The forces generated as a knee or hip goes through its range of motion require a strong material that can withstand repeated sliding and rotating. High fatigue strength and toughness are needed. The ideal TJA (total joint arthroplasty) material should also be smooth and resist abrasion to minimize generation of wear particles. This combination of properties has been difficult to find - until the introduction of a revolutionary material for joint implants - OXINIUM Oxidized Zirconium.
While a ceramic implant provides a smooth, abrasion-resistant articular surface, it has poor fracture toughness and may shatter when impacted. On the other hand, metal implants have an excellent fracture toughness but tend to roughen and scratch over time, gouging the polyethylene and producing particles. 1,2
Efforts to reduce the wear rate of metal implants through surface modifications have had difficulty with durability. Coatings can crack, chip or peel, especially when damaged. Through a patented process, oxygen is absorbed into zirconium metal, actually transforming the surface to ceramic while the rest of the material remains metal to retain its strength. The result is in a superior bearing surface. Please review the information within this site to learn more about this superior option for TJA or call your local Smith & Nephew sales representative.
Wear in Total Joint Arthroplasty
Wear of polyethylene components has often been reported in TJA to be a primary cause of complications and failure. Retrieval analyses and published articles support that a high percentage of inserts and patellas develop a significant wear pattern clinically.
Wear In THA
In THA, the reduction in friction and wear with the OXINIUM bearing coupling is significant because aseptic loosening is a leading cause of implant failure, and wear debris is the leading cause of aseptic loosening. While virtually all advanced bearing couplings produce nearly immeasurable wear, metal-on-metal couplings produce cobalt and chromium ions. Ceramic couplings risk fracture.
With OXINIUM femoral heads, low wear reduces the chances of aseptic loosening and may extend the life of the joint. The OXINIUM material may offer extended joint life through reduced wear and friction.
Wear in TKA
In eight TKA retrieval studies covering the last 20 years, polyethylene wear was identified in over 50% of the 3,300-plus knees examined.
More than 10 publications in the past 10 years have linked polyethylene wear to complications and failure of TKA. 7-17
For additional information, please contact your local rep.
1. R.H. Zimlich, M. Levesque, W. Jones, H.D. Schutte, Jr., B.J. Livingston, W. Sauer, M. Spector, and K. Weaver, "In-vitro and in-vivo effect of particulate debris on TKA articulating surfaces", scientific exhibit SE038, 65th Ann. Mtg. Am. Acad. Orthop. Surg., New Orleans, LA, March 19-23, 1998.
2. M. Levesque, B.J. Livingston, W.M. Jones, and M. Spector, "Scratches on condyles in normal functioning total knee arthroplasty", Trans. 44th Ann. Mtg. Orthop. Res. Soc., Orthopaedic Research Society, Chicago, IL, 1998, p. 247.
3. M. Long, L. Riester, and G. Hunter, “Nano-hardness measurements of oxidized Zr-2.5Nb and various orthopaedic materials”, Trans. Soc. Biomaterials, 21, 1998, p. 528.
4. G. Hunter and M. Long, “Abrasive wear of oxidized Zr-2.5Nb, CoCrMo, and Ti-6Al-4V against bone cement”, 6th World Biomaterials Cong. Trans., Society For Biomaterials, Minneapolis, MN, 2000, p. 835.
5. G. Hunter, “Adhesion testing of oxidized zirconium”, Trans. Soc. Biomaterials, 24, 2001, p. 540.
6. S. Tsai, J. Sprague, G. Hunter, R. Thomas, and A. Salehi, “Mechanical testing and finite element analysis of oxidized zirconium femoral components”, Trans. Soc. Biomaterials, 24, 2001, p. 163.
7. L. Que, L.D.T. Topoleski, and N.L. Parks, "Surface roughness of retrieved CoCrMo alloy femoral components from PCA artificial total knee joints", J. Biomed. Mater. Res., 53 (1), 1999, pp. 111- 118.
8. J.G. Lancaster, D. Dowson, G.H. Isaac, and J. Fisher, "The wear of ultra-high molecular weight polyethylene sliding on metallic and ceramic counterfaces representative of current femoral surfaces in joint replacement", Proc. Instn. Mech. Engrs., 211 (H1), 1997, pp. 17-24.
9. J. Fisher, P. Firkins, E.A. Reeves, J.L. Hailey, and G.H. Isaac, "The influence of scratches to metallic counterfaces on the wear of ultra-high molecular weight polyethylene", Proc. Instn. Mech. Engrs., 209 (H4), 1995, pp. 263-264.
10. J.L. Hailey, E. Ingham, M. Stone, B.M. Wroblewski, and J. Fisher, "Ultra-high molecular weight polyethylene wear debris generated in vivo and in laboratory tests; the influence of counterface roughness", Proc. Instn. Mech. Engrs., 210 (H1), 1996, pp. 3-10.
11. B. Weightman and D. Light, "The effect of the surface finish of alumina and stainless steel on the wear rate of UHMW polyethylene", Biomaterials, 7 (1), 1986, pp. 20-24.
12. H. Oonishi, Y. Hanatate, E. Tsuji, and H. Yunoki, "Comparisons of wear of UHMW polyethylene sliding against metal and alumina in total knee prostheses", Bioceramics, H. Oonishi, H. Aoki, and K. Sawai (eds.), Ishiyaku EuroAmerica, Tokyo, 1989, pp. 219-224.
13. J.A. Davidson, "Characteristics of metal and ceramic total hip bearing surfaces and their effect on long-term ultra high molecular weight polyethylene wear", Clin. Orthop., 294, 1993, pp. 361-378.
14. J. Fisher and D. Dowson, "Tribology of total artificial joints", Proc. Instn. Mech. Engrs., 205 (H2), 1991, pp. 73-79.
15. M. Jasty, C.R. Bragdon, K. Lee, A. Hanson, and W.H. Harris, "Surface damage to cobalt-chrome femoral head prostheses", J. Bone Joint Surg., 76-B (1), 1994, pp. 73-77.
16. R.Barrack, F.Castro, E. Szuszczewicz, T.Schmalzried, “Analysis of Retrieved Uncemented Porous-Coated Acetabular Components in Patients With and Without Pelvic Osteolysis”, Orthopedics, 25:12, 2002, pp. 1373-1378.
17. Sychterz CJ, Engh CA Jr, Swope SW, McNulty DE, Engh CA, “Analysis of prosthetic femoral heads retrieved at autopsy”, Clin Orthop. 1999 Jan; (358):223-34.
18. R.A. Poggie, J.J. Wert, A.K. Mishra, and J.A. Davidson, “Friction and wear characterization of UHMWPE in reciprocating sliding contact with Co-Cr, Ti-6Al-4V and zirconia implant bearing surfaces”, Wear and Friction of Elastomers, ASTM STP 1145, R. Denton and M.K. Keshavan (eds.), American Society for Testing and Materials, Philadelphia, PA, 1992, pp. 65-81.
19. A.M. Patel and M. Spector, “Tribological evaluation of oxidized zirconium using an articular cartilage counterface: a novel material for potential use in hemiarthroplasty”, Biomaterials, 18 (5), 1997, pp. 441-447.
20. M. Spector, M.D. Ries, R.B. Bourne, W.S. Sauer, M. Long, and G. Hunter, “Wear performance of ultra-high molecular weight polyethylene on oxidized zirconium total knee femoral components”, J. Bone Joint Surg., 83-A (S2), 2001, pp. 80-86.
21. N.J. Hallab, K. Merritt, and J.J. Jacobs “Metal sensitivity in patients with Orthopaedic implants”, J. Bone Joint Surg., 83-A, March, 2001, pp. 428-436.
22. G. Hunter, W.M. Jones, and M. Spector, “Oxidized zirconium”, Total Knee Arthroplasty, J. Bellemans, M.D. Ries, and J. Victor (eds.), Springer Verlag, Heidelberg, Germany, 2005, pp. 370-377.
23. Jani et al, ORS, 49, 2002.
24. Good V, Ries M, Barrack RL, Widding K, Hunter G, Heuer D, Reduced Wear with Oxidized Zirconium Femoral Heads, JBJS in print, 2003.
25. M.D. Ries, W.L. Sauer, S.A. Banks, M. Anthony, and K. Weaver, "Effect of femoral component scratches on wear in total knee arthroplasty", Am. Acad. Orthop. Surg. 66th Ann. Mtg. Proc., American Academy of Orthopaedic Surgeons, Rosemont, IL, 1999, p. 231.
26. M. Ries, S. Banks, W. Sauer, and M. Anthony, "Abrasive wear simulation in total knee arthroplasty", Trans. 45th Ann. Mtg. Orthop. Res. Soc., Orthopaedic Research Society, Chicago, IL, 1999, p. 853.