Total hip replacement (THR) is a very successful procedure, reporting very high success rates. The bearing surface is a key feature of replacement hip joints. It is generally accepted that excessive amounts of wear debris precludes their long-term survivorship. Hip simulator testing has resulted in a new generation of bearing surfaces. In general, these laboratory (in vitro) improvements in wear performance have resulted in a similar improvement in performance in the body (in vivo). However, there have been reports of components that have not performed as well as expected and this has been linked to the mal-positioning of components in the body. This article reviews bearing surface options and considers the effects of component mal-position on each of those bearings. There are three bearing surfaces in common use in THR. The effect of component mal-position in all cases is increased levels of wear. In metal/metal bearings this can result in cup rim wear and elevated blood metal ion levels. In metal (or ceramic)/polyethylene bearings wear can be measured radiographically and can result in increased osteolysis. In ceramic/ceramic bearings mal-positioning can result in stripe wear and squeaking.
SemlitschM.StreicherR. M.WeberH.‘The wear behavior of capsules and heads of CoCrMo casts in long-term implanted all-metal hip prostheses’Othopade18 (1989): 377–381
3.
CharnleyJ.Low friction arthroplasty of the hip (Berlin: Springer-Verlag1979)
4.
GriffithM. J.SeidensteinM.WilliamsD.CharnleyJ.‘Socket wear in Charnley low friction arthroplasty of the hip’Clin. Orthop.137 (1978): 37–47
5.
WillertH.-G.SemlitschM.‘Reactions of the articular capsule to wear products of artificial joint prostheses’J. Biomed. Mater. Res.11 (1977): 157–164
6.
SutulaL. C.CollierJ. P.SaumK. A.CurrierB. H.CurrierJ. H.SanfordW. M.MayorM. B.WoodingR. E.SperlingD. K.WilliamsI. R.KasprzakD. J.SurprenantV. A.‘The Otto Aufranc Award. Impact of gamma sterilization on clinical performance of polyethylene in the hip’Clin. Orthop.319 (1995): 28–40
7.
IsaacG. H.AtkinsonJ. R.DowsonD.KennedyP. D.SmithM. R.‘The causes of femoral head roughening in explanted Charnley hip prostheses’Engng Med.16 (1987): 167–173
8.
FisherJ.FirkinsP.ReevesE. A.HaileyJ. L.IsaacG. H.‘The influence of scratches to metallic counterfaces on the wear of ultra-high molecular weight polyethylene’Proc. IMechE, Part H: J. Engineering in Medicine209 (1995): 263–264
9.
WagnerM.WagnerH.‘Medium-term results of a modern metal-on-metal system in total hip replacement’Clin. Orthop.379 (2000): 123–133
10.
BoutinP.ChristelP.DorlotJ. M.MeunierA.de RoquancourtA.BlanquaertD.HermanS.SedelL.WitvoetJ.‘The use of dense alumina—alumina ceramic combination in total hip replacement’J. Biomed. Mater. Res.22 (1988): 1203–1232
11.
MittelmeierH.HeiselJ.‘Sixteen-years’ experience with ceramic hip prostheses’Clin. Orthop.282 (1992): 64–72
12.
SemlitschM.WillertH.-G.‘Clinical wear behaviour of ultra-high molecular weight polyethylene cups paired with metal and ceramic ball heads in comparison to metal—metal pairings of hip joint replacements’Proc. IMechE, Part H: J. Engineering in Medicine211 (1997): 73–88
13.
JinZ. M.DowsonD.FisherJ.‘Analysis of fluid film lubrication in artificial hip joint replacements with surfaces of high elastic modulus’Proc. IMechE, Part H: J. Engineering in Medicine211 (1997): 247–256
14.
MurrayD. W.‘The definition and measurement of acetabular orientation’J. Bone Jt Surg. Br.75 (1993): 228–232
15.
LewinnekG. E.LewisJ. L.TarrR.CompereC. L.ZimmermanJ. R.‘Dislocations after total hip-replacement arthroplasties’J. Bone Jt Surg. Am.60 (1978): 217–220
16.
BoskerB. H.VerheyenC. C.HorstmanW. G.TulpN. J.‘Poor accuracy of freehand cup positioning during total hip arthroplasty’Arch. Orthop. Trauma Surg.127 (2007): 375–379
17.
ArchboldH. A.MockfordB.MolloyD.McConwayJ.OgondaL.BeverlandD.‘The transverse acetabular ligament: An aid to orientation of the acetabular component during primary total hip replacement: A preliminary study of 1000 cases investigating postoperative stability’J. Bone Jt Surg. Br88 (2006): 883–886
18.
ArchboldH. A.SlomczykowskiM.CroneM.EckmanK.JaramazB.BeverlandD. E.‘The relationship of the orientation of the transverse acetabular ligament and acetabular labrum to the suggested safe zones of cup positioning in total hip arthroplasty’Hip Int18 (2008): 1–6
19.
EndoM.TipperJ. L.BartonD. C.StoneM. H.InghamE.FisherJ.‘Comparison of wear, wear debris and functional biological activity of moderately crosslinked and non-crosslinked polyethylenes in hip prostheses’Proc. IMechE, Part H: J. Engineering in Medicine216 (2002): 111–122
20.
WilliamsS.SchepersA.IsaacG.HardakerC.InghamE.van der JagtD.BreckonA.FisherJ.‘The 2007 Otto Aufranc Award. Ceramic-on-metal hip arthroplasties: A comparative in vitro and in vivo study’Clin. Orthop. Related Res465 (2007): 23–32
21.
SieberH.-P.RiekerC. B.KottigP.‘Analysis of 118 second-generation metal-on-metal retrieved hip implants’J. Bone Jt Surg. Br.80 (1998): 46–50
22.
IsaacG. H.WroblewskiB. M.AtkinsonJ. R.DowsonD.‘A tribological study of retrieved hip pros-theses’Clin. Orthop. Related Res.276 (1992): 115–125
23.
WilliamsS.IsaacG.PorterN.FisherJ.OlderJ.‘Long-term radiographic assessment of cemented polyethylene acetabular cups’Clin. Orthop. Related Res466 (2008): 366–372
24.
CampbellP.BeauléP. E.EbramzadehE.LeDuffM.De SmetK.LuZ.AmstutzH. C.‘The John Charnley Award: A study of implant failure in metal-on-metal surface arthroplasties’Clin. Orthop. Related Res453 (2006): 35–46
25.
MorlockM. M.BishopN.ZustinJ.HahnM.RütherW.AmlingM.‘Modes of implant failure after hip resurfacing: Morphological and wear analysis of 267 retrieval specimens’J. Bone Jt Surg. Am90 (2008): 89–95
26.
DanielJ.ZiaeeH.PradhanC.PynsentP. B.McMinnD. J.‘Blood and urine metal ion levels in young and active patients after Birmingham hip resurfacing arthroplasty: Four-year results of a prospective longitu- dinal study’J. Bone Jt Surg. Br892 (2007): 169–173
27.
AntoniouJ.ZukorD. J.FacksonM.MinarikW.PetitA.HukO. L.‘Metal ion levels in the blood of patients after hip resurfacing: A comparison between twenty-eight and thirty-six-millimeter-head metal-on-metal prostheses’J. Bone Jt Surg. Am90 (2008): 142–148
ParkY. S.MoonY. W.LimS. J.YangJ. M.AhnG.ChoiY. L.‘Early osteolysis following second-generation metal-on-metal hip replacement’J. Bone Jt Surg. Am87 (2005): 1515–1521
30.
KorovessisP.PetsinisG.RepantiM.RepantisT.‘Metallosis after contemporary metal-on-metal total hip arthroplasty. Five to nine-year follow-up’J. Bone Jt Surg. Am88 (2006): 1183–1191
31.
WillertH.-G.BuchhornG. H.FayyaziA.FluryR.WindlerM.KosterG.LohmannC. H.‘Metal-on-metal bearings and hypersensitivity in patients with artificial hip joints’J. Bone Jt Surg.87 (2005): 28–36
32.
PanditH.Glyn-JonesS.McLardy-SmithP.GundleR.WhitwellD.GibbonsC. L.OstlereS.AthanasouN.GillH. S.MurrayD. W.‘Pseudo-tumours associated with metal-on-metal hip resurfacings’J. Bone Jt Surg. Br90 (2008): 847–851
33.
PaavolainenP.PukkalaE.PulkkinenP.VisuriT.‘Cancer incidence in Finnish hip replacement patients from 1980–1995: A nationwide cohort study involving 31,651 patients’J. Arthroplasty15 (2000): 136–137
34.
LuetznerJ.KrummenauerF.LengelA. M.ZieglerJ.WitzlebW. C.‘Serum metal ion exposure after total knee arthroplasty’Clin. Orthop. Related Res461 (2007): 136–42
35.
CucklerJ. M.MooreK. D.LombardiA. V.McPhersonE.EmersonR.‘Large versus small femoral heads in metal-on-metal total hip arthroplasty’J. Arthroplasty19 (2004): 41–44
36.
SmithT. M.BerendK. R.LombardiA. V.EmersonR. H.MalloryT. H.‘Metal-on-metal total hip arthroplasty with large heads may prevent early dislocation’Clin. Orthop. Related Res441 (2005): 137–142
37.
AmstutzH. C.BeauléP. E.DoreyF. J.Le DuffM. J.CampbellP. A.GruenT. A.‘Metal-on-metal hybrid surface arthroplasty: Two to six-year follow-up study’J. Bone Jt Surg. Am86 (2004): 28–39
38.
PetersC. L.McPhersonE.JacksonJ. D.EricksonJ. A.‘Reduction in early dislocation rate with large-diameter femoral heads in primary total hip arthroplasty’J. Arthroplasty22 (2007): 140–144
39.
DowsonD.HardakerC.FlettM.IsaacG. H.‘A hip joint simulator study of the performance of metal-on-metal joints. Part II: Design’J. Arthoplasty19 (2004): 124–130
40.
SmithS. L.DowsonD.GoldsmithA. A. J.‘The effect of femoral head diameter upon lubrication and wear of metal-on-metal total hip replacements’Proc. IMechE, Part H: J. Engineering in Medicine215 (2001): 161–170
41.
ChanF. W.BobynJ. DMedleyJ. B.KrygierJ. J.TanzerM.‘Wear and lubrication of metal-on-metal hip implants’Clin. Orthop.369 (1999): 10–24
42.
ScholesS. C.GreenS. M.UnsworthA.‘The wear of metal-on-metal total hip prostheses measured in a hip simulator’Proc. IMechE, Part H: J. Engineering in Medicine215 (2001): 523–530
43.
RiekerC. B.SchönR.KonradR.LiebentrittG.GnepfP.ShenM.RobertsP.GrigorisP.‘Influence of the clearance on in-vitro tribology of large diameter metal-on-metal articulations pertaining to resurfacing hip implants’Orthop. Clin. North Am.36(2) (2005): 135–142 vii.
44.
ClarkeM. T.LeeP. T.AroraA.VillarR. N.‘Levels of metal ions after small- and large-diameter metal-on-metal hip arthroplasty’J. Bone Jt Surg. Br.85 (2003): 913–917
45.
ZaheeH.DanielJ.PradhanC.McMinnD. In Proceedings of the 54th Annual Meeting ORS, San Francisco, CA, March (2008)
46.
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
47.
HartA.AdamJ.SkinnerJ.Muirhead-AllwoodS.‘Component malposition in patients with very high metal ion levels following hip resurfacing’ (2008)
48.
IsaacG. H.CobbA.McLenan-SmithR.OakshottR.O'SullivanT.SchmalzriedT.VailT.SiebelT.‘Metal ion levels and component positioning after surface replacement of the hip. Early results’ (2008)
49.
LangtonD. J.JamesonS. S.JoyceT. J.WebbJ.NargolA.V.‘The effect of component size and orientation on the concentrations of metal ions after resurfacing arthroplasty of the hip’J. Bone Jt Surg. Br.909 (2008): 1143–1151
50.
LivermoreJ.IlstrupD.MorreyB.‘Effect of femoral head size on wear of the polyethylene acetabular component’J. Bone Jt Surg. Am.72 (1990): 518–528
51.
KaboJ. M.GebhardJ. S.LorenG.AmstutzH. C.‘In vivo wear of polyethylene acetabular components’J. Bone Jt Surg. Br.75 (1993): 254–258
KurtzS. M.HozackW. J.PurtillJ. J.MarcolongoM.KraayM. J.GoldbergV. M.SharkeyP. F.ParviziJ.RimnacC. M.EdidinA. A.‘Otto Aufranc Award Paper: Significance of in vivo degradation for polyethylene in total hip arthroplasty’Clin. Orthop. Related Res453 (2006): 47–57
54.
McKellopH.ShenF. W.LuB.CampbellP.SaloveyR.‘Development of an extremely wear-resistant ultra high molecular weight polyethylene for total hip replacements’J. Orthop. Res.17 (1999): 157–166
55.
MuratogluO. K.BragdonC. R.O'ConnorD. O.JastyM.HarrisW. H.‘A novel method of cross- linking ultra-high-molecular-weight polyethylene to improve wear, reduce oxidation, and retain mechanical properties’J. Arthroplasty16 (2001): 149–160
56.
EnghC. A.StepniewskiA. S.GinnS. D.BeykirchS. E.Sychterz-TerefenkoC. J.HopperR. H.EnghC. A.‘A randomized prospective evaluation of outcomes after total hip arthroplasty using cross-linked Marathon and non-cross-linked Enduron polyethylene liners’J. Arthroplasty216 (2006): 17–25
57.
CalvertG. T.DevaneP. A.FieldenJ.AdamsK.HorneJ. G.‘A double-blind, prospective, randomized controlled trial comparing highly cross-linked and conventional polyethylene in primary total hip arthroplasty’J. Arthroplasty (2008): (in press).
58.
Glyn-JonesS.McLardy-SmithP.GillH. S.MurrayD. W.‘The creep and wear of highly cross-linked polyethylene: A three-year randomized, controlled trial using radiostereometric analysis’J. Bone Jt Surg. Br90 (2008): 556–561
59.
Glyn-JonesS.IsaacS.HauptfleischJ.McLardy-SmithP.MurrayD. W.GillH. S.‘Does highly cross-linked polyethylene wear less than conventional polyethylene in total hip arthroplasty? A double-blind, randomized, and controlled trial using roentgen stereophotogrammetric analysis’J. Arthroplasty23 (2008): 337–343
60.
GiureaA.ZehetgruberH.FunovicsP.GramppS.KaramatL.Gottsauner-WolfF.‘Risk factors for dislocation of a cementless total hip endoprosthesis — a statistical analysis’Z Orthop Ihre Grenzgeb139 (2001): 194–199
61.
SchmalzriedT. P.GuttmannD.GreculaM.AmstutzH. C.‘The relationship between the design, position, and articular wear of acetabular components inserted without cement and the development of pelvic osteolysis’J. Bone Jt Surg. Am76 (1994): 677–688
62.
UdomkiatP.DorrL. D.WanZ.‘Cementless hemispheric porous-coated sockets implanted with press-fit technique without screws: Average ten-year follow-up’J. Bone Jt Surg. Am84 (2002): 1195–1200
63.
HirakawaK.MitsugiN.KoshinoT.SaitoT.HirasawaY.KuboT.‘Effect of acetabular cup position and orientation in cemented total hip arthroplasty’Clin. Orthop. Related Res388 (2001): 135–142
64.
BizotP.LarrouyM.WitvoetJ.SedelL.NizardR.‘Press-fit metal-backed alumina sockets: A minimum 5-year followup study’Clin. Orthop. Related Res.379 (2000): 134–142
65.
PignattiG.StagniC.FravisiniM.GiruntiA.‘Ceramic-ceramic coupling. Total hip arthroplasty in young patients’Chir. Organi Mov.88 (2003): 369–375
66.
TateiwaT.ClarkeI. C.WilliamsP. A.GarinoJ.ManakaM.ShishidoT.YamamotoK.ImakiireA.‘Ceramic total hip arthroplasty in the United States: Safety and risk issues revisited’Am. J. Orthop37 (2008): E26-E31 (review)
67.
MuraliR.BonarS. F.KirshG.WalterW. K.WalterW. L.‘Osteolysis in third-generation alumina ceramic-on-ceramic hip bearings with severe impingement and titanium metallosis’J. Arthroplasty23 (2008): 1240.e13–1240.e19.
68.
WillmannG.‘Ceramic femoral head retrieval data’Clin. Orthop.379 (2000): 22–28
69.
StewartT. D.TipperJ. L.InsleyG.StreicherR. M.InghamE.FisherJ.‘Long-term wear of ceramic matrix composite materials for hip prostheses under severe swing phase microseparation’J. Biomed. Mater. Res. B Appl. Biomater66 (2003): 567–573
70.
NevelosJ. E.InghamE.DoyleC.NevelosA. B.FisherJ.‘Analysis of retrieved alumina ceramic components for Mittelmeier total hip prostheses’Biomaterials20 (1999): 1833–1840
71.
WalterW. L.InsleyG. M.WalterW. K.TukeM. A.‘Edge loading in third generation alumina ceramic-on-ceramic bearings: Stripe wear’J. Arthroplasty19 (2004): 402–413
72.
WalterW. L.O'tooleG. C.WalterW. K.EllisA.ZicatB. A.‘Squeaking in ceramic-on-ceramic hips: The importance of acetabular component orientation’J. Arthroplasty22 (2007): 496–503
