Clinical wear behaviour of ultra-high molecular weight polyethylene cups paired with metal and ceramic ball heads in comparison to metal-on-metal pairings of hip joint replacements

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Abstract
In the course of 30 years of hip endoprosthetics, a number of material combinations for the cups and balls of total hip prostheses have proven successful under clinical conditions. Favourably priced hip prostheses with polyethylene cups and metal balls are available for older patients with a moderate range of activity. Polyethylene wear of 100-300 μm/year is to be expected with these models. Ceramic balls (aluminium oxide for diameters 32 and 28 mm and zirconium oxide for 22 mm) paired with polyethylene cups are recommended for patients with a life expectancy of 10 to 20 years, because the expected polyethylene wear rate with this material combination is only 50-150 μm/year. In other words, the life cycle of the polyethylene cup is doubled, when it is paired with a ceramic ball. A similar polyethylene wear rate is also to be expected with oxygen-deep-hardened TiAlNb metal balls, which are currently the subject of a clinical field study. Last but not least, CoCrMoC metal-metal and Al2O3 ceramic-ceramic pairings, which have the lowest wear rate of 2-20 μm/year, are available for highly active patients with a life expectancy of more than 20 years. As far as the cup-ball pairing is concerned and under the current pressure of costs, the surgeon should be able to select the optimum hip prosthesis model for every patient from these three categories.

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