Microseparation and stripe wear in alumina-on-alumina hip implants

The combination of materials that still has highest wear resistance for total hip replacement is ceramic-on-ceramic. However, brittleness is a major concern for ceramics: in vivo and in vitro studies on ceramic hip prostheses correlate microseparation with hip noise, ceramic wear, or ceramic liner damage. Ceramic microseparation can lead to edge load, ceramic head wear, and squeaking. The aim of this in vitro study was to investigate whether different angles of inclination influence the wear pattern of alumina-on-alumina hip joints with micro-separation during the swing phase. We also evaluated the wear rate obtained from this in vitro investigation with retrieval specimens obtained at 13 years' mean follow-up. The study was performed using a 12-station hip joint wear simulator (Shore Western, Monrovia, CA, USA) under bovine calf serum used as lubricant. Wear was evaluated by the gravimetric method and the test length was set at two million cycles. After two million cycles, a volumetric loss of 0.11 ±0.03 mm3 and 0.12 ±0.06 mm3 was observed, respectively, for 23° and 63° angles of inclination. In particular, the results obtained in this work revealed an increase of about 12-fold compared to previous results without microseparation conditions. No significant differences were observed between the two different inclinations on the wear patterns of the acetabular cups with a level of significance of a = 0.5. The location and general shape of the stripes wear were similar for the retrieved and simulator balls.