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Journal of Bone and Joint Surgery - British Volume, Vol 91-B, Issue 9, 1134-1141.
doi: 10.1302/0301-620X.91B9.22306  
Copyright © 2009 by British Editorial Society of Bone and Joint Surgery
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Ceramic-on-metal bearings in total hip replacement

WHOLE BLOOD METAL ION LEVELS AND ANALYSIS OF RETRIEVED COMPONENTS

G. H. Isaac, PhD, Visiting Professor, Distinguished Hip Fellow1; C. Brockett, PhD, Research Fellow2; A. Breckon, MSc, Research Assistant3; D. van der Jagt, FCS(SA)Orth, Orthopaedic Surgeon4; S. Williams, PhD, Academic Research Fellow2; C. Hardaker, MSc, Research and Test Manager1; J. Fisher, DEng, Professor of Mechanical Engineering2; and A. Schepers, FCS(SA)Ortho, Orthopaedic Surgeon4

1 DePuy International Ltd., Number 1 White Rose Office Park, Leeds LS11 0BG, UK.
2 Institute of Medical and Biological Engineering, School of Mechanical Engineering University of Leeds, Woodhouse Lane, Leeds LS2 9JT, UK.
3 Orthomedics (Pty) Ltd., P. O. Box 145, Linbro Park 2065, Johannesburg, South Africa.
4 Johannesburg Hospital and Division of Orthopaedic Surgery University of the Witwatersrand, Johannesburg, South Africa.

Correspondence should be sent to Professor G. H. Isaac; e-mail: gisaac{at}its.jnj.com

This study reports on ceramic-on-metal (CoM) bearings in total hip replacement. Whole blood metal ion levels were measured. The median increase in chromium and cobalt at 12 months was 0.08 µg/1 and 0.22 µg/1, respectively, in CoM bearings. Comparable values for metal-on-metal (MoM) were 0.48 µg/1 and 0.32 µg/1. The chromium levels were significantly lower in CoM than in MoM bearings (p = 0.02). The cobalt levels were lower, but the difference was not significant. Examination of two explanted ceramic heads revealed areas of thin metal transfer. CoM bearings (one explanted head and acetabular component, one explanted head and new acetabular component, and three new heads and acetabular components) were tested in a hip joint simulator. The explanted head and acetabular component had higher bedding-in. However, after one million cycles all the wear rates were the same and an order of magnitude less than that reported for MoM bearings. There were four outliers in each clinical group, primarily related to component malposition.






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Hip, Knee, Trauma, Upper limb, Foot & Ankle, Paediatrics, Oncology, Spine, Arthroplasty, General