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Introduction: The aim of this study is to evaluate clinical, radiographic and laboratory results of ceramic-on-metal (CoM) (hybrid hard bearing) in total hip arthroplasty (THA), associated with a short stem implant. Methods: From a cohort of 37 patients suffering from primary or secondary hip osteoarthritis who underwent THA using CoM bearing, 19 were suitable for this study. All procedures were performed by the same surgeon using a posterior-lateral approach. All patients were compared clinically using the Harris Hip Score (HHS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), visual analogue scale (VAS), 12-item Short Form Health Survey (SF12F/M), and radiographically (offset, CD angle, limb length discrepancy, cup inclination and anteversion, subsidence, osseointegration, heterotopic ossification). Blood samples were collected in order to evaluate chromium (Cr) and cobalt (Co) ions level. Radiographic evaluations were carried out by 3 different blinded surgeons. A statistical analysis was performed. Results: At a mean follow-up of 97 (73–125) months all implanted stems were well-positioned and osseointegrated. Clear improvements were observed for clinical scores comparing preoperative and postoperative values. Radiographic evaluation showed a good ability to restore proper articular geometry. Cr ion analysis revealed values below the safety threshold except for 1 case. Serum levels of Co were below the threshold in all patients. There was a statistically significant correlation only between Cr metal ions and length of follow-up. Conclusions: CoM bearing has proven to be reliable and safe at a mean 8-year follow-up for patients in whom the components were correctly implanted. The rise of blood metal ions was minimal and involved neither systemic or local toxicity nor influenced clinical results.

Background Recent clinical studies have suggested that systemic metal ion levels are significantly elevated at midterm follow-up in patients with ceramic-on-metal (COM) bearing. However, it is not clear whether there is a correlation between patient-related factors including the lifestyle and elevated levels of serum metal ions following COM total hip arthroplasty (THA). Methods Serum metal levels were measured in 201 patients (234 hips) including 121 COM patients (140 hips) and 80 non-COM patients (94 hips). The Harris Hip Score, University of California, Los Angeles activity scale score, and Western Ontario and McMaster Universities Osteoarthritis Index score were measured and radiographs were obtained for the analysis. Results Significantly higher levels of cobalt (Co) and chromium (Cr) were detected in the serum of the COM THA group (Co: 1.86 ± 4.0 μg/L; Cr: 1.81 ± 2.87 μg/L) than those of the non-COM THA group (Co: 0.27 ± 0.14 μg/L; Cr: 0.19 ± 0.25 μg/L; P The serum metal levels of patients who achieved the squatting position and the kneeling position were significantly higher than those of patients who could not squat (Co: P = .033; Cr: P = .074) and kneel (Co: P = .049; Cr: P = .031). The metal ion levels of the COM THA group correlated with the total range of motion (Co: P = .0293; Cr: P = .0399). Conclusion Patients who underwent a 36-mm COM THA showed high serum metal levels although good clinical outcomes at the midterm follow-up. We found that COM THA patients who were capable of greater range of motion, squatting, and kneeling are at risk of metal ion–related problems.

The increasing demand for total hip arthroplasty (THA) in relatively young, high-demand patients has led to the use of hard-on-hard bearing surfaces. Adverse local tissue reaction/pseudotumor and elevated serum metal ion levels are commonly reported complications encountered in metal-on-metal THA, while audible articulation and rim fracture are reported in ceramic-on-ceramic THA. For this reason, ceramic-on-metal THA was implemented as an ideal hard-on-hard bearing combination. In this report, we describe a case of bilateral simultaneous ceramic-on-metal THA in a 69-year-old woman who presented 7 years postoperatively with unilateral hip pain associated with underlying pseudotumor and elevated serum cobalt and chromium ion levels. Pre-revision workup, intraoperative findings, and postoperative evaluation are included and suggest acetabular malposition as a potential source for complication. Keywords: Total hip arthroplasty, Adverse local tissue reaction, Pseudotumor, Hard-on-hard, Ceramic-on-metal

Pseudotumor is a rare complication following total hip arthroplasty (THA) with ceramic-on-metal (CoM) bearings. There is still in controversy about the using of CoM bearings when conducting surgery. We reported a case of a 47-year-old woman who underwent cementless CoM bearing THA because of left Crowe type III dislocation of the hip (DDH) in December 2009. One year after THA, she presented at our hospital complaining of crunching noise, pain, and decreased level of function. A revision surgery was performed because of left hip instability in December 2010, we adjusted the excessive anteversion of stem and replaced the head by using the long-neck ceramic head. In February 2019, she was admitted to our hospital complaining of repeated dislocation and fracture of greater trochanter. During the re-revision surgery, a pseudotumor and grey synovial sac were revealed. The metal liner was replaced with a ceramic liner and the greater trochanter was reattached using the Cable-Ready system. Clinical outcome was successful at 6 months postoperatively. This case vividly demonstrated CoM bearing should be avoided in THA. The pseudotumor highly destructed the periprosthetic soft tissues and the bone, which leaded to dislocation and periprosthetic fracture. The surgeon should be aware of the complication so that prompt diagnosis and treatment can be performed.

BACKGROUND The aim of our prospective, multicenter, randomized, controlled trial (titled M2A-38 Ceramic-on-Metal RCT, NCT00754520) is to demonstrate noninferiority of a ceramic-on-metal (CoM) articulation compared with metal-on-metal (MoM) in total hip arthroplasty. The study arms are at 8 years since implantation, with metal ion and functional score analysis at 5 years. METHODS We recruited 211 patients between 2009 and 2011. The patients were randomized to ceramic or metal. A cohort of these patients had whole blood metal ions performed yearly, and all patients underwent annual radiographic and clinical outcome assessment. All revisions were recorded and some explants were analyzed. Recruitment ceased earlier than planned owing to concerns raised with failure of MoM implants. RESULTS No significant difference was seen in patient demographics, radiographic parameters, or functional outcomes at any time point. Lower cobalt ion levels were seen in the CoM group (P < .01) at all time points. Chromium levels were significantly lower in the CoM group up to 3 years, but raised at 5 years. There were slightly fewer revisions for adverse reaction to metal debris in the CoM group. Explant analysis suggested a different wear pattern to those seen in the MoM group. CONCLUSION The results demonstrated that the CoM articulation behaved the same as the MoM in terms of functional outcome and radiographic parameters. The CoM coupling also demonstrates raised metal ions beyond 3 years and increasing revisions for adverse reaction to metal debris. It remains difficult to see a clinical application for CoM and further exploration or use is not warranted.

Multiple studies have been published on high revision rates for metal-on-metal (MoM) total hip arthroplasty as a result of early failures and pseudotumor formation1-4. The use of MoM articulations has decreased dramatically, and other hard-on-hard bearings have been promoted. The pathogenesis of pseudotumor formation is unknown, although this adverse local tissue reaction has demonstrated histologic features thought to reflect a hypersensitivity response (metallosis) to cobalt and/or chromium particles1,5-8. High serum levels of these metals are positively correlated with the angle of inclination of the acetabular component, presumably due to the resultant edge loading and high wear9-12. We report a case of massive pseudotumor formation in a patient who had undergone bilateral ceramic-on-metal (CoM) total hip arthroplasty. The patient was informed that data concerning the case would be submitted for publication, and she provided consent. In February 2009, a seventy-one-year-old woman had undergone bilateral cementless total hip arthroplasty with CoM articulation via an anterior supine intermuscular approach at another facility. A modular uncemented porous-coated cup with a cobalt-chromium (CoCr) liner and a 36-mm Biolox delta ceramic head (Biomet, Warsaw, Indiana) were used. Postoperatively, two dislocations of the right hip had occurred, one in November 2010 and one in October 2011. In December 2011, the patient visited the outpatient clinic of our hospital with pain in the right groin and audible crepitations during movement of the right hip. The patient had a body mass index of 26 kg/m2. Examination of the right hip showed flexion of 110°, external rotation of 40°, and internal rotation of 30°. Clear crepitations were audible during flexion and extension; no mass was palpable. An acetabular anteversion angle of 38° and an inclination angle of 57° were estimated from the anteroposterior radiograph …

Ceramic-on-metal (CoM) is a relatively new bearing combination for total hip arthroplasty (THA) with few reported outcomes. A total of 287 CoM THAs were carried out in 271 patients (mean age 55.6 years (20 to 77), 150 THAs in female patients, 137 in male) under the care of a single surgeon between October 2007 and October 2009. With the issues surrounding metal-on-metal bearings the decision was taken to review these patients between March and November 2011, at a mean follow-up of 34 months (23 to 45) and to record pain, outcome scores, radiological analysis and blood ion levels. The mean Oxford Hip Score was 19.2 (12 to 53), 254 patients with 268 hips (95%) had mild/very mild/no pain, the mean angle of inclination of the acetabular component was 44.8o (28o to 63o), 82 stems (29%) had evidence of radiolucent lines of > 1 mm in at least one Gruen zone and the median levels of cobalt and chromium ions in the blood were 0.83 μg/L (0.24 μg/L to 27.56 μg/L) and 0.78 μg/L (0.21 μg/L to 8.84 μg/L), respectively. The five-year survival rate is 96.9% (95% confidence interval 94.7% to 99%). Due to the presence of radiolucent lines and the higher than expected levels of metal ions in the blood, we would not recommend the use of CoM THA without further long-term follow-up. We plan to monitor all these patients regularly. Cite this article: Bone Joint J 2015;97-B:300–5.

Background. Increased metal ion levels following total hip arthroplasty (THA) with metal-on-metal bearings are a highly debated topic. Local soft tissue reactions with chronic pain and systemic side effects such as neuropathy are described. The aim of the current study was to determine the serum metal ion concentrations of Cobalt (Co) and Chrome (Cr) after THA with a ceramic-on-metal (CoM) bearing. Patients and Methods. Between 2008 and 2010, 20 patients underwent THA using a CoM bearing. Clinical function was evaluated by standardized scores systems (Harris Hip Score and WOMAC Score) and radiological examination included X-rays. Patient’s blood samples were obtained for metal ion analysis and correlation analysis was done between these results and implant position. Results. Overall, 13 patients with 14 CoM devices were available for the current series. The mean age at time of surgery was 61 years (range, 41 to 85). The postoperative follow-up ranged from 49 to 68 months (mean, 58). Metal ion determination showed mean concentrations of 3,1 µg/L (range, 0,3–15,2 µg/L) for Co and 1,6 µg/L (range, 0,1–5,5 µg/L) for Cr, respectively. A correlation between cup anteversion and Co and Cr concentrations was shown. Conclusion. The current series showed increments for Co and Cr following CoM THA. However, these levels are lower compared to metal ion concentrations in patients with metal-on-metal bearings and the international accepted threshold for revision of MoM devices. We recommend routine follow-up including at least one obligatory evaluation of serum metal ion concentrations and an MRI once to exclude local soft tissue reactions.

We prospectively assessed the efficacy of a ceramic-on-metal (CoM) hip bearing with uncemented acetabular and femoral components in which cobalt­–chrome acetabular liners and alumina ceramic heads were used. The cohort comprised 94 total hip replacements (THRs) in 83 patients (38 women and 45 men) with a mean age of 58 years (42 to 70). Minimum follow-up was two years. All patients had pre- and post-operative assessment using the Western Ontario and McMaster Universities osteoarthritis index (WOMAC), Oxford hip score and Short-Form 12 scores. All showed a statistically significant improvement from three months post-operatively onwards (all p < 0.001). After two years whole blood metal ion levels were measured and chromosomal analysis was performed. The levels of all metal ions were elevated except vanadium. Levels of chromium, cobalt, molybdenum and titanium were significantly higher in patients who underwent bilateral THR compared with those undergoing unilateral THR (p < 0.001). Chromosomal analysis demonstrated both structural and aneuploidy mutations. There were significantly more breaks and losses than in the normal population (p < 0.001). There was no significant difference in chromosomal aberration between those undergoing unilateral and bilateral procedures (all analyses p ≥ 0.62). The use of a CoM THR is effective clinically in the short-term, with no concerns, but the significance of high metal ion levels and chromosomal aberrations in the long-term remains unclear. Cite this article: Bone Joint J 2013;95-B:1040–44.

Ceramic-on-metal (CoM) total hip replacements have shown reduced wear and friction. Lubrication and contact mechanics analyses play an important role in providing an overall understanding for the tribological performance of CoM bearings. In the present study, the steady-state contact mechanics and elastohydrodynamic lubrication (EHL) and transient EHL of CoM bearings were analyzed. The dry and lubricated contact pressures of CoM bearings showed typical characteristics of hard-on-hard hip bearings. The effects of head radius and radial clearance on the lubrication performance were predicted. CoC and CoM bearings are more likely to benefit full fluid film lubrication than MoM bearings.

Ceramic-on-metal (COM) hip replacements, where the head is BIOLOX® Delta ceramic and the liner is CoCrMo alloy, have demonstrated reduced wear under standard simulator conditions compared to metal-on-metal (MOM) bearings. COM hips are now being used clinically around the world. MOM hip resurfacings have raised concerns regarding poor clinical performance and increased in vivo wear was associated with steeply inclined acetabular components and translationally malpositioned components. The aim of this study was to compare the wear rates of MOM and COM total hip prostheses under adverse edge-loading conditions in a hip simulator test. COM and MOM 36 mm hip prostheses were tested in a hip simulator, with liners mounted to provide a clinical inclination angle of 55°. A simplified gait cycle and microseparation conditions were applied for two million cycles in 25% new born calf serum. The overall mean volumetric wear rate of COM bearings under adverse conditions was 0.36 ± 0.55 mm3/million cycles; this was significantly less than MOM wear (1.32 ± 0.91 mm3/million cycles). Under these adverse conditions; the contact zone on the head intersects the rim of the cup causing substantially elevated contact stresses, disrupting the protective boundary and mixed lubrication regime causing changes in types and severity of wear mechanisms. In COM bearings, the harder head does not become damaged when there is lubricant starvation and wear does not accelerate. In conclusion, COM bearings showed reduced wear compared to MOM bearings under standard and adverse clinically relevant simulator conditions and COM bearings may provide an advantage over MOM bearings under edge-loading conditions clinically. © 2013 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 2013.

Aims The primary aim of this independent prospective randomised trial was to compare serum metal ion levels for ceramic-on-metal (CoM) and metal-on-metal (MoM) bearing surfaces in total hip arthroplasty (THA). Our one-year results demonstrated elevation in metal ion levels above baseline with no significant difference between the CoM and MoM groups. This paper reviews the five-year data. Patients and Methods The implants used in each patient differed only in respect to the type of femoral head (ceramic or metal). At five-year follow-up of the 83 enrolled patients, data from 67 (36 CoM, 31 MoM) was available for comparison. Results The mean serum cobalt (Co) and chromium (Cr) ion levels remained above baseline in both groups (CoM: Co 1.16 μg/l (0.41 to 14.67), Cr 1.05 μg/l (0.16 to 12.58); MoM: Co 2.93 μg/l (0.35 to 30.29), Cr 1.85 μg/l (0.36 to 17.00)) but the increase was significantly less in the CoM cohort (Co difference p = 0.001, Cr difference p = 0.002). These medium-term results, coupled with lower revision rates from national joint registries, suggest that the performance of CoM THA may be superior to that of MoM. Conclusion While both bearing combinations have since been withdrawn these results provide useful information for planning clinical surveillance of CoM THAs and warrants continued monitoring. Cite this article: Bone Joint J 2017;99-B:1298–1303.

There is currently much discussion over the use of ceramic femoral components against metal acetabular cups, for use in total hip arthroplasty. The current study investigates six hot isostatically pressed alumina femoral heads of 38 mm diameter articulating against six as-cast Co—Cr—Mo metallic acetabular cups. Standard walking-cycle simulator wear testing was carried out to 5×106 cycles using the Durham Mark II hip wear simulator, and wear was determined gravimetrically. In addition, surface topography, using a non-contacting profilometer, an atomic force microscope, and an optical microscope, was monitored throughout the wear test. The wear of the ceramic heads was found to be undetectable using the current gravimetric method; however, a change in the surface topography was seen, as grain removal on the pole was observed through atomic force microscopy analysis. A biphasic wear pattern was found for the metallic cups, with low wear rates of 1.04 ± 0.293 mm3/106 cycles (mean, ±95 per cent confidence interval) and 0.0209 ± 0.004 mm3/106 cycles (mean, ±95 per cent confidence interval) for running-in and steady state wear phases respectively. Frictional measurement revealed that the joints were tending towards full fluid-film lubrication in parts of the walking cycle. The results show that the combination of hot isostatically pressed alumina and as-cast Co—Cr—Mo is a promising alternative for total hip arthroplasties.

Osteolysis induced by polyethylene wear debris from metal-on-polyethylene total joint replacements is one of the major reasons for the renewed interest in metal-on-metal (MoM) bearings for total hip arthroplasty. However, long-term clinical performance is as yet unknown for the second generation MoM hip prostheses. The main concerns are the released metal ions and metallic wear debris from the artificial joints. It is well known that the metal ion release processes (corrosion) are electrochemical in nature. When two contacted components are in relative motion, wear can occur and it can accelerate corrosion. The role of corrosion in the generation of metallic wear debris is still not well understood. This paper addresses this point and makes a comparison of MoM and ceramic-on-metal (CoM) contacts. In this paper, tests were conducted on a pin-on-plate tester with an integrated electrochemical cell in 25 per cent bovine serum to determine the effects of pin rotation on the wear and metal ion release of two different combinations (metal pins with metal plates and metal pins with medical grade Alumina plates). The overall wear and released metallic ions were reduced with rotational movement of the pin in addition to the reciprocating action of the plate. For the CoM combination, a reduction of wear was associated with a more noble open circuit potential compared with the MoM combination.

Hip simulator studies have been carried out extensively to understand and test artificial hip implants in vitro as an efficient alternative to obtaining long-term results in vivo. Recent studies have shown that a ceramic-on-metal material combination lowers the wear by up to 100 times in comparison with a typical metal-on-metal design. The reason for this reduction remains unclear and for this reason this study has undertaken simple tribometer tests to understand the fundamental material loss mechanisms in two material combinations: metal-on-metal and ceramic-on-ceramic. A simple-configuration reciprocating pin-on-plate wear study was performed under open-circuit potential (OCP) and with applied cathodic protection (CP) in a serum solution using two tribological couples: firstly, cobalt—chromium (Co—Cr) pins against Co—Cr plates; secondly, Co—Cr pins against alumina (Al2O3) plates. The pin and plate surfaces prior to and after testing were examined by profilometry and scanning electron microscopy. The results showed a marked reduction in wear when CP was applied, indicating that total material degradation under the OCP condition was attributed to corrosion processes. The substitution of the Co—Cr pin with an Al2O3 plate also resulted in a dramatic reduction in wear, probably due to the reduction in the corrosion—wear interactions between the tribological pair.

The performance of novel ceramic-on-metal bearing couples has been compared with metal-on-metal and ceramic-on-ceramic bearing couples in laboratory and short-term clinical studies. Laboratory studies compared ceramic-on-metal with metal-on-metal and ceramic-on-ceramic bearings with diameters of 28 and 36 mm under standard conditions and under adverse conditions with head loading on the rim of the cup. Clinical studies compared metal ion levels in ceramic-on-metal with metal-on-metal, ceramic-on-ceramic, and ceramic-on-polyethylene bearings in a randomized prospective study. In the laboratory studies, friction, wear, and ion levels were lower in ceramic-on-metal bearings compared with metal-on-metal, with results similar to ceramic-on-ceramic couples. Under adverse conditions and rim loading, all bearings showed increased wear with lower wear and absence of stripe wear in ceramic-on-metal compared with metal-on-metal bearings. Short-term studies in 31 patients at 6 months revealed lower metal ion levels (cobalt and chromium) in those with ceramic-on-metal compared with metal-on-metal bearings.

Orion Electric Co. has developed an XGA resolution, 165 μm pitch 25″ Plasma Display Back Panel by combining the process and cost benefits of the LTCC-M (Low Temperature Co-fired Ceramic on Metal) substrate technology with a high-resolution one-step “Barrier Embossing” technique. Tensile tests on green sheets were conducted and the effects of green sheet mechanical properties on embossed barrier height were investigated. LTCCM back panels (8″) were sealed to sodalime glass front panels and the assembled parts were successfully evacuated to 10−7 torr without cracks on the glass side.

Wear and adverse reactions to wear particles remain a concern, particularly with young and active patients with long life expectancies. There is considerable interest in the clinical use of improved bearing materials such as cross-linked polyethylene, metal on metal, ceramic on ceramic and ceramic on metal. In addition to reducing wear, there is also clinical interest in using larger head sizes to improve stability and range of motion. However, in polyethylene bearings, a larger head size can lead to increased wear. Most previous research work has studied the wear performance of bearings under a standard set of walking conditions with components correctly positioned. Indeed, with improvements in bearing technology, the wear under standard walking conditions has reduced to low levels, and this has encouraged the use of diameter larger heads. However, under adverse conditions the wear of some bearings can increase.

The purpose of this study was to compare the wear of zirconia-toughened alumina (ZTA) and alumina femoral heads tested against as-cast CoCrMo alloy acetabular cups under both standard and severe wear conditions. A new severe test, which included medio-lateral displacement of the head and rim impact upon relocation, was developed. This resulted in an area of metal transfer and an area of increased wear on the superior-anterior segment of the head that were thought to be due to dislocation and rim impact respectively. While the wear of all ceramic heads was immeasurable using the gravimetric method, the wear rates for the metallic cups from each test were readily calculated. An average steady state wear rate of 0.023 ± 0.005 mm3/106 cycles was found for the cups articulating against ZTA under standard wear conditions. A similar result had previously been obtained for the wear of cups articulated against alumina heads of the same size (within the same laboratory). Under severe wear conditions an increase in the metallic cup steady state wear rate was found with the ZTA and alumina tests giving 0.623 ± 0.252 and 1.35 ± 0.154 mm3/106 cycles respectively. Wear of the ceramic heads was detected using atomic force microscopy which showed, under severe wear conditions, a decrease in polishing marks and occasional grain removal. The surfaces of the ZTA heads tested under standard conditions were virtually unchanged from the unworn samples. Friction tests showed low friction factors for all components, pre and post wear.

In the last two decades the performance of total hip replacements (THR) has constantly improved, thanks largely to advances in the field of material science and technology. Although contemporary devices are clinically very reliable, some problems still need to be addressed: the wear of ultra high molecular weight polyethylene components, the release of metal ions from metal-on-metal joints, the toughness of the ceramic cups and the possibility of squeaking for ceramic-on-ceramic couplings. All these drawbacks become particularly relevant in case of THR for young and active patients, when the life expectancy of the orthopedic device is very high and the possibility of mechanical shocks is not negligible.In the last few years an innovative ceramic-on-metal tribologic coupling has been introduced in clinical use. This novel configuration represents a very promising solution to all the aforementioned issues. Ceramic-on-metal offers both the strength points of ceramic and metal surfaces, and overcomes the limits of metal-on-metal and ceramic-on-ceramic bearings. For this reason, the ceramic-on-metal coupling has become the object of investigation for several laboratory studies and has been tested in clinical trials. This review study compares the scientific outcomes of the research on ceramic-on-metal bearings, confirming that this innovative articulation has the potential to be a suitable and attractive solution for young and active patients.

In the year 1999 we proposed a breakthrough technology for making Plasma display back panel so called LTCC-M (Low Temperature Co-fired Ceramic on Metal) PDP 1. In this paper we present the evaluation results of 40″ LTCC-M PDP. We have developed a 40″ LTCC-M plasma display back panel and succeeded in fabricating LTCC-M PDP module. We verified that LTCC-M back panel can replace the conventional glass back panel providing many advantages

This study reports on ceramic-on-metal (CoM) bearings in total hip replacement. Whole blood metal ion levels were measured. The median increase in chromium and cobalt at 12 months was 0.08 μg/1 and 0.22 μg/1, respectively, in CoM bearings. Comparable values for metal-on-metal (MoM) were 0.48 μg/1 and 0.32 μg/1. The chromium levels were significantly lower in CoM than in MoM bearings (p = 0.02). The cobalt levels were lower, but the difference was not significant. Examination of two explanted ceramic heads revealed areas of thin metal transfer. CoM bearings (one explanted head and acetabular component, one explanted head and new acetabular component, and three new heads and acetabular components) were tested in a hip joint simulator. The explanted head and acetabular component had higher bedding-in. However, after one million cycles all the wear rates were the same and an order of magnitude less than that reported for MoM bearings. There were four outliers in each clinical group, primarily related to component malposition.

The failure of metal on polyethylene total hip replacements due to wear particle induced osteolysis and late aseptic loosening has focused interest upon alternative bearings, such as metal on metal implants. A recent advance in this field has been the development of a novel ceramic on metal implant. The characteristics of the wear particles generated in this low-wearing bearing have not been previously determined. The aims of this study were to characterise metal wear particles from metal on metal and ceramic on metal hips under standard and adverse (microseparation) wear conditions. Accurate characterisation of cobalt-chrome wear particles is difficult since the reactive nature of the particles prevents them from being isolated using acids and bases. A method was developed to isolate the metal wear particles using enzymes to digest serum containing lubricants from metal on metal and ceramic on metal hip simulations. High resolution scanning electron microscopy was then used to characterise the wear particles generated by both metal on metal and ceramic on metal implants under standard and microseparation wear conditions. The wear particles isolated from all simulations had a mean size of less than 50 nm with a rounded and irregular morphology. No significant difference was found between the size of wear particles generated under any conditions.

Commentary on: Sedrakyan A, Normand SL, Dabic S, et al. Comparative assessment of implantable hip devices with different bearing surfaces: systematic appraisal of evidence. BMJ 2011;343:d7434.[OpenUrl][1][Abstract/FREE Full Text][2] Total hip replacement surgery (THR) is a highly successful procedure for relieving painful degenerative conditions of the hip and restoring function. The articulating surfaces of the prosthetic joint can be manufactured from a number of different materials. Traditionally, metal (cobalt-chromium-molybdenum alloys) has been employed for the femoral head bearing surface and polyethylene for the acetabular bearing surface. Polyethylene wear particles have been implicated in loosening of the components and the need for revision surgery. More recently, the focus is on alternative bearing couples (combinations of materials) in an attempt to improve the longevity of THR and reduce the rate with which revision surgery is required. To this end, metal on metal, ceramic on ceramic and ceramic on metal bearings have been employed. Possible advantages include improved longevity and the ability to use a larger diameter articulation, thus reducing risk of dislocation. Possible disadvantages include exposure … [1]: {openurl}?query=rft.jtitle%253DBMJ%26rft_id%253Dinfo%253Adoi%252F10.1136%252Fbmj.d7434%26rft_id%253Dinfo%253Apmid%252F22127517%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [2]: /lookup/ijlink?linkType=ABST&journalCode=bmj&resid=343/nov29_2/d7434&atom=%2Febmed%2F18%2F1%2F22.atom

Alumina-on-metal total hip replacements have recently been shown to exhibit exceptionally low wear rates compared to conventional metal or ceramic-on-polyethylene joints 1. , 2. . In this study, another novel alternative coupling of zirconia-on-metal has been explored using a hip simulator. The effect of diameter and diametral clearance on lubrication and wear was also investigated. Increasing diameter from 22.225mm to 28mm reduced wear by over an order of magnitude. Similarly, decreasing diametral clearance from 90μm to 60μm reduced wear four-fold. By optimising the design of zirconia-on-metal joints, extremely low long-term wear rates may be realised with minimal bedding-in wear.

Osteolysis and loosening of artificial joints caused by polyethylene wear debris has prompted renewed interest in alternative bearing materials for hip prosthesis designs. Lower wearing metal-on-metal (MOM) and ceramic-on-ceramic prostheses are being used more extensively, and there is considerable interest in further improving on their performance. This study investigated the wear properties and debris morphology of a novel differential hardness ceramic-on-metal (COM) prosthesis, in comparison with MOM articulations in a physiological anatomical hip joint simulator. The COM pairings were found to have wear rates approximately 100-fold lower than the MOM pairings. The MOM pairings showed a higher "bedding in" wear rate (3.09+/-0.46mm(3)/10(6) cycles) in the first million cycles, which then reduced to a steady state wear rate of 1.23+/-0.5mm(3)/10(6) cycles. The wear rate of the COM pairings over the duration of the test was approximately 0.01mm(3)/10(6) cycles with very little wear detected on the surface of the prosthesis components. The wear particles from both articulations were oval to round in shape and in the nanometer size range. After one million cycles the mean maximum diameter of the MOM and COM wear particles were 30+/-2.25 and 17.57+/-1.37nm, respectively. After five million cycles the wear particles were statistically significantly smaller than at one million cycles, 13.9+/-0.72nm for the MOM pairings and 6.11+/-0.40nm for the COM pairings. The wear rates of the MOM prostheses were representative of clinical values. The use of differential hardness COM pairings dramatically reduced the wear rate compared to MOM hip prostheses. The wear particles from the MOM articulation were similar to particles found in retrieved tissues from around MOM prostheses. The extremely low wearing differential hardness COM bearings presented in this study produced far smaller volumetric particle loads compared to MOM prostheses currently used clinically.

This paper discusses the design and radiofrequency (RF)/microwave performance of low temperature cofired ceramic (LTCC) substrate technology for use in wireless applications. The advantages of multi-layer LTCC technology with integral embedded passives are clearly shown with wireless subsystem package designs in various formats including ball grid array (BGA) and low temperature cofired ceramic on metal (LTCC-M).

Ceramic-on-metal (CoM) bearings are considered to be a promising alternative to polyethylene-based bearings or hard-on-hard bearings (Ceramic-on-Ceramic (CoC) and Metal-on-Metal (MoM)). Although, CoM shows lower wear rates than MoM, in-vitro wear testing of CoM shows widely varying results. This may be related to limitations of wear-measuring methods. Therefore, the aim of this study was to improve the gravimetric measurement technique and to test wear behaviour of CoM bearings compared to CoC bearings. Level walking according to ISO-14242 was simulated for four CoM and four CoC bearings. Prior to simulation, errors in measurement of gravimetric wear were detected and improvements in measurement technique incorporated. The results showed no differences in mean wear rates between CoM and CoC bearings. However, the CoM bearings showed wear results over a wide range of wear performance. High reliability of wear results was recorded for the CoC bearings. Material transfer was observed on the ceramic heads of the CoM bearings. Therefore, for level walking a partial mixed or boundary lubrication has to be assumed for this type of bearing. CoM is a highly sensitive wear-couple. The reasons for the observed behaviour cannot be clarified from this study. Simulator studies have to be considered as an ideal loading condition. Therefore, high variations in wear rates as seen in this study, even at low levels, may have an adverse effect on the in-vivo wear behavior. Careful clinical use may be advisable until the reasons for the variation are fully clarified and understood.

The total hip arthroplasty procedure has improved substantially over the past two decades, including the design, materials used, and the fixation. Minimizing bearing surface wear has become a determinant of long-term implant survival. Approaches to minimize bearing surface wear have included improvement in polyethylene as well as the introduction of hard-on-hard bearing couples. Presently, the most commonly used hard bearing surfaces include metal-on-metal (MOM) and ceramic-on-ceramic (COC) couples. Both have excellent tribological properties, but they also have limitations. Second-generation MOM articulations have lower wear rates compared with metal-on-ultra-high-molecular-weight polyethylene (UHMWPE)1-3. However, despite lower volumetric wear, the wear particles are very small and their presence locally and systemically is concerning4-11. COC articulations have better wear properties than MOM and UHMWPE couples12-17, but issues such as squeaking18,19 and implant fracture remain problematic16,20,21. In the hope of overcoming the adverse issues of MOM and COC bearing couples, an innovative ceramic-on-metal (COM) articulation, utilizing a ceramic head and metal liner, has been recently introduced. Proposed advantages of COM couples include reduced wear, with resultant lower serum metal ion levels compared with MOM12,17,22-24, although COM and COC couples have similar wear rates12,24,25. Adverse soft-tissue reactions are a well-known complication of MOM hip resurfacing arthroplasty7,26-28 as well as contemporary MOM total hip arthroplasty29,30. Such soft-tissue reactions have not been reported with COM bearings; however, these devices have had limited use and only short-term follow-up. We report the case of a patient who experienced early failure of a COM total hip arthroplasty. The patient was informed that data concerning her case would be …

25″ XGA (165 μm pitch) PDP panel was developed using LTCC-M (Low Temperature Cofired Ceramic on Metal) technology. Simulations of optimum barrier height and gas composition for maximum power efficiency was carried out and the gas composition was determined to be 71 % He-25 % Ne-4 % Xe (in vol %) for the LTCC-M PDP panel. Some packaging issues including vacuum compatibility of LTCC-M panel are addressed and the LTCC-M panel properties are described.

Many processes are being currently explored to fabricate the back panel of PDP. This paper presents a unique process for fabricating plasma display back panel, called “Low Temperature Co-fired Ceramic on Metal (LTCC-M)” back panel which is very simple and most cost-effective approach to color PDP manufacturing as compared to other processes. By eliminating the complicated processes and replacing the base glass plate with thin metal sheet for barrier rib fabrication, this process will provide the lowest cost. This back panel has weight of less than one third and thickness of one fourth of conventional glass panel. Furthermore this back panel has a base metal plate and thus provides many advantages such as excellent thermal dissipation, no thermal distortion and ease of handling due to its flexibility and robustness.

The arc plasma spraying process was applied to obtain ceramic coatings on stainless steel substrates. The outer coatings were formed from pure alumina or alumina + 2 wt. % titania mixture. The nichrome intermediate coating was applied to increase adhesion of ceramic coating to stainless steel. The X-ray analysis, metallographic and SEM investigations of the sprayed coatings were also carried out. The effect of interaction of thick film conductor and resistor compositions was studied. Conductor ink P 202 PdAg and resistor ink DP 1321 were evaluated. The TCR, resistance stability were measured as a function of firing cycles. These parameters and the resistivity of sprayed alumina were compared with standard 96% alumina substrate characteristics.