Tribological principles in metal-on-metal hip joint design.

An analysis of some 100 published and communicated findings on running-in volumetric wear and steady state wear rates from simulator tests carried out in eight laboratories in three countries has been undertaken. Powerful indications have emerged of the dominant role of mixed lubrication in current metal-on-metal hip replacements, with elastohydrodynamic film thickness controlling wear. The background to the calculation of film thickness in the elastic-isoviscous mode of lubrication has been outlined and graphs of representative film thickness and lambda ratio have been presented. For minimum wear and wear rate the diameter of the femoral component should be as large as possible, while the clearance should be as small as is practicable. The findings are valid for both monolithic and surface replacement implants. A tentative proposal is made for the prediction of lifetime wear in metal-on-metal total hip replacements.