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Metal-on-metal Bearing Surfaces

Perspectives on Modern Orthopaedics articles provide an objective appraisal of new or controversial techniques or areas of investigation in orthopaedic surgery.

Dr. Jacobs is Professor and Chairman, Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL. Mr. Urban is Associate Professor, Department of Orthopaedic Surgery, Rush University Medical Center. Dr. Hallab is Associate Professor, Department of Orthopaedic Surgery, Rush University Medical Center. Ms. Skipor is Instructor, Department of Orthopaedic Surgery, Rush University Medical Center. Dr. Fischer is Professor of Mechanical Engineering, University Essen-Duisburg, Duisberg, Germany. Dr. Wimmer is Associate Professor, Department of Orthopaedic Surgery, Rush University Medical Center.

Joshua J. Jacobs, MD, et al

Reprint requests: Dr. Jacobs, Department of Orthopaedic Surgery, Rush University Medical Center, Suite 1063, 1725 West Harrison Street, Chicago, IL 60612.

Funding for the research described in this review was provided by NIH/NIAMS, Zimmer, Wright Medical, the Crown Family Chair of Orthopaedic Surgery, and the Rush Arthritis and Orthopaedics Institute.  Dr. Jacobs or a member of his immediate family has received research or institutional support from NIH, Zimmer, Medtronic, Advanced Spine Technology, Spinal Motion, and Wright Medical Technology and is a consultant to or an employee of Zimmer and Medtronic. Mr. Urban or a member of his immediate family has received research or institutional support from NIH, Zimmer, and Wright Medical Technology. Dr. Hallab or a member of his immediate family has received research or institutional support from NIH, Zimmer, and Wright Medical Technology; nonincome support (such as equipment or services), commercially derived honoraria, or other non-research–related funding (such as paid travel) from Zimmer and DePuy; has been on a speakers bureau or given paid presentations for Medtronic; and serves as a paid consultant to or is an employee of BioEngineering Solutions, Orthopedic Analysis, and Medtronic. Dr. Wimmer or a member of his immediate family has received research or institutional support from Zimmer, Wright Medical Technology, and Medtronic and serves as an unpaid consultant to Endolab. None of the following authors or a member of their immediate families has received anything of value from or owns stock in a commercial company or institution related directly or indirectly to the subject of this article: Ms. Skipor and Dr. Fischer.

Metal-on-metal bearing couples remain a popular option in total hip arthroplasty and are the only currently available option for surface replacement arthroplasty. In general, the intermediate-term clinical performance of metal-on-metal bearings has been favorable. There are, however, lingering concerns about the biologic consequences of metal release from these bearings in terms of both local tissue effects, including delayed-type hypersensitivity reactions in a subset of patients, and potential systemic effects as a consequence of chronic elevations in serum cobalt and chromium content. Advances in the understanding of the operant wear mechanisms in these bearings provide strategies for reducing the burden of metal released into the periprosthetic milieu, which in turn will mitigate the concerns about the biologic response to the metal debris. Continued surveillance of patients with these bearings is warranted to determine whether metal-on-metal bearing couples provide a long-term survivorship advantage over other bearing couple options and to evaluate whether chronic elevations in the body burden of cobalt and chromium is well tolerated over the long term.

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