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8th Combined Meeting Of Orthopaedic Research Societies (CORS)


Summary Statement

The frictional torque of ceramic-on-ceramic bearings tended to increase with increasing the bearings size (32, 48, 56mm). However, the frictional torque was significantly lower than that measured on metal-on-metal bearings under well positioned and well lubricated conditions.


Larger head size in total hip replacement theoretically provides increased range of motion and enhanced stability. However, there are potential clinical concerns regarding increased frictional torques with large diameter metal-on-metal bearings causing loosening of the acetabular cups and corrosion at the taper. The aim of this study was to determine the frictional torques of large diameter BIOLOX® delta ceramic-on-ceramic bearings.

Materials and Methods

The single-station pendulum friction simulator (SimSol, UK) was used to determine the frictional torque of three ceramic-on-ceramic bearing sizes: 32mm and 48mm (DeltaMotion®, DePuy Synthes Joint Reconstruction, Leeds, UK) and a 56mm prototype design. Four repeats were tested for each bearing size using 100% new-born calf serum, 25% new-born calf serum and water as lubricants. The input profiles were a simplified loading regime with a peak of 2kN and an angular motion of ±25° [1]. The frictional torque was determined under swing phase loads of 25N, 100N or 300N. The bearings were tested under standard conditions where the cup was positioned so the face was horizontal to the loading axis and at an inclination angle equivalent to 65° in vivo.


When lubricated with 100% serum, size 48mm bearings showed similar frictional toque to the 32mm bearings (1.5Nm and 1.7Nm respectively, p=0.28), however, the frictional torque of the 56mm prototype design bearings was significantly higher (2.2Nm, p=0.01). When using 25% serum, there was a trend of increased frictional torque (p=0.016) with increased head size; increasing from 1.2 Nm to 1.5 Nm to 1.9 Nm for the 32mm, 48mm, and 56mm bearings respectively. The frictional torque significantly decreased when water was used compared to using new-born calf serum as lubricant. There was no significant difference in the frictional torque between all bearings sizes with water as lubricant, however, there was a trend of increased frictional torque with increased swing phase load. Changing the swing phase load had no influence on the frictional torques obtained for all bearing sizes when using 100% or 25% new-born calf serum. Under a steep inclination angle, the frictional torque for all bearing sizes did not significantly change compared to the flat cup condition.

Discussion and Conclusion

The frictional torque tended to increase with increased head size. The highest frictional torque measured in this study was 2.5Nm for the 56mm ceramic-on-ceramic bearing (25% serum, steep cup) compared to 5.3Nm maximum torque measured using the same method for well-positioned and well lubricated 54mm metal-on-metal bearings. The frictional torque for all ceramic-on-ceramic bearing sizes (32mm, 48mm, and 56mm) decreased as the concentration of protein decreased. This was consistent with previous work done on 28mm bearings and the understanding that for ceramic-on-ceramic bearings the adherence of proteins to the surface reduces the effectiveness of lubricant film thickness, thus resulting in higher frictional torques due to the force required to shear the proteins.