Similar Wear in Total Hip Arthroplasties with Metallic or Zirconia Femoral Heads


Ceramic femoral heads have been used in an attempt at reducing polyethylene wear of total hip arthroplasties. Clinical results with zirconia femoral heads have been mixed. This study was undertaken to compare the polyethylene wear and incidence of periprosthetic osteolysis in total hip replacements performed using a 28-mm zirconia versus a 28-mm cobalt chromium femoral head. Thirty-five hips with a 28-mm cobalt chromium head and 68 hips with a 28-mm zirconia head were evaluated after a minimum follow-up of 2 years (average, 4.0 years; range, 2.0 to 9.1 years). A monoblock acetabular component was used in all patients. Polyethylene wear was measured in serial radiographs from 58 of the hips utilizing a computer-assisted vector wear technique. Periacetabular osteolysis developed in three patients (two with a zirconia head and one with a cobalt chromium head). The total wear and the annual wear rate were 0.48 mm and 0.11 mm/year for the cobalt chromium heads and 0.53 mm and 0.14 mm/year for the zirconia heads, respectively. We found no benefit with respect to the rate of polyethylene wear or incidence of osteolysis with the use of zirconia femoral heads.

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  1. 1.

    Ackland MK, Bourne WB, Uhthoff HK (1986) Anteversion of the acetabular cup: measurement of angle after total hip replacement. J Bone Jt Surg Br 68:409–413

    CAS  Google Scholar 

  2. 2.

    Allain J, Le Mouel S, Goutallier D, Voisin MC (1999) Poor eight-year survival of cemented zirconia-polyethylene total hip replacements. J Bone Jt Surg Br 81:835–842, doi:10.1302/0301-620X.81B5.9454

    Article  CAS  Google Scholar 

  3. 3.

    Chevalier J, Cales B, Drouin JM (1999) Low-temperature aging of Y-TZP ceramics. J Am Ceram Soc 82:2150–2204

    CAS  Google Scholar 

  4. 4.

    Chowdhury S, Vohra YK, Lemons JE, Ueno M, Ikeda J (2007) Accelerating aging of zirconia femoral head implants: change of surface structure and mechanical properties. J Biomed Mater Res B Appl Biomater 81:486–492

    PubMed  CAS  Google Scholar 

  5. 5.

    DeLee JG, Charnley J (1976) Radiological demarcation of cemented sockets in total hip replacement. Clin Orthop Relat Res 121:20–32

    PubMed  Google Scholar 

  6. 6.

    Della Valle AG, Doty S, Gradl G, Labissiere A, Nestor BJ (2004) Wear of a highly cross-linked polyethylene liner associated with metallic deposition on a ceramic femoral head. J Arthroplasty 19:532–536, doi:10.1016/j.arth.2003.12.065

    PubMed  Article  Google Scholar 

  7. 7.

    Dumbleton JH, Manley MT, Edidin AA (2002) A literature review of the association between wear rate and osteolysis in total hip arthroplasty. J Arthroplasty 17:649–661, doi:10.1054/arth.2002.33664

    PubMed  Article  Google Scholar 

  8. 8.

    Fernandez-Fairen M, Sala P, Gil FJ (2006) Failures of yttria-stabilised tetragonal zirconia: 52 retrieved ceramic femoral heads of total hip prostheses. Biomed Mater Eng 16:415–422

    PubMed  CAS  Google Scholar 

  9. 9.

    Gonzalez Della Valle A, Su E, Zoppi A, Sculco TP, Salvati EA (2004) Wear and periprosthetic osteolysis in a match-paired study of modular and nonmodular uncemented acetabular cups. J Arthroplasty 19:972–977, doi:10.1016/j.arth.2004.06.001

    PubMed  Article  Google Scholar 

  10. 10.

    Gruen TA, McNeice GM, Amstutz HC (1979) “Modes of failure” of cemented stem-type femoral components: a radiographic analysis of loosening. Clin Orthop Relat Res 141:17–27

    PubMed  Google Scholar 

  11. 11.

    Hamadouche M, Sedel L (2000) Ceramics in orthopaedics. J Bone Jt Surg Br 82:1095–1099, doi:10.1302/0301-620X.82B8.11744

    Article  CAS  Google Scholar 

  12. 12.

    Haraguchi K, Sugano N, Nishii T, Miki H, Oka K, Yoshikawa H (2001) Phase transformation of a zirconia ceramic head after total hip arthroplasty. J Bone Jt Surg Br 83:996–1000, doi:10.1302/0301-620X.83B7.12122

    Article  CAS  Google Scholar 

  13. 13.

    Hernigou P, Bahrami T (2003) Zirconia and alumina ceramics in comparison with stainless-steel heads: polyethylene wear after a minimum ten-year follow-up. J Bone Jt Surg Br 85:504–509, doi:10.1302/0301-620X.85B4.13397

    Article  CAS  Google Scholar 

  14. 14.

    Inoue A, Asaumi K, Endo H, Fujiwara K, Mitani S, Ozaki T (2006) Assessment of head wear more than ten years after total hip arthroplasty: 22-mm zirconia vs. metal heads. Acta Med Okayama 60:311–318

    PubMed  Google Scholar 

  15. 15.

    Kim YH (2005) Comparison of polyethylene wear associated with cobalt-chromium and zirconia heads after total hip replacement: a prospective, randomized study. J Bone Jt Surg Am 87:1769–1776, doi:10.2106/JBJS.D.02572

    Article  Google Scholar 

  16. 16.

    Kim YH, Kim JS, Cho SH (2001) A comparison of polyethylene wear in hips with cobalt-chrome or zirconia heads: a prospective, randomised study. J Bone Jt Surg Br 83:742–750, doi:10.1302/0301-620X.83B5.10941

    Article  CAS  Google Scholar 

  17. 17.

    Kraay MJ, Thomas RD, Rimnac CM, Fitzgerald SJ, Goldberg VM (2006) Zirconia versus Co-Cr femoral heads in total hip arthroplasty: early assessment of wear. Clin Orthop Relat Res 453:86–90, doi:10.1097/01.blo.0000246544.95316.1f

    PubMed  Article  Google Scholar 

  18. 18.

    Liang B, Kawanabe K, Ise K, Iida H, Nakamura T (2007) Polyethylene wear against alumina and zirconia heads in cemented total hip arthroplasty. J Arthroplasty 22:251–257, doi:10.1016/j.arth.2006.03.004

    PubMed  Article  Google Scholar 

  19. 19.

    Maloney WJ, Galante JO, Anderson M et al (1999) Fixation, polyethylene wear, and pelvic osteolysis in primary total hip replacement. Clin Orthop Relat Res 369:157–164, doi:10.1097/00003086-199912000-00016

    PubMed  Article  Google Scholar 

  20. 20.

    Martell JM, Berdia S (1997) Determination of polyethylene wear in total hip replacements with use of digital radiographs. J Bone Jt Surg Am 79:1635–1641

    CAS  Google Scholar 

  21. 21.

    Masonis JL, Bourne RB, Ries MD, McCalden RW, Salehi A, Kelman DC (2004) Zirconia femoral head fractures: a clinical and retrieval analysis. J Arthroplasty 19:898–905, doi:10.1016/j.arth.2004.02.045

    PubMed  Article  Google Scholar 

  22. 22.

    Orishimo KF, Claus AM, Sychterz CJ, Engh CA (2003) Relationship between polyethylene wear and osteolysis in hips with a second-generation porous-coated cementless cup after seven years of follow-up. J Bone Jt Surg Am 85:1095–1099

    Google Scholar 

  23. 23.

    Santos EM, Vohra S, Catledge SA, McClenny MD, Lemons J, Moore KD (2004) Examination of surface and material properties of explanted zirconia femoral heads. J Arthroplasty 19(Suppl 2):30–34, doi:10.1016/j.arth.2004.06.017

    PubMed  Article  Google Scholar 

  24. 24.

    Sochart DH (1999) Relationship of acetabular wear to osteolysis and loosening in total hip arthroplasty. Clin Orthop Relat Res 363:135–150, doi:10.1097/00003086-199906000-00018

    PubMed  Article  Google Scholar 

  25. 25.

    Wroblewski BM, Fleming PA, Siney PD (1999) Charnley low-frictional torque arthroplasty of the hip: 20-to-30 year results. J Bone Jt Surg Br 81:427–430, doi:10.1302/0301-620X.81B3.9521

    Article  CAS  Google Scholar 

  26. 26.

    Wroblewski M, Siney PD, Nagai H, Fleming PA (2004) Wear of ultra-high-molecular-weight polyethylene cup articulating with 22.225 mm zirconia diameter head in cemented total hip arthroplasty. J Orthop Sci 9:253–255, doi:10.1007/s00776-004-0777-4

    PubMed  Article  CAS  Google Scholar 

  27. 27.

    Yoshimura M, Noma T, Kawabata K, Somiya S (1987) Role of H2O on the degradation process of Y-TZP. J Mater Sci Lett 6:465–467, doi:10.1007/BF01756800

    Article  CAS  Google Scholar 

  28. 28.

    Zhou J, Mah J, Shrotriya P, Mercer C, Soboyejo WO (2007) Contact damage in an yttria stabilized zirconia: implications. J Mater Sci Mater Med 18:71–78, doi:10.1007/s10856-006-0664-y

    PubMed  Article  CAS  Google Scholar 

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The authors thank Hilary Gamble for her help in preparing this manuscript.

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Correspondence to Charles N. Cornell MD.

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Cohn, R.M., González Della Valle, A., Peterson, M. et al. Similar Wear in Total Hip Arthroplasties with Metallic or Zirconia Femoral Heads. HSS Jrnl 4, 107–111 (2008).

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  • polyethylene wear
  • zirconia
  • cobalt chrome
  • femoral head