Archives of Orthopaedic and Trauma Surgery

, Volume 132, Issue 1, pp 123–129 | Cite as

Cushion bearings versus large diameter head metal-on-metal bearings in total hip arthroplasty: a short-term metal ion study

  • Antonio Moroni
  • Emanuele Nocco
  • Martha Hoque
  • Elena Diremigio
  • Dario Buffoli
  • Francesco Cantù
  • Simona Catalani
  • Pietro Apostoli
Hip Arthroplasty



Metal-on-metal total hip arthroplasty (MOM THA) has the advantage of replicating the femoral head size, but the postoperative elevation of serum metal ion levels is a cause for concern. Metal-on-polycarbonate-urethane is a new cushion bearing featuring a large diameter metal head coupled with a polycarbonate-urethane liner.


The aim of this study was to assess and compare serum cobalt (Co) and chromium (Cr) levels in a group of 15 patients treated with a cushion bearing THA system (Group A) and a group of 15 patients treated with a MOM THA system (Group B) at short-term. At a mean follow-up of 27.3 months (18–35 months), in Group A the median Cr and Co serum levels were significantly lower than in Group B, measuring 0.24 μg/L (0.1–2.1 μg/L) and 0.6 μg/L (0.29–2.3 μg/L) compared to 1.3 μg/L (0.1–9 μg/L, p < 0.001) and 2.9 μg/L (0.85–13.8 μg/L, p < 0.001) respectively.


All patients demonstrated an excellent clinical result, as shown by the Harris and Oxford hip scores. The cushion bearing THA studied in this paper showed clinical outcomes similar to the MOM THA bearing, with the advantage of no significant metal ion elevation in the serum.


These findings warrant the continued clinical study of compliant bearing options.


Total hip arthroplasty Polycarbonate-urethane Metal-on-metal Metal ions 



This work was supported by Active Implants Corporation. One of the authors (AM) has a financial relationship with this organization.


  1. 1.
    Kurtz S, Ong K, Lau E, Mowat F, Halpern M (2007) Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am 89(4):780–785PubMedCrossRefGoogle Scholar
  2. 2.
    Harris WH (1995) The problem is osteolysis. Clin Orthop Relat Res 311:46–53PubMedGoogle Scholar
  3. 3.
    Weber BG (1996) Experience with the Metasul total hip bearing system. Clin Orthop (329 Suppl):S69Google Scholar
  4. 4.
    Smith TM, Berend KR, Lombardi AV, Emerson RH, Mallory TH (2005) Metal-on-metal hip arthroplasty with large heads may prevent early dislocation. Clin Orthop Rel Res 441:137–142CrossRefGoogle Scholar
  5. 5.
    Burroughs BR, Hallstrom B, Golladay GJ, Hoeffel D, Harris WH (2005) Range of motion and stability in total hip arthroplasty with 28, 32, 38 and 44 mm femoral head sizes. J Arthroplasty 20(1):11–19PubMedCrossRefGoogle Scholar
  6. 6.
    Cuckler JM, Moore KD, Lombardi AV, McPherson E, Emerson R (2004) Large versus small femoral heads in metal-on-metal total hip arthroplasty. J Arthroplasty 19(8 s3):41–44Google Scholar
  7. 7.
    Berry DJ, von Klnoch M, Schleck CD, Harmsen WS (2005) Effect of femoral head diameter and operative approach on risk of dislocation after primary total hip arthroplasty. J Bone Joint Surg [Am] 87:2456–2463CrossRefGoogle Scholar
  8. 8.
    Quesada MJ, Marker DR, Mont MA (2008) Metal-on-metal hip resurfacing: advantages and disadvantages. J Arthroplasty 23:69–73PubMedCrossRefGoogle Scholar
  9. 9.
    Mont MA, Seyler TM, Ragland PS, Starr R, Erhart J, Bhave A (2007) Gait analysis of patients with resurfacing hip arthroplasty compared with hip osteoarthritis and standard total hip arthroplasty. J Arthroplasty 22:100–108PubMedCrossRefGoogle Scholar
  10. 10.
    Doorn PF, Campbell PA, Worrall J, Benya PD, McKellop HA, Amstutz HC (1998) Metal wear particle characterization from metal-on-metal total hip replacements: transmission electron microscopy study of periprosthetic tissues and isolated particles. J Biomed Mater Res 42:103–111PubMedCrossRefGoogle Scholar
  11. 11.
    MacDonald SJ (2004) Metal-on-metal total hip arthroplasty: the concerns. Clin Orthop. 429:86–93PubMedCrossRefGoogle Scholar
  12. 12.
    Visuri T, Pukkala E, Paavolainen P, Pulkkinen P, Riska EB (1996) Cancer risk after metal-on-metal and polyethylene-on-metal total hip arthroplasty. Clin Orthop 329(Suppl):280–289Google Scholar
  13. 13.
    Hart AJ, Buddhev P, Winship P, Faria N, Powell J, Skinner J (2008) Cup inclination angle of greater than 50 degrees increases whole blood concentrations of cobalt and chromium ions after metal-on-metal hip resurfacing. Hip Int 18(3):212–219PubMedGoogle Scholar
  14. 14.
    Desy NM, Bergeron SG, Petit A, Huk OL, Antoniou J (2011) Surgical variables influence metal ion levels after hip resurfacing. Clin Orthop Relat Res 469(6):1635–1641PubMedCrossRefGoogle Scholar
  15. 15.
    Scholes SC, Unsworth A, Blamey JM, Burgess IC, Jones E, Smith N (2005) Design aspects of compliant, soft layer bearings for an experimental hip prosthesis. Proc Inst Mech Eng H 219(2):79–87PubMedGoogle Scholar
  16. 16.
    Unsworth A, Dowson D, Wright V (1975) The frictional behaviour of human synovial joints–Part 1: natural joints. Trans ASME J Lubr Technol 97(3):369–376CrossRefGoogle Scholar
  17. 17.
    Kretzer JP, Kleinhans JA, Jakubowitz E, Thomsen M, Heisel C (2009) A meta-analysis of design- and manufacturing-related parameters influencing the wear behaviour of metal-on-metal hip joint replacements. J Orthop Res 27(11):1473–1480PubMedCrossRefGoogle Scholar
  18. 18.
    Elsner JJ, Shemesh M, Mezape Y, Levenshtein M, Hakshur K, Shterling A, Linder-Ganz E, Eliaz N (2011) Long-term evaluation of a compliant cushion form acetabular bearing for hip joint replacement: a 20 million cycles wear simulation. J Orthop Res. doi: 10.1002/jor.21471
  19. 19.
    Chan FW, Bobyn JD, Medley JB, Krygier JJ, Tanzer M (1999) Wear and lubrication of metal-on-metal hip implants. Clin Orthop 369:10–24PubMedCrossRefGoogle Scholar
  20. 20.
    Heisel C, Streich N, Krachler M, Jakubowitz E, Kretzer JP (2008) Characterization of the running-in period in total hip resurfacing arthroplasty—an in vivo and in vitro metal ion analysis. J Bone Joint Surg [Am] 90(3):125–133CrossRefGoogle Scholar
  21. 21.
    Harris WH (1969) Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty. An end-result study using a new method of result evaluation. J Bone Joint Surg [Am] 51(4):737–755Google Scholar
  22. 22.
    Murray DW, Fitzpatrick R, Rogers K, Pandit H, Beard DJ, Carr AJ, Dawson J (2007) The use of the Oxford hip and knee scores. J Bone Joint Surg [Br] 89(8):1010–1014CrossRefGoogle Scholar
  23. 23.
    Jones PR, Taylor CJ, Hukins DW, Porter ML, Hardinge K (1989) Prosthetic hip failure: retrospective radiograph image analysis of the acetabular cup. J Biomed Eng 11:253–257PubMedCrossRefGoogle Scholar
  24. 24.
    Martell JM, Berdia S (1997) Determination of polyethylene wear in total hip replacements with use of digital radiographs. J Bone Joint Surg [Am] 79:1635–1641Google Scholar
  25. 25.
    Shaver SM, Brown TD, Hillis SL, Callaghan JJ (1997) Digital edge-detection measurement of polyethylene wear after total hip arthroplasty. J Bone Joint Surg [Am]. 79:690–700Google Scholar
  26. 26.
    MacDonald SJ, Brodner W, Jacobs JJ (2004) A consensus paper on metal ions in metal-on-metal hip arthroplasties. J Arthroplasty 19(8 Suppl 3):12–16PubMedCrossRefGoogle Scholar
  27. 27.
    Clarke IC, Good IV, Williams P, Schroeder D, Anissian L, Stark A, Oonishi H, Schuldies J, Gustafson G (2000) Ultra-low wear rates for rigid-on-rigid bearings in total hip replacement. Proc Inst Mech Eng H 214:331–347PubMedCrossRefGoogle Scholar
  28. 28.
    Sieber HP, Rieker CB, Köttig P (1999) Analysis of 118 second-generation metal-on-metal retrieved hip implants. J Bone Joint Surg [Br] 81:46–50CrossRefGoogle Scholar
  29. 29.
    Kreibich DN, Moran CG, Delves HT, Owen TD, Pinder IM (1996) Systemic release of cobalt and chromium after total hip replacement. J Bone Joint Surg [Br] 78(1):18–21Google Scholar
  30. 30.
    Jacobs JJ, Skipor AK, Patterson LM, Hallab NJ, Paprosky WG, Black J, Galante JO (1998) Metal release in patients who have had a primary total hip arthroplasty. A prospective, controlled, longitudinal study. J Bone Joint Surg [Am] 80(10):1447–1458Google Scholar
  31. 31.
    Savarino L, Granchi D, Ciapetti G, Cenni E, Nardi Pantoli A, Rotini R, Veronesi CA, Baldini N, Giunti A (2002) Ion release in patients with metal-on-metal hip bearings in total joint replacement: a comparison with metal-on-polyethylene bearings. J Biomed Mater Res 63(5):467–474PubMedCrossRefGoogle Scholar
  32. 32.
    Savarino L, Greco M, Cenni E, Cavasinni L, Rotini R, Baldini N, Giunti A (2006) Differences in ion release after ceramic-on-ceramic and metal-on-metal total hip replacement. Medium-term follow-up. J Bone Joint Surg [Br] 88:472–476Google Scholar
  33. 33.
    Jacobs JJ, Urban RM, Gilbert JL, Skipor AK, Black J, Jasty M, Galante JO (1995) Local and distant products from modularity. Clin Orthop 319:94–105PubMedGoogle Scholar
  34. 34.
    Brodner W, Bitzan P, Meisinger V, Kaider A, Gottsaumer-Wolf F, Kotz R (2003) Elevated serum cobalt with metal-on-metal articulating surfaces. J Bone Joint Surg [Am] 85:2168–2173Google Scholar
  35. 35.
    Antoniou J, Zukor DJ, Mwale F, Minarik W, Petit A, Huk OL (2008) 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 Joint Surg [Am] 90(3):142–148CrossRefGoogle Scholar
  36. 36.
    Lavigne M, Belzile EL, Roy A, Morin F, Amzica T, Vendittoli PA (2011) Comparison of whole-blood metal ion levels in four types of metal-on-metal large-diameter femoral head total hip arthroplasty: the potential influence of the adapter sleeve. J Bone Joint Surg [Am] 93(2):128–136CrossRefGoogle Scholar
  37. 37.
    Kretzer JP, Jakubowitz E, Krachler M, Thomsen M, Heisel C (2009) Metal release and corrosion effects of modular neck total hip arthroplasty. Int Orthop 33(6):1531–1536PubMedCrossRefGoogle Scholar
  38. 38.
    Brown SA, Flemming CA, Kawalec JS, Placko HE, Vassaux C, Merritt K, Payer JH, Kraay MJ (1995) Fretting corrosion accelerates crevice corrosion of modular hip tapers. J Appl Biomater 6(1):19–26PubMedCrossRefGoogle Scholar
  39. 39.
    Garbuz DS, Tanzer M, Greidanus NV, Masri BA, Duncan CP (2010) The John Charnley Award: metal-on-metal hip resurfacing versus large-diameter head metal-on-metal hip arthroplasty: a randomized clinical trial. Clin Orthop Relat Res 468(2):318–325PubMedCrossRefGoogle Scholar
  40. 40.
    Vendittoli PA, Mottard S, Roy AG, Dupont C, Lavigne M (2007) Chromium and cobalt ion release following the Durom high carbon content, forged metal-on-metal surface replacement of the hip. J Bone Joint Surg [Br] 89:441–448CrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • Antonio Moroni
    • 1
  • Emanuele Nocco
    • 2
  • Martha Hoque
    • 1
  • Elena Diremigio
    • 1
  • Dario Buffoli
    • 3
  • Francesco Cantù
    • 3
  • Simona Catalani
    • 4
  • Pietro Apostoli
    • 4
  1. 1.School of Sports ScienceUniversity of BolognaBolognaItaly
  2. 2.Active Implants CorporationMemphisUSA
  3. 3.Department of Physical Therapy and RehabilitationPoliclinico San PietroPonte San PietroItaly
  4. 4.Section of Occupational Health and Industrial Hygiene, Department of Experimental and Applied MedicineUniversity of BresciaBresciaItaly

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