Tribochemical reaction on metal-on-metal hip joint bearings: A comparison between in-vitro and in-vivo results

Metal-on-metal (MOM) hip joint bearings are considered one of the alternatives to the generally used metal-on-polyethylene bearings. In order to control and minimize wear of MOM bearings, an in-depth understanding of the acting wear mechanisms is essential. In a recent study it was suggested that layers of decomposed proteins are generated due to high pressures between contact spots of the cobalt–chromium alloy bearing. It was further suggested that these tribochemical reaction products greatly influence the wear behavior of the MOM articulation. Since these conclusions were limited to in-vitro test observations, the purpose of this study was to compare retrieved McKee–Farrar prostheses with the previously utilized in-vitro specimens to investigate tribochemical layer presence, composition and role in the overall wear process. Forty-two retrieved McKee–Farrar prostheses with a complete clinical record were compared to the in-vitro specimens. Ninety-three percent of the cups and 83% of the heads of the retrieval collection showed macroscopically and microscopically similar layers than the in-vitro bearings. SEM revealed a varying layer thickness with scratched or smeared sections. Combined SEM and EDS analysis suggested the presence of carbon and oxygen in most of the layers, while some layers showed traces of sodium, magnesium, calcium, nitrogen, sulfur, phosphorus and chlorine, too. These observations were quantitatively verified using XPS. By means of protein standards the organic origin of the layers was shown. Since the latter covered large areas of the contacting surfaces, adhesion is minimized and abrasion is reduced. Thus, the layers have a solid lubricating effect and the general wear behavior of the MOM bearing is affected by generation and delamination of the tribochemical reaction layers.