The Journal of Bone and Joint Surgery (American). 2005;87:1769-1776.
doi:10.2106/JBJS.D.02572
© 2005 The Journal of Bone and Joint Surgery, Inc.
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Comparison of Polyethylene Wear Associated with Cobalt-Chromium and Zirconia Heads After Total Hip Replacement

A Prospective, Randomized Study

Young-Hoo Kim, MD1

1 The Joint Replacement Center of Korea, Ewha Womans University Dong Dae Mun Hospital, 70, ChongRo 6-Ga, ChongRo-Gu, Seoul 110-783, Republic of Korea. E-mail address: younghookim{at}ewha.ac.kr

Investigation performed at The Joint Replacement Center of Korea, Ewha Womans University College of Medicine, Seoul, Republic of Korea

A commentary is available with the electronic versions of this article, on our web site (www.jbjs.org) and on our quarterly CD-ROM (call our subscription department, at 781-449-9780, to order the CD-ROM).

The author did not receive grants or outside funding in support of his research or preparation of this manuscript. He did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the author is affiliated or associated.

Background: A ceramic femoral head is an alternative to a metal femoral head for the bearing surface of total hip arthroplasty. The purpose of this study was to compare polyethylene wear in patients who had undergone bilateral total hip arthroplasty with implants that differed only with regard to the material used for the femoral head: a zirconia head was used on one side, and a cobalt-chromium head was inserted on the contralateral side.

Methods: A prospective, randomized study was performed to evaluate the outcomes in fifty-two patients who had undergone sequential bilateral primary total hip replacement. A zirconia head was used in one hip, and a cobalt-chromium head was used in the other. There were forty-eight men and four women; the mean age at the time of surgery was 44.2 years. The mean duration of follow-up was 7.1 years. Clinical and radiographic evaluations were performed preoperatively and at six weeks; three, six, and twelve months; and yearly postoperatively. Linear wear of the polyethylene liner was measured radiographically. Two femoral components with a zirconia head had aseptic loosening and were revised. The explanted heads were evaluated with use of interferometry, environmental scanning electron microscopy, and x-ray diffraction studies.

Results: The mean polyethylene wear rate was 0.08 mm/yr in association with the zirconia heads and 0.17 mm/yr in association with the cobalt-chromium heads (p = 0.004). The mean amount of volumetric polyethylene wear was 350.8 mm3 in association with the zirconia heads and 744.7 mm3 in association with the cobalt-chromium heads (p = 0.004). With regard to surface roughness, the Ra values of the two explanted zirconia heads were 15.87 and 17.35 nm and the Rpm values were 153.86 and 156.18 nm. Two identical zirconia heads that had not been implanted had Ra values of 5.31 and 5.48 nm and Rpm values of 65.27 and 66.35 nm. Four unimplanted cobalt-chromium heads that were identical to the ones implanted in this study had Ra values ranging between 25 and 50 nm and Rpm values ranging between 262.6 and 525.2 nm. Little phase transformation was noted in the two revised zirconia heads.

Conclusions: The mean amount and rate of polyethylene wear were significantly lower in the hips with a zirconia head than they were in the hips with a cobalt-chromium head, presumably because the zirconia heads had a smoother articulating surface.

Level of Evidence: Therapeutic Level I. See Instructions to Authors for a complete description of levels of evidence.


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R. A. Poggie, T. R. Turgeon, and R. D. Coutts
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