The Journal of Arthroplasty
Volume 26, Issue 6, Supplement , Pages 8-13, September 2011

Metal-on-Metal vs Metal-on-Improved Polyethylene Bearings in Total Hip Arthroplasty

  • Ryan G. Molli, DO

      Affiliations

    • Joint Implant Surgeons, Inc., New Albany, Ohio
    • ,
  • Adolph V. Lombardi Jr., MD, FACS

      Affiliations

    • Joint Implant Surgeons, Inc., New Albany, Ohio
    • Mount Carmel Health System, Columbus, Ohio
    • The Ohio State University, Columbus, Ohio
    • Corresponding Author InformationReprint requests: Adolph V. Lombardi, Jr., MD, FACS, Joint Implant Surgeons, Inc., 7277 Smith's Mill Road, Suite 200, New Albany, OH 43054.
    • ,
  • Keith R. Berend, MD

      Affiliations

    • Joint Implant Surgeons, Inc., New Albany, Ohio
    • Mount Carmel Health System, Columbus, Ohio
    • The Ohio State University, Columbus, Ohio
    • ,
  • Joanne B. Adams, BFA

      Affiliations

    • Joint Implant Surgeons, Inc., New Albany, Ohio
    • ,
  • Michael A. Sneller, BS

      Affiliations

    • Joint Implant Surgeons, Inc., New Albany, Ohio

Received 17 September 2010; accepted 20 April 2011. published online 04 July 2011.

Abstract 

Major weaknesses of total hip arthroplasty (THA) in the 20th century were polyethylene wear and dislocation. Efforts to improve THA took several directions including improvement of polyethylene and use of metal-on-metal (MoM) articulations. Metal-on-metal articulations showed excellent early results, but concerns mount over hypersensitivity and increasing failure. This study compares our experience with MoM and metal-on-improved polyethylene (MoIP) bearings in primary THA. We identified 1362 patients undergoing 1589 MoM THA and 693 patients undergoing 779 MoIP THA (all compression molded and sterilized in argon). Overall, more MoM than MoIP cups have been revised (4.0% vs 2.2%; P = .0241). Revision incidence for infection was similar; higher with MoM for loosening (P = .0020), metal complication (P = .0017), and combined aseptic causes (P = .0067); and higher for dislocation in MoIP (P = .0246). Metal-on-improved polyethylene devices had superior results compared with MoM in this study. Furthermore, 5 MoIP revisions were liner exchanges, a conservative option not available with MoM.

Keywords: total hip arthroplasty, acetabular cup, bearing surface, cross-linked polyethylene, metal-on-metal

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 The Conflict of Interest statement associated with this article can be found at doi:10.1016/j.arth.2011.04.029.

PII: S0883-5403(11)00213-0

doi:10.1016/j.arth.2011.04.029

The Journal of Arthroplasty
Volume 26, Issue 6, Supplement , Pages 8-13, September 2011

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