Ceramic Bearings with Titanium Adapter Sleeves Implanted During Revision Hip Arthroplasty Show Minimal Fretting or Corrosion: a Retrieval Analysis



The BIOLOX® option system, consisting of a BIOLOX® delta ceramic femoral head with a titanium alloy adapter sleeve, is being increasingly utilized in revision hip arthroplasty. The sleeve protects the ceramic head from fracture and improper motion about the stem trunnion when a damaged trunnion is encountered at revision surgery. Corrosion and fretting due to metal-metal contact at the taper region of hip prosthesis create the potential of causing periprosthetic osteolysis and adverse local tissue reactions.


The objective of this study was to identify the type and extent of damage to retrieved sleeves and ceramic heads to determine their in vivo performance.


Twenty-four ceramic heads with titanium alloy sleeves were examined. The articular and taper surfaces for each ceramic head were assessed for metal transfer using a subjective grading system. All surfaces of the 24 titanium sleeves and stem trunnions (only available for 7 of 24 cases) were assessed for corrosion and fretting using an established grading system. Scanning electron microscopy and energy dispersive X-ray analysis were conducted on representative sample of sleeves.


Fretting and corrosion were higher at the inner surface of the taper sleeve than the outer sleeve. Mean fretting scores at the inner taper and outer taper sleeve surfaces were 1.8 and 1.2, respectively. The mean corrosion score at the inner taper surface was 1.8; no corrosion was observed on the outer surface of any taper sleeve. SEM and EDS analyses provided further indications of low levels of damage.


Fretting and corrosion were less severe than previously reported for conventional THA metal-metal taper connections, indicating that a ceramic head and titanium sleeve is a safe alternative in revision THA.

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This study was partially funded by the Mary and Fred Trump Institute for implant analysis. The authors thank Elexis Baral for her assistance damage scoring.

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Corresponding author

Correspondence to Chelsea N. Koch BS.

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Conflict of Interest

Chelsea N. Koch, BS; Mark Figgie Jr., BS; and Marcella E. Elpers, BS have declared that they have no conflict of interest. Timothy M. Wright, PhD, reports other from Exactech, Inc., Orthobond, Stryker, and Wolters Kluwer Health-Lippincott Willians & Wilkins, outside the work. In addition, Dr. Wright reports patents and royalty payments from Exactech, Inc., Lima, and Mathys Ltd. Douglas E. Padgett, MD, reports personal fees from DJO, PixarBio, and Stryker, outside the work. Mark P. Figgie, MD, reports other from Mekanika, outside the work. In addition, Dr. Figgie reports a patent with Lima and receives royalties.

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All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008 (5).

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Informed consent was waived from all patients for being included in the study.

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Koch, C.N., Figgie, M., Figgie, M.P. et al. Ceramic Bearings with Titanium Adapter Sleeves Implanted During Revision Hip Arthroplasty Show Minimal Fretting or Corrosion: a Retrieval Analysis. HSS Jrnl 13, 241–247 (2017). https://doi.org/10.1007/s11420-017-9566-4

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  • total hip arthroplasty
  • retrieval analysis
  • fretting
  • corrosion
  • adapter sleeve