Clinical Orthopaedics and Related Research®

, Volume 472, Issue 2, pp 529–542 | Cite as

Stability and Trunnion Wear Potential in Large-diameter Metal-on-Metal Total Hips: A Finite Element Analysis

  • Jacob M. Elkins
  • John J. Callaghan
  • Thomas D. Brown
Symposium: 2013 Hip Society Proceedings



Large-diameter femoral heads for metal-on-metal THA hold theoretical advantages of joint stability and low bearing surface wear. However, recent reports have indicated an unacceptably high rate of wear-associated failure with large-diameter bearings, possibly due in part to increased wear at the trunnion interface. Thus, the deleterious consequences of using large heads may outweigh their theoretical advantages.


We investigated (1) to what extent femoral head size influenced stability in THA for several dislocation-prone motions; and the biomechanics of wear at the trunnion interface by considering the relationship between (2) wear potential and head size and (3) wear potential and other factors, including cup orientation, type of hip motion, and assembly/impaction load.


Computational simulations were executed using a previously validated nonlinear contact finite element model. Stability was determined at 36 cup orientations for five distinct dislocation challenges. Wear at the trunnion interface was calculated for three separate cup orientations subjected to gait, stooping, and sit-to-stand motions. Seven head diameters were investigated: 32 to 56 mm, in 4-mm increments.


Stability improved with increased diameter, although diminishing benefit was seen for sizes of greater than 40 mm. By contrast, contact stress and computed wear at the trunnion interface all increased unabatedly with increasing head size. Increased impaction forces resulted in only small decreases in trunnion wear generation.


These data suggest that the theoretical advantages of large-diameter femoral heads have a limit. Diameters of greater than 40 mm demonstrated only modest improvement in terms of joint stability yet incurred substantial increase in wear potential at the trunnion.

Clinical Relevance

Our model has potential to help investigators and designers of hip implants to better understand the optimization of trunnion design for long-term durability.


  1. 1.
    Archard J. Contact and rubbing of flat surfaces. J Appl Phys. 1953;24:981–988.CrossRefGoogle Scholar
  2. 2.
    Australian Orthopaedic Association. Annual Report of the Australian Orthopaedic Association National Joint Registry. Available at: Accessed November 2012.
  3. 3.
    Bartz RL, Noble PC, Kadakia NR, Tullos HS. The effect of femoral component head size on posterior dislocation of the artificial hip joint. J Bone Joint Surg Am. 2000;82:1300–1307.PubMedGoogle Scholar
  4. 4.
    Berton C, Girard J, Krantz N, Migaud H. The Durom large diameter head acetabular component: early results with a large-diameter metal-on-metal bearing. J Bone Joint Surg Br. 2010;92:202–208.PubMedCrossRefGoogle Scholar
  5. 5.
    Bolland B, Culliford D, Langton D, Millington J, Arden N, Latham J. High failure rates with a large-diameter hybrid metal-on-metal total hip replacement: clinical, radiological and retrieval analysis. J Bone Joint Surg Br. 2011;93:608–615.PubMedCrossRefGoogle Scholar
  6. 6.
    Bozic KJ, Kurtz SM, Lau E, Ong K, Vail TP, Berry DJ. The epidemiology of revision total hip arthroplasty in the United States. J Bone Joint Surg Am. 2009;91:128–133.PubMedCrossRefGoogle Scholar
  7. 7.
    Brockett C, Williams S, Jin Z, Isaac G, Fisher J. Friction of total hip replacements with different bearings and loading conditions. J Biomed Mater Res B Appl Biomater. 2007;81:508–515.PubMedCrossRefGoogle Scholar
  8. 8.
    Brown S, Flemming C, Kawalec J, Placko H, Vassaux C, Merritt K, Payer J, Kraay M. Fretting corrosion accelerates crevice corrosion of modular hip tapers. J Appl Biomater. 1995;6:19–26.PubMedCrossRefGoogle Scholar
  9. 9.
    Browne JA, Bechtold CD, Berry DJ, Hanssen AD, Lewallen DG. Failed metal-on-metal hip arthroplasties: a spectrum of clinical presentations and operative findings. Clin Orthop Relat Res. 2010;468:2313–2320.PubMedCrossRefGoogle Scholar
  10. 10.
    Burroughs BR, Hallstrom B, Golladay GJ, Hoeffel D, Harris WH. Range of motion and stability in total hip arthroplasty with 28-, 32-, 38-, and 44-mm femoral head sizes: an in vitro study. J Arthroplasty. 2005;20:11–19.PubMedCrossRefGoogle Scholar
  11. 11.
    Cinotti G, Lucioli N, Malagoli A, Calderoli C, Cassese F. Do large femoral heads reduce the risks of impingement in total hip arthroplasty with optimal and non-optimal cup positioning? Int Orthop. 2011;3:317–323.CrossRefGoogle Scholar
  12. 12.
    Collier JP, Mayor MB, Williams IR, Surprenant VA, Surprenant HP, Currier BH. The tradeoffs associated with modular hip prostheses. Clin Orthop Relat Res. 1995;311:91–101.PubMedGoogle Scholar
  13. 13.
    Cook SD, Barrack RL, Clemow A. Corrosion and wear at the modular interface of uncemented femoral stems. J Bone Joint Surg Br. 1994;76:68–72.PubMedGoogle Scholar
  14. 14.
    Crowninshield RD, Maloney WJ, Wentz DH, Humphrey SM, Blanchard CR. Biomechanics of large femoral heads: what they do and don’t do. Clin Orthop Relat Res. 2004;429:102–107.PubMedCrossRefGoogle Scholar
  15. 15.
    Cuckler JM, Moore KD, Lombardi AV, McPherson E, Emerson R. Large versus small femoral heads in metal-on-metal total hip arthroplasty. J Arthroplasty. 2004;19:41–44.PubMedCrossRefGoogle Scholar
  16. 16.
    De Haan R, Pattyn C, Gill HS, Murray DW, Campbell PA, De Smet K. Correlation between inclination of the acetabular component and metal ion levels in metal-on-metal hip resurfacing replacement. J Bone Joint Surg Br. 2008;90:1291–1297.PubMedCrossRefGoogle Scholar
  17. 17.
    D’Lima DD, Urquhart AG, Buehler KO, Walker RH, Colwell CW. 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 Joint Surg Am. 2000;82:315–321.PubMedGoogle Scholar
  18. 18.
    Dobbs H, Minski M. Metal ion release after total hip replacement. Biomaterials. 1980;1:193–198.PubMedCrossRefGoogle Scholar
  19. 19.
    Donell S, Darrah C, Nolan J, Wimhurst J, Toms A, Barker T, Case C, Tucker J. Early failure of the Ultima metal-on-metal total hip replacement in the presence of normal plain radiographs. J Bone Joint Surg Br. 2010;92:1501–1508.PubMedCrossRefGoogle Scholar
  20. 20.
    Dorr LD, Wolf AW, Chandler R, Conaty JP. Classification and treatment of dislocations of total hip arthroplasty. Clin Orthop Relat Res. 1983;173:151–158.PubMedGoogle Scholar
  21. 21.
    Dowson D, Hardaker C, Flett M, Isaac GH. A hip joint simulator study of the performance of metal-on-metal joints. Part II: Design. J Arthroplasty. 2004;19:124–130.Google Scholar
  22. 22.
    Elias JJ, Nagao M, Chu YH, Carbone JJ, Lennox DW, Chao E. Medial cortex strain distribution during noncemented total hip arthroplasty. Clin Orthop Relat Res. 2000;370:250–258.PubMedCrossRefGoogle Scholar
  23. 23.
    Elkins JM, Kruger KM, Pedersen DR, Callaghan JJ, Brown TD. Edge-loading severity as a function of cup lip radius in metal-on-metal total hips—a finite element analysis. J Orthop Res. 2012;30:169–177.PubMedCrossRefGoogle Scholar
  24. 24.
    Elkins JM, O’Brien MK, Stroud NJ, Pedersen DR, Callaghan JJ, Brown TD. Hard-on-hard total hip impingement causes extreme contact stress concentrations. Clin Orthop Relat Res. 2011;469:454–463.PubMedCrossRefGoogle Scholar
  25. 25.
    Elkins JM, Stroud NJ, Rudert MJ, Tochigi Y, Pedersen DR, Ellis BJ, Callaghan JJ, Weiss JA, Brown TD. The capsule’s contribution to total hip construct stability—a finite element analysis. J Orthop Res. 2011;29:1642–1648.PubMedCentralPubMedCrossRefGoogle Scholar
  26. 26.
    Fessler H, Fricker D. Friction in femoral prosthesis and photoelastic model cone taper joints. Proc Inst Mech Eng H. 1989;203:1–14.PubMedCrossRefGoogle Scholar
  27. 27.
    Fisher J. Bioengineering reasons for the failure of metal-on-metal hip prostheses: an engineer’s perspective. J Bone Joint Surg Br. 2011;93:1001–1004.PubMedCrossRefGoogle Scholar
  28. 28.
    Garbuz DS, Tanzer M, Greidanus NV, Masri BA, Duncan CP. The John Charnley Award. Metal-on-metal hip resurfacing versus large-diameter head metal-on-metal total hip arthroplasty: a randomized clinical trial. Clin Orthop Relat Res. 2010;468:318–325.PubMedCrossRefGoogle Scholar
  29. 29.
    Gilbert JL, Buckley CA, Jacobs JJ. In vivo corrosion of modular hip prosthesis components in mixed and similar metal combinations: the effect of crevice, stress, motion, and alloy coupling. J Biomed Mater Res. 1993;27:1533–1544.PubMedCrossRefGoogle Scholar
  30. 30.
    Girard J, Bocquet D, Autissier G, Fouilleron N, Fron D, Migaud H. Metal-on-metal hip arthroplasty in patients thirty years of age or younger. J Bone Joint Surg Am. 2010;92:2419–2426.PubMedCrossRefGoogle Scholar
  31. 31.
    Goldberg JR, Gilbert JL. In vitro corrosion testing of modular hip tapers. J Biomed Mater Res B Appl Biomater. 2003;64:78–93.PubMedCrossRefGoogle Scholar
  32. 32.
    Goldberg JR, Gilbert JL, Jacobs JJ, Bauer TW, Paprosky W, Leurgans S. A multicenter retrieval study of the taper interfaces of modular hip prostheses. Clin Orthop Relat Res. 2002;401:149–161.PubMedCrossRefGoogle Scholar
  33. 33.
    Heiney JP, Battula S, Vrabec GA, Parikh A, Blice R, Schoenfeld AJ, Njus GO. Impact magnitudes applied by surgeons and their importance when applying the femoral head onto the Morse taper for total hip arthroplasty. Arch Orthop Trauma Surg. 2009;129:793–796.PubMedCrossRefGoogle Scholar
  34. 34.
    Insall JN. Presidential address to The Knee Society: choices and compromises in total knee arthroplasty. Clin Orthop Relat Res. 1988;226:43–48.PubMedGoogle Scholar
  35. 35.
    Jacobs JJ, Gilbert JL, Urban RM. Current concepts review: corrosion of metal orthopaedic implants. J Bone Joint Surg Am. 1998;80:268–282.PubMedGoogle Scholar
  36. 36.
    Khan M, Kuiper JH, Richardson J. The exercise-related rise in plasma cobalt levels after metal-on-metal hip resurfacing arthroplasty. J Bone Joint Surg Br. 2008;90:1152–1157.PubMedCrossRefGoogle Scholar
  37. 37.
    Kop AM, Swarts E. Corrosion of a hip stem with a modular neck taper junction: a retrieval study of 16 cases. J Arthroplasty. 2009;24:1019–1023.PubMedCrossRefGoogle Scholar
  38. 38.
    Langton D, Jameson S, Joyce T, Gandhi J, Sidaginamale R, Mereddy P, Lord J, Nargol A. Accelerating failure rate of the ASR total hip replacement. J Bone Joint Surg Br. 2011;93:1011–1016.PubMedCrossRefGoogle Scholar
  39. 39.
    Langton D, Jameson S, Joyce T, Hallab N, Natu S, Nargol A. Early failure of metal-on-metal bearings in hip resurfacing and large-diameter total hip replacement: a consequence of excess wear. J Bone Joint Surg Br. 2010;92:38–46.PubMedCrossRefGoogle Scholar
  40. 40.
    Leslie IJ, Williams S, Isaac G, Ingham E, Fisher J. High cup angle and microseparation increase the wear of hip surface replacements. Clin Orthop Relat Res. 2009;467:2259–2265.PubMedCrossRefGoogle Scholar
  41. 41.
    Liu F, Leslie I, Williams S, Fisher J, Jin Z. Development of computational wear simulation of metal-on-metal hip resurfacing replacements. J Biomech. 2008;41:686–694.PubMedCrossRefGoogle Scholar
  42. 42.
    Lombardi AV, Skeels MD, Berend KR, Adams JB, Franchi OJ. Do large heads enhance stability and restore native anatomy in primary total hip arthroplasty? Clin Orthop Relat Res. 2011;469:1547–1553.PubMedCrossRefGoogle Scholar
  43. 43.
    Mao X, Tay GH, Godbolt DB, Crawford RW. Pseudotumor in a well-fixed metal-on-polyethylene uncemented hip arthroplasty. J Arthroplasty. 2012;27:493e13–493e16.CrossRefGoogle Scholar
  44. 44.
    McKellop HA, Sarmiento A, Brien W, Park SH. Interface corrosion of a modular head total hip prosthesis. J Arthroplasty. 1992;7:291–294.PubMedCrossRefGoogle Scholar
  45. 45.
    Morlock M, Schneider E, Bluhm A, Vollmer M, Bergmann G, Muller V, Honl M. Duration and frequency of everyday activities in total hip patients. J Biomech. 2001;34:873–881.PubMedCrossRefGoogle Scholar
  46. 46.
    Murray D. The definition and measurement of acetabular orientation. J Bone Joint Surg Br. 1993;75:228–232.PubMedGoogle Scholar
  47. 47.
    Nadzadi ME, Pedersen DR, Yack HJ, Callaghan JJ, Brown TD. Kinematics, kinetics, and finite element analysis of commonplace maneuvers at risk for total hip dislocation. J Biomech. 2003;36:577–591.PubMedCrossRefGoogle Scholar
  48. 48.
    Pandit H, Glyn-Jones S, McLardy-Smith P, Gundle R, Whitwell D, Gibbons CL, Ostlere S, Athanasou N, Gill HS, Murray DW. Pseudotumours associated with metal-on-metal hip resurfacings. J Bone Joint Surg Br. 2008;90:847–851.PubMedCrossRefGoogle Scholar
  49. 49.
    Peters CL, McPherson E, Jackson JD, Erickson JA. Reduction in early dislocation rate with large-diameter femoral heads in primary total hip arthroplasty. J Arthroplasty. 2007;22:140–144.PubMedCrossRefGoogle Scholar
  50. 50.
    Sanders AP, Brannon RM. Assessment of the applicability of the Hertzian contact theory to edge-loaded prosthetic hip bearings. J Biomech. 2011;44:2802–2808.PubMedCentralPubMedCrossRefGoogle Scholar
  51. 51.
    Scifert CF, Brown TD, Pedersen DR, Callaghan JJ. A finite element analysis of factors influencing total hip dislocation. Clin Orthop Relat Res. 1998;355:152–162.PubMedCrossRefGoogle Scholar
  52. 52.
    Silva M, Heisel C, Schmalzried TP. Metal-on-metal total hip replacement. Clin Orthop Relat Res. 2005;430:53–61.PubMedCrossRefGoogle Scholar
  53. 53.
    Stuchin SA. Anatomic diameter femoral heads in total hip arthroplasty: a preliminary report. J Bone Joint Surg Am. 2008;90(suppl 3):52–56.PubMedCrossRefGoogle Scholar
  54. 54.
    Svensson O, Mathiesen EB, Reinholt F, Blomgren G. Formation of a fulminant soft-tissue pseudotumor after uncemented hip arthroplasty: a case report. J Bone Joint Surg Am. 1988;70:1238–1242.PubMedGoogle Scholar
  55. 55.
    Walsh AJ, Nikolaou VS, Antoniou J. Inflammatory pseudotumor complicating metal-on-highly cross-linked polyethylene total hip arthroplasty. J Arthroplasty. 2012;27:324.e5–324.e8.Google Scholar
  56. 56.
    Willert HG, Buchhorn GH, Fayyazi A, Flury R, Windler M, Koster G, Lohmann CH. Metal-on-metal bearings and hypersensitivity in patients with artificial hip joints: a clinical and histomorphological study. J Bone Joint Surg Am. 2005;87:28–36.PubMedCrossRefGoogle Scholar
  57. 57.
    Williams S, Leslie I, Isaac G, Jin Z, Ingham E, Fisher J. Tribology and wear of metal-on-metal hip prostheses: influence of cup angle and head position. J Bone Joint Surg Am. 2008;90:111–117.PubMedCrossRefGoogle Scholar
  58. 58.
    Zywiel MG, Sayeed SA, Johnson AJ, Schmalzried TP, Mont MA. Survival of hard-on-hard bearings in total hip arthroplasty. Clin Orthop Relat Res. 2011;469:1536–1546.PubMedCrossRefGoogle Scholar

Copyright information

© The Association of Bone and Joint Surgeons® 2013

Authors and Affiliations

  • Jacob M. Elkins
    • 1
    • 2
  • John J. Callaghan
    • 1
    • 2
    • 3
  • Thomas D. Brown
    • 1
    • 2
    • 4
  1. 1.Department of Orthopaedics and RehabilitationUniversity of IowaIowa CityUSA
  2. 2.Department of Biomedical EngineeringUniversity of IowaIowa CityUSA
  3. 3.Iowa City Veterans Administration Medical CenterIowa CityUSA
  4. 4.Orthopaedic Biomechanics LaboratoryUniversity of IowaIowa CityUSA

Personalised recommendations