Biomechanical Alignment of Main Wear-Pattern on MOM Total Hip Replacement


  • Paul Burton Arrowhead Orthopedics
  • Erla Medina
  • Michelle Burgett-Moreno
  • Thomas Donaldson
  • Ian Clarke



wear-pattern, alignment, metal-on-metal, heads, total hip


In the majority of retrievals, femoral heads and cups are sent for analysis with no designation as to positioning in-vivo. In addition, when patients retain the femoral prosthesis, evidence of neck impingement damage is lost. In this case report we studied head and cup wear-patterns and stripe damage in a novel case that included a large diameter metal-on-metal THA that was retrieved with the head still fused to the stem. This provided anatomical positioning of head wear-pattern and stripe damage as represented by the orientation of the femoral stem in radiographic images. We investigated (1) size, shape and location of head and cup wear-patterns, (2) cup-to-stem impingement damage, and (3) head stripe-wear. The head wear-pattern was elliptical in shape, 40mm diameter with area covering 2200 Its hemispherical ratio was 56% with aspect ratio 1.2 and typical of large-diameter MOM retrievals. Wear-pattern extended from 12° above superior head-margin to approximately 40° inferior to polar axis. Centroidal vector in coronal plane was 13° posterior to polar axis and in transverse plane was 19° superior to polar axis. These vector data corresponded well with biomechanical predictions of resultant load axes in gait studies. Stripe damage was identified on the head, and the cup rim could thereby be aligned to verify neck impingement and also head subluxation mechanisms. Cup wear-pattern was not centrally contained, indicating this patient had experienced repetitive edge-wear during gait. Thinning of the cup rim by 350- 400?m indicated that posterior impingement with repetitive anterior subluxation of the head had created this edge-wear.

Author Biography

Paul Burton, Arrowhead Orthopedics



Zahiri CA, Schmalzried TP, Ebramzadeh E, Szuszczewicz ES, Salib D, Kim C, Amstutz HC. Lessons learned from loosening of the McKee-Farrar metal-on-metal total hip replacement. J Arthroplasty 1999;14-3:326-32.

Amstutz HC, Grigoris P, Dorey FJ. Evolution and future of surface replacement of the hip. J Orthop Sci 1998;3-3:169-86.

Amstutz HC, Le Duff MJ, Harvey N, Hoberg M. Improved survivorship of hybrid metal-on-metal hip resurfacing with second-generation techniques for Crowe-I and II developmental dysplasia of the hip. J Bone Joint Surg Am 2008;90 Suppl 3:12-20.

Daniel J, Ziaee H, Kamali A, Pradhan C, Band T, McMinn DJW. Ten-year results of a double-heat-treated metal-on-metal hip resurfacing. J Bone Joint Surg Am 2010;92B:20 - 7.

Amstutz HC, Le Duff M, Johnson AJ. Socket position determines hip resurfacing 10-year survivorship. Clinical Orthopaedics and Related Research 2012;470:3127 - 33.

Glyn-Jones S, Pandit H, Kwon YM, Doll H, Gill HS, Murray DW. Risk factors for inflammatory pseudotumour formation following hip resurfacing. J Bone Joint Surg Br 2009;91-B:1566-74.

Langton D, Jameson S, Joyce T, Hallab N, Natu S, Nargol A. Early failure of metal-on-metal bearings in hip resurfacing and large-diameter total hip replacement. A consequence of excess wear. Journal of Bone and Joint Surgery Br 2010;92-B:38 - 46.

Hart AJ, Hester T, Sinclair K, Powell JJ, Goodship AE, Pele L, Fersht NL, Skinner J. The association between metal ions from hip resurfacing and reduced T-cell counts. J Bone Joint Surg Br 2006;88-4:449-54.

De Smet K, De Haan R, Calistri A, Campbell PA, Ebramzadeh E, Pattyn C, Gill HS. Metal ion measurement as a diagnostic tool to identify problems with metal-on-metal hip resurfacing. J Bone Joint Surg Am 2008;90 Suppl 4:202-8.

MHRA. Press release: MHRA issues new advice to surgeons about metal-on-metal total hip replacements. Medicines and Healthcare products Regulatory Agency, 2012.

Shimmin AJ, Walter WL, Esposito C. The influence of the size of the component on the outcome of resurfacing arthroplasty of the hip. Journal of Bone and Joint Surgery BR 2010;92 -B:469 - 76.

Griffin WL, Nanson CJ, Springer BD, Davies MA, Fehring TK. Reduced articular surface of one-piece cups. A cause of runaway wear and early failure. Clin Orthop Relat Res 2010;468:2328 - 32.

Murray D, Grammatopoulos G, Gundle R, Gibbons CL, Whitwell D, Taylor A, Glyn-Jones S, Pandit HG, Ostlere S, Gill H, Athanasou NA, McLardy-Smith P. Hip resurfacing and pseudotumour. ISSN 2011:279 -83.

Langton DJ, Sprowson AP, Joyce TJ, Reed M, Carluke I, Partington P, Nargol AV. Blood metal ion concentrations after hip resurfacing arthroplasty: a comparative study of articular surface replacement and Birmingham Hip Resurfacing arthroplasties. J Bone Joint Surg Br 2009;91-10:1287-95.

Morlock MM, Bishop NE, Zustin J, Hahn M, Ruther W, Amling M. Modes of Implant Failure After Hip Resurfacing: Morphological and Wear Analysis of 267 Retrieval Specimens. J Bone Joint Surg Am 2008;90:89 -95.

Mellon SJ, Kwon YM, Glyn-Jones S, Murray DW, Gill HS. The effect of motion patterns on edge-loading of metal-on-metal hip resurfacing. Medical Engineering & Physics 2011;33:1212 - 20.

Kwon YM, Mellon SJ, Monk P, Murray DW, Gill HS. In vivo evaluation of edge-loading in metal-on-metal hip resurfacing patients with pseudotumours. Bone Joint Res. 2012;1-4:42 -9.

Underwood RJ, Zografos A, Sayles RS, Hart A, Cann P. Edge loading in metal-on-metal hips: low clearance is a new risk factor. J Eng in Med 2012;226-3:217 - 6.

De Haan R, Pattyn C, Gill HS, Murray DW, Campbell PA, De Smet K. Correlation between inclination of the acetabular component and metal ion levels in metal-on-metal hip resurfacing replacement. J Bone Joint Surg Br 2008;90-10:1291-7.

McKellop HA, Campbell P, Park SH, Schmalzried TP, Grigoris P, Amstutz HC, Sarmiento A. The origin of submicron polyethylene wear debris in total hip arthroplasty. Clin Orthop 1995-311:3-20.

McKellop HA, ed. Distinguishing among wear modes, wear mechanisms and wear damage in prosthetic joints. 2011:103 - 13.

Shishido T, Clarke IC, Williams P, Boehler M, Asano T, Shoji H, Masaoka T, Yamamoto K, Imakiire A. Clinical and simulator wear study of alumina ceramic THR to 17 years and beyond. J Biomed Mater Res 2003;67B-1:638-47.

Tateiwa T, Clarke IC, Pezzotti G, Sedel L, Kumakura T, Shishido T, Yamamoto K. Surface micro-analyses of long-term worn retrieved “Osteal (TM)” alumina ceramic total hip replacement. Journal of Biomedical Materials Research Part B-Applied Biomaterials 2007;83B-2:562-70.

Dorlot JM, Christel P, Meunier A. Wear analysis of retrieved alumina heads and sockets of hip prostheses. J Biomed Mater Res 1989;23-A3 Suppl:299-310.

Nevelos JE, Ingham E, Doyle C, Fisher J, Nevelos AB. Analysis of retrieved alumina ceramic components from Mittelmeier total hip prostheses. Biomaterials 1999;20-19:1833-40.

Walter WL, Insley GM, Walter WK, Tuke MA. Edge loading in third generation alumina ceramic-on-ceramic bearings: stripe wear. J Arthroplasty 2004;19-4:402-13.

Manaka M, Clarke IC, Yamamoto K, Shishido T, Gustafson A, Imakiire A. Stripe wear rates in alumina THR--comparison of microseparation simulator study with retrieved implants. J Biomed Mater Res 2004;69B-2:149-57.

McKellop H, Park S, Chiesa R, Doorn P, Lu B, Normand P, Grigoris P, Amstutz H. In vivo wear of 3 types of metal on metal hip prostheses during 2 decades of use. Clinical Orthopaedics and Related Research 1996;329S:128 - 40.

Glyn-Jones S, Roques A, Gill R, Taylor A, Whitwell D, Esposito C, Walter W, Tuke M, Murray D. Metal on metal hip resurfacing arthroplasty-related pseudotumours are associated with increased bearing surface wear, caused by impingement and edge-loading. 56th Annual Meeting of the ORS. 2010:Poster No. 2164.

Tuke M, Taylor A, Roques A, Maul C. 3D linear and volumetric wear measurement on artificial hip joints - Validation of a new methodology. Precision Engineering. Elsevier, 2010:777 - 83.

Clarke IC, Donaldson TK, Burgett MD, Smith EJ, Bowsher J, Savisaar C, John A, Lazennec JY, McPherson E, Peters CL. Normal and Adverse Wear Patterns Created In-vivo on MOM Surfaces - a retrieval study representing four vendors. In: Metal-on-Metal Total Hip Replacement Devices. (Ed. Kurtz SM, Greenwald SA, Mihalko WM, Lemons JA). ASTM International: West Conshohocken, PA; 2013 STP1560; 157-92.

McHugh D, Currier J, Kennedy F, Collier J, Van Critters D. Plastic Deformation from Edge Loading is common on Retrieved Metal-on-Metal Hips and Can Be Predicted with Finite Element Analysis. In: Metal-on-Metal Total Hip Replacement Devices. (Ed. Kurtz SM, Greenwald SA, Mihalko WM, Lemons JA). ASTM International: West Conshohocken, PA; 2013 STP1560; 157-92.

Heiner A D, Kruger K M, Tikekar N M, Lannutti J J, Callaghan J J, Brown T D. Uncertainty of Head Orientation on the Trunnion Undermines Reliability of Case-Specific Retrieval Wear Simulations. 59th Annual Meeting of the ORS. 2013:Poster No. 1027.

Bowsher J G, Clarke I C, Williams P A, Donaldson T K. What is a “normal” wear pattern for metal-on-metal hip bearings? J Biomed Mater Res B Appl Biomater 2009; 91 (1): 297-308.

Clarke I C, Lazennec J Y, Brusson A, Savisaar C, Bowsher J G, Burgett M, et al. Risk of Impingement and Third-body Abrasion With 28-mm Metal-on-metal Bearings. Clin Orthop Relat Res 2014; 472 (2): 497-508.

Bergmann G, Deuretzbacher G, Heller M, Graichen F, Rohlmann A, Strauss J, et al. Hip contact forces and gait patterns from routine activities. J Biomech 2001; 34 (7): 859-71

Paul J P. Biomechanics. The biomechanics of the hip-joint and its clinical relevance. Proc R Soc Med 1966; 59 (10): 943-8.




How to Cite

Burton, P., Medina, E., Burgett-Moreno, M., Donaldson, T., & Clarke, I. (2015). Biomechanical Alignment of Main Wear-Pattern on MOM Total Hip Replacement. Reconstructive Review, 5(2).



Case Report