‘Effect of acetabular component orientation on recurrent dislocation, pelvic osteolysis, polyethylene wear, and component migration.’J. Arthroplasty13 (1998): 530–534
21.
HirakawaK.MitsugiN.KoshinoT.SaitoT.HirasawaY.KuboT.‘Effect of acetabular cup position and orientation in cemented total hip arthroplasty.’Clin. Orthop. Related Res.388 (2001): 135–142
22.
Del SchutteJ. H.LipmanA. J.BannarS. M.LivermoreJ. T.IlstrupD.MorreyB. F.‘Effects of acetabular abduction on cup wear rates in total hip arthroplasty.’J. Arthroplasty13 (1998): 621–626
23.
KligmanM.MichaelH.RoffmanM.‘The effect of abduction differences between cup and contralateral acetabular angle on polyethylene component wear.’Orthopedics25 (2002): 65–67
24.
LancinP.EssnerA.SeylerT.MontM.WangA.DelanoisR.‘Effect of acetabular cup abduction angle on UHMWPE wear in hip simulator testing.’ In Proceedings of the 53rd Annual Meeting of the Orthopaedic Research Society, San Diego, California, USA, 11–14 February 2007, paper no. P1649 p. 128 (Orthopaedic Research SocietyRosemont, Illinois).
25.
PatilS.BergulaA.ChenP. C.ColwellC. W.JrD'LimaD.D.‘Polyethylene wear and acetabular component orientation.’J. Bone Jt Surg. Am.85 (Suppl. 4) (2003): 56–63
26.
OkiH.AndoM.OmoriH.OkumuraY.NegoroK.UchidaK.BabaH.‘Relation between vertical orientation and stability of acetabular component in the dysplastic hip simulated by nonlinear three-dimensional finite element method.’Artif. Organs28 (2004): 1050–1054
27.
D'LimaD. D.ChenP. C.ColwellC. W.Jr‘Optimizing acetabular component position to minimize impingement and reduce contact stress.’J. Bone Jt Surg. Am.83 (Suppl. 2, Part 2) (2001): 87–91
AffatatoS.BersagliaG.FoltranI.EmilianiD.TrainaF.ToniA.‘The influence of implant position on the wear of alumina-on-alumina studied in a hip simulator.’Wear256 (2004): 400–405
30.
NevelosJ.InghamE.DoyleC.NevelosA. B.FisherJ.‘The influence of acetabular cup angle on the wear of ‘BIOLOX Forte’ alumina ceramic bearing couples in a hip joint simulator.’J. Mater. Sci.: Mater. Medicine12 (2001): 141–144
31.
JinZ.MakM. M.‘Effect of acetabular cup position on the contact mechanics of ceramic-on-ceramic hip joint replacements.’Key Engng Mater. 245–256 (2004): 639–642
32.
KummerF. J.ShahS.IyerS.DiCesareP. E.‘The effect of acetabular cup orientations on limiting hip rotation.’J. Arthroplasty14 (1999): 509–513
33.
CampbellP.DeHaanR.DeSmetK.‘Implant retrieval analysis of hybrid metal on metal surface arthroplasties.’ In Proceedings of the 52nd Annual Meeting of the Orthopaedic Research Society, Chicago, Illinois, USA, 19–22 March 2006, paper no. 0508 (Orthopaedic Research Society, Rosemont, Illinois).
34.
HartA. J.BuddhevP.WinshipF.FariaN.PowellJ.SkinnerJ.‘Cup inclination angle of greater than 50 degrees increases whole blood concentrations of cobalt and chromium ions after metal-on-metal hip resurfacing.’Hip International18 (3) (2008): 212–219
35.
BrodnerW.GrublA.JankovskyR.MeisingerV.LehrS.Gottsauner-WolfF.‘Cup inclination and serum concentration of cobalt and chromium after metal-on-metal total hip arthroplasty.’J. Arthroplasty19 (2004): 66–70
36.
PaulJ. P.‘Force actions transmitted by joints in the human body: A discussion on the treatment of arthritis by joint replacement.’Proc. R. Soc. B192 (1976): 163–172
37.
PaulJ. P.‘Forces transmitted by joints in the human body.’Proc. Instn Mech. Engrs181 (3F) (1966): 8–15
38.
D'LimaD. D.UrquhartA. G.BuehlerK. O.WalkerR. H.ColwellC. W.Jr‘The effect of the orientation of the acetabular and femoral components on the range of motion of the hip at different head—neck ratios.’J. Bone Jt Surg. Am.82 (2000): 315–321
39.
MorlockM. M.BishopN.DellingG.HahnM.RutherW.‘In-vivo wear of metal-on-metal hip resurfacing implants depends strongly on cup alignment.’ In Proceedings of the 53rd Annual Meeting of the Orthopaedic Research Society, San Diego, California, USA, 11–14 February 2007, paper no. P1663, p. 129 (Orthopaedic Research SocietyRosemont, Illinois).
40.
ReddyV.DorairajanJ.NevelosJ.KriklerS.‘Medium-term serum cobalt and chromium levels in patients with metal-on-metal resurfacing.’ In Proceedings of the 49th Annual Meeting of the Orthopaedic Research Society, New Orleans, Louisiana, USA, 2–5 February 2003, poster no. P029 (Orthopaedic Research Society, Rosemont, Illinois).
41.
BowsherJ. G.NevelosJ.WilliamsP. A.SheltonJ. C.‘‘Severe’ wear challenge to ‘as-cast’ and ‘double heat-treated’ large-diameter metal-on-metal hip bearings.’Proc. IMechE, Part H: J. Engineering in Medicine220 (2006): 135–143 DOI: 10.1243/09544119JEIM81.
42.
De HaanR.PattynC.GillH. S.MurrayD. W.CampbellP. A.De SmetK. A.‘Correlation between inclination of the acetabular component and metal ion levels in metal-on-metal hip resurfacing replacement.’J. Bone Jt Surg. Br.90 (10) (2008): 1291–1297
43.
HartA.SkinnerJ.HenckelJ.UnderwoodR.LloydG.SampsonB.SandisonA.CannP. ‘How can analysis of failed metal on metal (MoM) hip bearing surfaces help patients?’ In Bearing Surfaces in Hip Replacement: Past, Present and Future, IMechE Seminar, London, UK, 13 November 2008.
