Thirty total hip replacements in twenty-eight patients in which a Zirconia/Polyethylene articulation was utilized were compared to a control group undergoing total hip replacement utilizing Cobalt-Chrome/Polyethylene articulation. These patients were matched for gender, BMI and pre-operative diagnosis.

At nine years after implantation there was no difference in the functional outcome between the two groups and no difference in liner wear rate on x-ray (Livermore technique). There was a 27% revision rate in the Zirconia group compared to the 11.5% revision rate in the Cobalt-Chrome group.

Bearing surfaces require long- term clinical follow-up to validate in vitro performance.

To determine the benefit of Zirconia on polyethylene versus cobalt-chrome on polyethylene in total hip articulation.

Zirconia offers no advantage over a cobalt-chrome head in decreasing in vivo polyethylene wear at ten- year follow-up.

Newer bearing surfaces require long- term clinical follow-up to validate in vitro laboratory performance.

All primary total hip replacements at this institution are entered prospectively in a database and are assessed on an annual basis. All patients in this study were followed for a mean of nine years with a range of six to thirteen years.

Thirty cementless total hip arthroplasties were performed in twenty-eight patients utilizing a Zirconia head coupled with a polyethylene acetabular component. Twenty-six hips have been followed for a mean of nine years. These were matched to a control group of twenty-six hips in twenty-six patients utilizing a cobalt-chrome head coupled with an identical polyethylene liner followed for a mean of ten years (range five to fourteen years). There was no functional difference in outcome at nine years between the two groups utilizing the Livermore technique there was no difference in the liner wear rate between the two patient groups. However, seven hips (27%) of the Zirconia group required revision due to loosening and/or extensive osteolysis around the cup and only three hips (11.5%) required revision in the cobalt-chrome group. Our study demonstrates that although changes in component designs and materials may offer theoretical advantages over current components their effect in vivo remains questionable.