The Otto Aufranc Award. Wear and lubrication of metal-on-metal hip implants.

The implication of polyethylene wear particles as the dominant cause of periprosthetic osteolysis has created a resurgence of interest in metal-on-metal implants for total hip arthroplasty because of their potential for improved wear performance. Twenty-two cobalt chromium molybdenum metal-on-metal implants were custom-manufactured and tested in a hip simulator. Accelerated wear occurred within the first million cycles followed by a marked decrease in wear rate to low steady-state values. The volumetric wear at 3 million cycles was very small, ranging from 0.15 to 2.56 mm3 for all implants tested. Larger head-cup clearance and increased surface roughness were associated with increased wear. Independent effects on wear of material processing (wrought, cast) and carbon content were not identified. Implant wear decreased with increasing lambda ratio, a parameter used to relate lubricant film thickness to surface roughness, suggesting some degree of fluid film lubrication during testing. This study provided important insight into the design and engineering parameters that affect the wear behavior of metal-on-metal hip implants and indicated that high quality manufacturing can reproducibly lead to very low wear.