Third-body Wear Damage Produced in CoCr Surfaces by Hydroxyapatite and Alumina Ceramic Debris: A 10-cycle Metal-on-Metal Simulator Study

  • Thomas Halim Donaldson Arthritis Research Foundation, 900 E. Washington Street, Suite 200 Colton, CA 92324 US
  • Michelle Burgett-Moreno Donaldson Arthritis Research Foundation, 900 E. Washington Street, Suite 200 Colton, CA 92324 US
  • Thomas Donaldson Donaldson Arthritis Research Foundation, 900 E. Washington Street, Suite 200 Colton, CA 92324 US
  • Ian Clarke
Keywords: ceramic hydroxyapatite alumina debris CoCr, 3rd-body abrasive wear, MOM hip arthroplasty, simulator


Ceramic particles are believed to be particularly abrasive due to their extreme hardness. Ceramic debris has been reported in retrieved total hip arthroplasty (THA) due to chipping and fracture of alumina components or by flaking of hydroxyapatite from implant coatings. However there appears to be no abrasion ranking of such particle behavior. The hypotheses in this study were, i) alumina particles would create large scratches in CoCr surfaces and ii) hydroxyapatite would produce very mild scratching comparable to bone-cement particles. Hydroxyapatite beads came in two types of commercial powders while the flakes were scraped from retrieved femoral stems. Alumina beads came in two commercial powders and flakes were retrieved from a fractured ceramic head. Particle morphologies were determined by SEM and CoCr surface damage by interferometry and SEM. Six 38-mm MOM were mounted inverted in a hip simulator and run with ceramic particles inserted for a 10-second test. Surface-roughness ranking after 10-second abrasion test revealed that bone cement and hydroxyapatite produced least damage to CoCr surfaces while alumina produced the most. Alumina increased surface roughness 19-fold greater than either hydroxyapatite or bone-cement particles. The alumina debris produced numerous scratches typically 20-80 µm wide with some up to 140µm wide. Surprisingly the alumina beads and flakes were pulverized within the 10-second test interval and remained adherent to the CoCr surfaces. Additionally, the hydroxyapatite although also a ceramic had no more effect on CoCr than the bone-cement debris. Use of well-characterized and commercially available alumina and hydroxyapatite powders appeared advantageous for abrasion tests. These new data indicated that such ceramic powders have merit.


Clarke IC, Lazennec JY, Brusson A, et al. Impingement and 3rd-body Wear Mechanisms with 28mm MOM - A trigger mechanism for adverse wear in CoCr bearings. Clin Orthop Relat Res. 2013 (submitted).

McMurtrie A, Abhijit R, Guha AR and Wootton JR. Loose Metasul liner causing partial amputation of the neck of the femoral component. Journal of Arthroplasty. 2009; 24: 159.e1 - 3.

Heiner AD, Lundberg HJ, Baer TE, Pedersen DR, Callaghan JJ and Brown TD. Effects of episodic subluxation events on third body ingress and embedment in the THA bearing surface. J Biomech. 2008; 41: 2090-6.

Rodriguez JA. The squeaking hip is a multifactorial concern. rim impingement, microseparation, subluxation are all suspects in the sound generation. Orthopedics Today: 28 - 92 (2008).

McPherson EJ, Clarke IC and Donaldson TK. Lesson learned from retrieval analysis of a dislocating, large diameter MoM revision THA - A case report. Reconstructive Review. 2012; 2: 10 -4.

Bowsher JG, Donaldson TK, Williams PA and Clarke IC. Surface damage after multiple dislocations of a 38-mm-diameter, metal-on-metal hip prosthesis. J Arthroplasty. 2008; 23: 1090-6.

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

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

Morlock MM, Bishop NE, Zustin J, Hahn M, Ruther W and 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.

Nevelos J, Ingham E, Doyle C, et al. Microseparation of the centers of alumina-alumina artificial hip joints during simulator testing produces clinically relevant wear rates and patterns. J Arthroplasty. 2000; 15: 793-5.

Leslie IJ, Williams S, Isaac G, Ingham E and Fisher J. High cup angle and microseparation increase the wear of hip surface replacements. Clin Orthop Relat Res. 2009; 467: 2259-65.

Clarke I, Lazennec JY, Brusson A, Burgett M and Donaldson TK. Impingement and Abrasion Risks with 28mm MOM - The trigger mechanism for adverse wear in CoCr bearings. Clin Orthop 2013 (submitted to Hip Soc. Awards 2013).

Lundberg HJ, Liu SS, Callaghan JJ, et al. Association of third body embedment with rim damage in retrieved acetabular liners. Clin Orthop Relat Res. 2007; 465: 133-9.

Kligman M, Furman BD, Padgett DE and Wright TM. Impingement contributes to backside wear and screw-metallic shell fretting in modular acetabular cups. J Arthroplasty. 2007; 22: 258-64.

Shon WY, Baldini T, Peterson MG, Wright TM and Salvati EA. Impingement in total hip arthroplasty a study of retrieved acetabular components. J Arthroplasty. 2005; 20: 427-35.

Hall RM, Siney P, Unsworth A and Wroblewski BM. Prevalence of impingement in explanted Charnley acetabular components. J Orthop Sci. 1998; 3: 204-8.

Yamaguchi M, Akisue T, Bauer TW and Hashimoto Y. The spatial location of impingement in total hip arthroplasty. J Arthroplasty. 2000; 15: 305-13.

Eickmann TH, Clarke IC and Gustafson A. Squeaking in a ceramic on ceramic total hip. In: Zippel H and Dietrich M, (eds.). Bioceramics in Joint Arthroplasty. Berlin, Germany: Steinkopff Verlag, Darmstadt, 2003, p. 187 - 92.

Clarke IC and Manley MT. How do alternative bearing surfaces influence wear behavior? J Am Acad Orthop Surg. 2008; 16: S86-93.

Dennis DA, Komistek RD, Northcut EJ, Ochoa JA and Ritchie A. "In vivo" determination of hip joint separation and the forces generated due to impact loading conditions. J Biomech. 2001; 34: 623-9.

Komistek R. In vivo sounds of various total hip arthroplasty bearings. International Congress for Joint Replacements. Coronado, CA2012.

McKellop HA, Campbell P, Park SH, et al. The origin of submicron polyethylene wear debris in total hip arthroplasty. Clin Orthop. 1995: 3-20.

McKellop HA. Distinguishing among wear modes, wear mechanisms and wear damage in prosthetic joints. In: Streicher R, (ed.). Tribology and Bearing Surfaces in Total Joint Replacements. 2011, p. 103 - 13.

McHugh D, Currier J, Kennedy F, Collier J and 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: Kurtz SM, Greenwald SA, Mihalko WM and Lemons JA, (eds.). Metal-On-Metal Total Hip Replacement Devices. 2013, p. 235-50.

Clarke IC, Donaldson TK, Burgett MD, et al. Normal and Adverse Wear Patterns Created In-vivo on MOM Surfaces - a retrieval study representing four vendors. In: Kurtz SM, Greenwald SA, Mihalko WM and Lemons JA, (eds.). Metal-on-Metal Total Hip Replacement Devices. West Conshohocken, PA: ASTM International, 2013 p. 157-92.

Howie DW, McCalden RW, Nawana NS, Costi K, Pearcy MJ and Subramanian C. The long-term wear of retrieved McKee-Farrar metal-on-metal total hip prostheses. J Arthroplasty. 2005; 3: 350-7.

Kubo K, Clarke IC, Donaldson TK, et al. Wear Mapping analysis with retrieval 28mm CoCr-CoCr Hip Bearings - 11 years Experience. J Bone Joint Surg Br. 2010; 92-B: 734-42.

Raimondi MT, Vena P and Pietrabissa R. Quantitative evaluation of the prosthetic head damage induced by microscopic third-body particles in total hip replacement. J Biomed Mater Res. 2001; 58: 436-48.

McNie CM, Barton DC, Fisher J and Stone MH. Modeling of damage to articulating surfaces by third body particles in total joint replacements. J Mater Sci Mater Med. 2000; 11: 569-78.

Lu B, Marti A and McKellop H. Wear of a second-generation metal-on-metal hip replacement effect of third-body abrasive particles. Trans Sixth World Biomat Congr. Kamuela, Hawaii2000, p. 183.

Liao Y-S, Swope S, Whitaker D, Vass S, Reimink M and Render T. Effects of 3rd body Hydroxylapatite (HA) Particles on the Wear Performance of 36 mm Ceramic-on-Metal (COM) and Metal-on-Metal (MOM) Hip Joint components in a Wear Simulation Study. 56th Annual meeting ORS 2010, p. 2325.

Parikh A, Hill P, Pawar V and Sprague J. Hip simulator wear testing of modular diffusion hardened oxidized zirconium couples. Orthopedic Research Society. San Antonio, Texas2013, p. 298.

Parikh A, Hill P, Pawar V and Sprague J. Long-term simulator wear performance of an advanced bearing technology for THA. Orthopedic Research Society. San Antonio, Texas2013, p. 1028.

Kubo K, Clarke IC, Sorimachi T, Williams PA, Donaldson TK and Yamamoto K. Aggressive 3rd-body wear challenge to highly crosslinked polyethylene: A hip simulator model. 17th International Conference on Wear of Materials. 2009, p. 734-42.

Pelt CE, Erickson J, Clarke IC, Donaldson TK, Layfield L and Peters CL. Histologic, Serologic, and Tribologic Findings in Failed Metal on Metal Total Hip Arthroplasty. AAOS Exhibit Selection. J Bone Joint Surg Am. 2013; 95 (21): 1-11.

Wang A and Essner A. Three-body wear of UHMWPE acetabular cups by PMMA particles against CoCr, alumina and zirconia heads in a hip joint simulator. Wear. 2001; 250: 212-6.

Sorimachi T, Clarke IC, Williams PA, Yamamoto K and Donaldson TK. Third-body abrasive wear challenge of 32mm conventional and 44mm highly crosslinked polyethylene liners in a hip simulator model. J Eng in Med. 2009; 223 part H.

Bragdon CR, Jasty M, Muratoglu OK, O'Connor DO and Harris WH. Third-body wear of highly cross-linked polyethylene in a hip simulator. J Arthroplasty. 2003; 18: 553-61.

Halim T, Burgett M, Donaldson TK, Savisaar C, Bowsher JG and Clarke IC. Profiling the third-body wear damage produced in CoCr surfaces by bone cement, CoCr, and Ti6A14V debris: A 10-cycle metal-on-metal simulator test. J Eng in Med. 2014; Proc. IMechE 1-11.

Bauer TW, Geesink RC, Zimmerman R and McMahon JT. Hydroxyapatite-coated femoral stems. Histological analysis of components retrieved at autopsy. J Bone Joint Surg Am. 1991; 73: 1439-52.

Bauer TW, Stulberg BN, Ming J and Geesink RG. Uncemented acetabular components. Histologic analysis of retrieved hydroxyapatite-coated and porous implants. J Arthroplasty. 1993; 8: 167-77.

Bloebaum RD, Bachus KN, Rubman MH and Dorr LD. Postmortem comparative analysis of titanium and hydroxyapatite porous-coated femoral implants retrieved from the same patient. A case study. J Arthroplasty. 1993; 8: 203-11.

Bloebaum RD, Beeks D, Dorr LD, Savory CG, DuPont JA and Hofmann AA. Complications with hydroxyapatite particulate separation in total hip arthroplasty. Clin Orthop. 1994: 19-26.

Bloebaum RD and Dupont JA. Osteolysis from a press-fit hydroxyapatite-coated implant. A case study. J Arthroplasty. 1993; 8: 195-202.

Bloebaum RD, Lundeen GA, Bachus KN, Ison I and Hofmann AA. Dissolution of particulate hydroxyapatite in a macrophage organelle model. J Biomed Mater Res. 1998; 40: 104-14.

Bloebaum RD, Merrell M, Gustke K and Simmons M. Retrieval analysis of a hydroxyapatite-coated hip prosthesis. Clin Orthop. 1991: 97-102.

Krol R, Wiatrak A and Kaminski A. Management of fractures of ceramic heads in total hip arthroplasty patients. Ortop Traumatol Rehabil. 2007; 9: 429-35.

Ha YC, Kim SY, Kim HJ, Yoo JJ and Koo KH. Ceramic liner fracture after cementless alumina-on-alumina total hip arthroplasty. Clin Orthop Relat Res. 2007; 458: 106-10.

Toni A, Traina F, Stea S, et al. Early diagnosis of ceramic liner fracture. Guidelines based on a twelve-year clinical experience. J Bone Joint Surg Am. 2006; 88 Suppl 4: 55-63.

Habermann B, Ewald W, Rauschmann M, Zichner L and Kurth AA. Fracture of ceramic heads in total hip replacement. Arch Orthop Trauma Surg. 2006; 126: 464-70.

Liao Y-S, Swope S, Whitaker D, Vass S, Reimink M and Render T. Effects of 3rd body Hudroxylapatite (HA) particles on the wear performance of 36 mm Ceramic-on-Metal (COM) and Metal-on-Metal (MOM) Hip Joint Components in a Wear Simulation Study. ORS 56th Annual Meeting. 2010, p. poster 2325.

Halim T, Clarke IC, Burgett-Moreno M, Donaldson TK, Savisaar C and Bowsher JG. A Simulator Study of Adverse Wear with Metal and Cement Debris Contamination in metal-on-metal (MOM) Hip Bearings. J Bone Joint Research (UK). 2015; 4: 29-37.

Clarke IC, Lazennec JY, Smith EJ, Sugano N, McEntire B and Pezzotti G. Ceramic-on-Ceramic Bearings: Simulator Wear Compared to Clinical Retrieval Data. In: Sonntag R and Kretzer JP, (eds.). Materials for Joint Arthroplasty - Biotribology of Potential Bearings. Imperial College Press, 2015.

Kempf I and Semlitsch M. Massive wear of a steel ball head by ceramic fragments in the polyethylene acetabular cup after revision of a total hip prosthesis with fractured ceramic ball. Arch Orthop Trauma Surg. 1990; 109: 284-7.

Mishra AK and Davidson JA. Zirconia/Zirconium: A new, abrasion resistant material for orthopedic applications. Mater Tech. 1993; 8: 16-21.

Davidson JA, Poggie RA and Mishra AK. Abrasive wear of ceramic, metal, and UHMWPE bearing surfaces from third-body bone, PMMA bone cement, and titanium debris. Biomed Mater Eng. 1994; 4: 213-29.

Wang A and Schmidig G. Ceramic femoral heads prevent runaway wear for highly crosslinked polyethylene acetabular cups by third-body bone cement particles. Wear, 14th International Conference on Wear of Materials. 2003; 255: 1057-63.

How to Cite
Halim, T., Burgett-Moreno, M., Donaldson, T., & Clarke, I. (2015). Third-body Wear Damage Produced in CoCr Surfaces by Hydroxyapatite and Alumina Ceramic Debris: A 10-cycle Metal-on-Metal Simulator Study. Reconstructive Review - Open Access Orthopaedic Journal of Reconstructive Arthroplasty, 5(4).
Basic Science