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No Difference in Conventional Polyethylene Wear Between Yttria-stabilized Zirconia and Cobalt-chromium-molybdenum Femoral Heads at 10 Years

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HSS Journal ®



Concerns have arisen regarding deterioration of wear properties of yttria-stabilized zirconia (YSZ) femoral head on conventional polyethylene (PE) bearings due to YSZ phase transformation.


The purpose of this study was to determine if there is a difference in long-term PE wear properties between YSZ and cobalt-chromium-molybdenum (Co-Cr-Mo) femoral heads.


Ten-year radiographic wear assessment was performed on a cohort of patients enrolled in a prospective randomized clinical trial comparing total hip arthroplasty with YSZ or Co-Cr-Mo femoral heads on conventional, non-cross-linked PE.


PE linear wear, annualized wear, and steady-state wear rates remained low and similar between groups. No cases of osteolysis were observed.


Measured conventional PE wear was similar between YSZ and Co-Cr-Mo femoral heads with the steady-state wear rates for both remaining below the generally accepted threshold at which osteolysis typically occurs. Whether clinically relevant phase transformation with YSZ femoral heads occurs is uncertain; however, the use of YSZ femoral heads in this study was not associated with increased PE wear, osteolysis, or deterioration of wear properties.

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  1. Allain J, Le Mouel S, Goutallier D, Voisin MC. Poor eight-year survival of cemented zirconia-polyethylene total hip replacements. J Bone Joint Surg Br. 1999;81:835–842.

  2. Cohn RM, González Della Valle A, Peterson M, Cornell CN. Similar wear in total hip arthroplasties with metallic or zirconia femoral heads. HSS Jrnl. 2008;4:107–111.

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

  4. Fukatsu K, Pezzotti G, Hayaishi Y, Sugano N. Evaluation of phase stability in Zirconia femoral heads from different manufacturers after in vitro testing or in vivo retrieval. J Arthroplast. 2009;24:1225–1230.

  5. Fukui K, Kaneuji A, Sugimori T, Ichiseki T, Matsumoto T. Retrieval analysis of new-generation yttria-stabilized Zirconia femoral heads after total hip arthroplasty. Eur J Orthop Surg Traumatol. 2014;24:1197–1202.

  6. Geerdink CH, Grimm B, Vencken W, Heyligers IC, Tonino AJ. The determination of linear and angular penetration of the femoral head into the acetabular component as an assessment of wear in total hip replacement: A comparison of four computer-assisted methods. J Bone Joint Surg Br. 2008;90:839–846.

    Article  CAS  PubMed  Google Scholar 

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

  8. Hernigou P, Bahrami T. Zirconia and alumina ceramics in comparison with stainless-steel heads. Polyethylene wear after a minimum ten-year follow-up. J Bone Joint Surg Br. 2003;85:504–509.

  9. Kadar T, Dybvik E, Hallan G, Furnes O, Havelin LI. Head material influences survival of a cemented total hip prosthesis in the Norwegian arthroplasty register. Clin Orthop Relat Res. 2012;470:3007–3013.

  10. Kim Y-H. Comparison of polyethylene wear associated with cobalt-chromium and zirconia heads after total hip replacement. A prospective, randomized study. J Bone Joint Surg Am. 2005;87:1769–1776.

  11. Kim YH, Kim JS. Tribological and material analyses of retrieved alumina and zirconia ceramic heads correlated with polyethylene wear after total hip replacement. J Bone Joint Surg Br. 2008;90:731–737.

  12. Kraay MJ, Moore RD, Martell JM, Rimnac CM. Reassessment of computerized wear measurement for total hip arthroplasty with correction for projectional image distortion: a brief follow-up report. J Bone Joint Surg Am. 2010;92:1858–1867.

  13. Kraay MJ, Thomas RD, Rimnac CM, Fitzgerald SJ, Goldberg VM. Zirconia versus Co-Cr femoral heads in total hip arthroplasty. Clin Orthop Relat Res. 2006;453:86–90.

    Article  PubMed  Google Scholar 

  14. Kurtz SM, Kocagöz S, Arnholt C, Huet R, Ueno M, Walter WL. Advances in zirconia toughened alumina biomaterials for total joint replacement. J Mech Behav Biomed Mater. 2014;31:107–116.

    Article  CAS  PubMed  Google Scholar 

  15. Masonis JL, Bourne RB, Ries MD, McCalden RW, Salehi A, Kelman DC. Zirconia femoral head fractures: a clinical and retrieval analysis. J Arthroplast. 2004;19:898–905.

    Article  Google Scholar 

  16. Roy ME, Whiteside LA, Katerberg BJ. Not all zirconia femoral heads degrade in vivo. Clin Orthop Relat Res. 2007;465:220–226.

  17. Schmalzried TP, Huk OL. Patient factors and wear in total hip arthroplasty. Clin Orthop Relat Res. 2004:94–97.

  18. Stilling M, Nielsen KA, Søballe K, Rahbek O. Clinical comparison of polyethylene wear with zirconia or cobalt-chromium femoral heads. Clin Orthop Relat Res. 2009;467:2644–2650.

  19. Sychterz CJ, Yang A, Engh CA. Analysis of temporal wear patterns of porous-coated acetabular components: Distinguishing between true wear and so-called bedding-in. J Bone Joint Surg Am. 1999;81:821–830.

  20. Ueno M, Iwamoto M, Ikeda J. Influence of complex frictional heating and mechanical stress effect for surface crystalline structure change of zirconia femoral head. Key Eng Mater. 2006;309-311:1239–1242.

    Article  CAS  Google Scholar 

  21. Weber KL, Callaghan JJ, Goetz DD, Johnston RC. Revision of a failed cemented total hip prosthesis with insertion of an acetabular component without cement and a femoral component with cement. A five to eight-year follow-up study. J Bone Joint Surg Am. 1996;78:982–994.

  22. Yoshitomi H, Shikata S, Ito H, Nakayama T, Nakamura T. Manufacturers affect clinical results of THA with zirconia heads: A systematic review. Clin Orthop Relat Res. 2009;467:2349–2355.

    Article  PubMed  PubMed Central  Google Scholar 

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We thank Dr. John Martell for his assistance with the radiographic wear analysis and the late Dr. Victor M. Goldberg for his surgical care of some of the study participants.

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Correspondence to Todd A. Morrison MD.

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Conflict of Interest

Todd A. Morrison, MD; Clare M. Rimnac, PhD; Jia Meng, BS; Rebecca D. Moore, MS have declared that they have no conflict of interest. Matthew J. Kraay, MD, MS, reports a grant from Orthopaedic Research Education Foundation (OREF), during the conduct of the study.

Human/Animal Rights

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 obtained from all patients for being included in the study.

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Level of Evidence: Level II: Randomized Control Trial

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Morrison, T.A., Moore, R.D., Meng, J. et al. No Difference in Conventional Polyethylene Wear Between Yttria-stabilized Zirconia and Cobalt-chromium-molybdenum Femoral Heads at 10 Years. HSS Jrnl 14, 60–66 (2018).

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