Alumina Femoral Heads Research Articles

Effect of Component Position and Inward–Outward Rotation on the Wear of Different Ultra-High Molecular Weight Polyethylenes in an Orbital Bearing Type Hip Joint Simulator

The orbital bearing machine is the world’s most widely used hip joint simulator design for wear testing of prosthetic hips. It has been used with inverted and anatomic component position and with and without inward–outward rotation. Still the effect of component position on the wear of the most widely used bearing material, ultrahigh molecular weight polyethylene (UHMWPE), has not been studied directly. With a modified orbital bearing machine, the effects of the component position, anatomic versus inverted, and of the inward–outward rotation, present versus absent, on polyethylene wear were studied for the first time. Acetabular liners made from different ultra-high molecular weight polyethylenes articulated against alumina femoral heads in alpha calf serum. The inverted position resulted in the most realistic, burnished appearance of the polyethylene bearing surfaces. In the inverted position, the wear rate decreased with increasing gamma dose that is known to improve wear resistance by cross-linking. In the anatomic position, the bearing surface was not always entirely burnished. The wear was similar with and without inward–outward rotation. The mean wear rate of vitamin E stabilized highly cross-linked ultra-high molecular weight polyethylene was close to clinical observations. Clinically relevant wear could be produced with the orbital bearing machine for both established and advanced bearing materials. The inverted position appeared preferable in the orbital bearing machine. Inward–outward rotation did not appear important.

Development and Validation of a Finite Element Model of Wear in UHMWPE Liner Using Experimental Data From Hip Simulator Studies.

The wear of acetabular liner is one of the key factors determining osseointegration and long-term performance of total hip joint replacement implants. The experimental measurements of wear in total hip replacement components are time and cost-intensive. While addressing this aspect, a finite element model of a hip joint bearing consisting of zirconia-toughened alumina femoral head and ultrahigh molecular weight polyethylene liner was developed to predict the dynamic wear response of the liner. The Archard-Lancaster equation, consisting of surface contact pressure, wear rate, and sliding distance, was employed to predict the wear of the acetabular liner. The contact pressure and wear at the articulating surface were found to decrease over time. A new computational method involving three-dimensional point clouds from the finite element analyzed results were used to construct wear maps. The model was able to predict the linear wear, over 2 × 106 cycles with relative errors ranging from 9% to 36% when compared to the published results. The increasing error percentage occurring primarily from the use of a constant wear rate was reduced to a maximum of 17% by introducing a correction factor. The volumetric rate was predicted with a maximum relative error of 7% with the implementation of the correction factor. When the model was implemented to study acetabular liners of diameters ranging from 28 to 36 mm, the linear wear was seen to decrease with an increase in femoral head diameter, which is in agreement with the clinical data. This study emphasizes the need to develop more such FEA-based computational studies to reliably predict and correlate with experimentally measured temporal evolution of wear of load-bearing articulating joints.

Effect of surface texturing on the performance of artificial hip joint for Muslim prayer (Salat) activity

Currently, the artificial hip joint is the best option for total hip arthroplasty, and the demand for this procedure is increasing annually. However, a major deficiency of artificial hip joints is the performance limitation in a wide range of movements, such as those in Muslim prayer (salat), a major religious practice that consists of seven positions representing extreme movements. In this work, a numerical examination is conducted to investigate the performance of artificial hip joints with three texture configurations and with two different ball materials subjected to seven loading conditions of Muslim prayer (salat). Transient non-Newtonian elastohydrodynamic lubrication analyses are solved using the two-way Fluid–Structure Interaction (FSI) method. It is found that the femoral head and the inner liner with a pattern applied to the whole of their contacted surface show a substantial increase in load support when compared with the smooth one; the improvement is approximately 11% and 13%, respectively, for the movement of sitting between two prostrations for left leg, and the bowing position. Furthermore, slight increase in fluid pressure and load support is highlighted compared with the models in which only the liner or head are textured. In addition, the simulation solution shows that for other loading positions, the textured model reveals a reduction in performance. The amount of load support in prostration, sitting between two prostrations (right leg), and sitting (right leg) positions is insufficient, which may lead to direct contact. The simulation results also indicate that the alumina femoral head gives better result compared to the stainless steel one.

Does Taper Design Affect Taper Fretting Corrosion in Ceramic-on-Polyethylene Total Hip Arthroplasty? A Retrieval Analysis

BackgroundCeramic-on-polyethylene (CoP) implants have exhibited lower fretting and corrosion scores than metal-on-polyethylene implants. This study aims at investigating the effect of taper design on taper corrosion and fretting in modular CoP total hip arthroplasty (THA) systems. MethodsUnder an institutional review board–-approved protocol, a query of an implant retrieval library from 2002 to 2017 identified 120 retrieved CoP THA systems with zirconia toughened alumina femoral heads. Femoral stem trunnions were visually evaluated and graded for fretting, corrosion, and damage at the taper interface. Medical records were reviewed for patient demographics and implant characteristics. Data were statistically analyzed using Spearman correlation and rank-sum tests with a Dunn’s post hoc test, with a significance level of α = 0.05. ResultsFour different taper designs were evaluated: 11/13 (n = 18), 12/14 (n = 53), 16/18 (n = 21), and V40 (n = 28). There were no statistically significant demographic differences between taper groups for duration of implantation, laterality, patient age, and patient sex, but patients with 16/18 tapers had a higher body mass index than V40 tapers (P = .012). Duration of implantation had a weak positive correlation with both trunnion fretting (ρ = 0.224, P = .016) and corrosion (ρ = 0.253, P = .006). Summed fretting and corrosion scores were significantly greater on the V40 and 16/18 tapers compared with the 12/14 tapers (all P ≤ .001). ConclusionTaper fretting and corrosion were observed in CoP THA implants and were greatest with V40 and 16/18 tapers and lowest with 12/14 tapers. Differences in taper design characteristics may lead to greater micromotion at the taper-head interface, leading to increased fretting and corrosion.

Phase Transformation and Roughening in Artificially Aged and Retrieved Zirconia-Toughened Alumina Femoral Heads

BackgroundZirconia-toughened alumina (ZTA) used in hip arthroplasty contains yttria-stabilized zirconia (Y-TZP) as a toughening agent. However, Y-TZP is well known to degrade in vivo from tetragonal to monoclinic phase transformation. The stability of never-implanted ZTA femoral heads was evaluated in a severe artificial aging test, with retrieved ZTA heads also evaluated for clinical relevance. We hypothesized that ZTA would degrade due to tetragonal-to-monoclinic phase transformation, with changes in surface topography and progressive roughening. Y-TZP specimens served as a positive comparison group, while magnesia-stabilized zirconia (Mg-PSZ), which does not undergo phase transformation, served as a stable comparison group. MethodsMonoclinic phase concentration, surface topography, and roughness of never-implanted ZTA, Y-TZP, and Mg-PSZ heads were measured by X-ray diffraction and optical profilometry, before and after 2 rounds of 24 hours of hydrothermal aging. Explanted ZTA heads were characterized by the same methods. ResultsAfter 48 hours in an autoclave, the surface of ZTA heads exhibited irregularly spaced protrusions about 20-30 nm high by 100-150 μm in diameter, with significant increases in monoclinic phase concentration (from 12.2% to 21.3%) and surface roughness. Similar features were observed on the surface of explanted ZTA heads, with 33% monoclinic phase after 2.7 years in vivo. ConclusionBased on data collected from ZTA retrievals, this artificial aging test underestimated the amount of phase transformation in vivo. Phase transformation and surface roughening of ZTA heads steadily increased without reaching a plateau, which may lead to stress concentrations and weakening of the ceramic material, and could result in late fracture and wear.

Mechanical loading characteristics of total hip prosthetics subjected to dynamic loading cycles.

The selection of best material pair in the hip prosthetics design for improved performance and life relies on the estimation of hip joint contact stresses and contact pressure distribution during various dynamic loading cycles: Climbing Upstairs, Climbing downstairs and Knee bending. The maximum Von Mises stress, contact pressure and deformation are considered factors in selecting the material pair in this current study. This is done by analysis of a three-dimensional finite element model of the acetabular component during the different dynamics cycles using ANSYS®. The different material combination of bearing couples considered for this analysis are metal in contact with plastic, metal on metal, metal on ceramic, ceramic on plastic, ceramic on metal and ceramic on ceramic. The numerical results were validated by comparing them with the FEA results of Hai-Bo Jiang et al. for the existing material combinations and a high correlation of 92% was observed. We found that the Alumina femoral head paired with ultra-high molecular weight polyethylene (UHMWPE) cup reduces the maximum Von Mises stress and maximum contact pressure developed at the interface amongst other material pairs.

Massive wear in a CoCrMo head following the fracture of an alumina head.

The catastrophic fracture of an alumina femoral head is, fortunately, an increasingly rare event. The improvements made in the quality of modern ceramics, together with greater care in the manufacture of femoral stem cones and higher levels of expertise of the surgeons implanting the head itself, have significantly reduced this risk. A statistical analysis by Piconi (1) evaluates the percentage of breakage in modern ceramic heads at less than 0.02% (1 fracture every 5000 implants). We can therefore say that today the use of ceramic heads is highly reliable, but in certain cases, due mostly to negligence or technical errors, the fracture of the head is still possible. In these cases the problem we are facing is how to proceed in the revision of the implant, as simply replacing the head may lead to a further and more severe failure of the implant. (Hip International 2002; 1: 37-42).

Reducing fretting-initiated crevice corrosion in hip simulator tests using a zirconia-toughened alumina femoral head.

Taper fretting corrosion is considered a potentially limiting factor for total hip arthroplasty longevity. Recently, attention has been focused on new materials for ceramic femoral heads, for example, zirconia-toughened alumina (ZTA), since they have an alternative bearing surface that can improve the wear resistance. Moreover, ceramics have high chemical stability and corrosion resistance. In this study, we evaluated the effects of ZTA and Co-Cr-Mo alloy femoral heads on their taper fretting and/or corrosion characteristics under a controlled hip simulator test. After the test, less fretting and corrosion were observed in the taper surface of the trunnion against the ZTA femoral head than for that against the Co-Cr-Mo alloy femoral head. In addition, corrosion damages were only observed in the lateral-distal taper surface (noncontact area) of the trunnion in the Co-Cr-Mo alloy femoral head group. The ZTA femoral head group also eliminated the potential for Co ion release into the lubricants from taper corrosion, reducing the possibility of adverse local tissue inflammatory responses. In conclusion, ZTA femoral heads showed markedly less fretting corrosion compared to Co-Cr-Mo alloy femoral heads and have a lower potential for metal ion release. © 2017 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 106B: 2815-2826, 2018.

Ageing, Shocks and Wear Mechanisms in ZTA and the Long-Term Performance of Hip Joint Materials.

The surface morphologies and microstructures of Zirconia Toughened Alumina (ZTA) femoral heads were analyzed following in vitro tests aiming to simulate in vivo degradation. Three phenomena potentially leading to degradation were investigated: shocks, friction and hydrothermal ageing. Shocks due to micro-separation created the main damage with the formation of wear stripes on the femoral head surfaces. Atomic Force Microscopy (AFM) images suggested the release of wear debris of various shapes and sizes through inter- and intra-granular cracks; some debris may have a size lower than 100 nm. A decrease in hardness and Young’s modulus was measured within the wear stripes by nanoindentation technique and was attributed to the presence of surface and sub-surface micro-cracks. Such micro-cracks mechanically triggered the zirconia phase transformation in those worn areas, which in return presumably reduced further crack propagation. In comparison with shocks, friction caused little wear degradation as observed from AFM images by scarce pullout of grains. The long-term resistance of the ZTA composite material against hydrothermal ageing is confirmed by the present observations.

Wear resistance of poly(2-methacryloyloxyethyl phosphorylcholine)-grafted carbon fiber reinforced poly(ether ether ketone) liners against metal and ceramic femoral heads.

Younger, active patients who undergo total hip arthroplasty (THA) have increasing needs for wider range of motion and improved stability of the joint. Therefore, bearing materials having not only higher wear resistance but also mechanical strength are required. Carbon fiber-reinforced poly(ether ether ketone) (CFR-PEEK) is known as a super engineering plastic that has great mechanical strength. In this study, we focused on poly(2-methacryloyloxyethyl phosphorylcholine) (PMPC)-grafted CFR-PEEK and investigated the effects of PMPC grafting and the femoral heads materials on the wear properties of CFR-PEEK liners. Compared with untreated CFR-PEEK, the PMPC-grafted CFR-PEEK surface revealed higher wettability and lower friction properties under aqueous circumstances. In the hip simulator wear test, wear particles generated from the PMPC-grafted CFR-PEEK liners were fewer than those of the untreated CFR-PEEK liners. There were no significant differences in the size and the morphology of the wear particles between the differences of PMPC-grafting and the counter femoral heads. Zirconia-toughened alumina (ZTA) femoral heads had significantly smoother surfaces compared to cobalt-chromium-molybdenum alloy femoral heads after the hip simulator test. Thus, we conclude that the bearing combination of the PMPC-grafted CFR-PEEK liner and ZTA head is expected to be a lifelong bearing interface in THA. © 2017 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 106B: 1028-1037, 2018.

In Vitro versus In Vivo Phase Instability of Zirconia-Toughened Alumina Femoral Heads: A Critical Comparative Assessment.

A clear discrepancy between predicted in vitro and actual in vivo surface phase stability of BIOLOX®delta zirconia-toughened alumina (ZTA) femoral heads has been demonstrated by several independent research groups. Data from retrievals challenge the validity of the standard method currently utilized in evaluating surface stability and raise a series of important questions: (1) Why do in vitro hydrothermal aging treatments conspicuously fail to model actual results from the in vivo environment? (2) What is the preponderant microscopic phenomenon triggering the accelerated transformation in vivo? (3) Ultimately, what revisions of the current in vitro standard are needed in order to obtain consistent predictions of ZTA transformation kinetics in vivo? Reported in this paper is a new in toto method for visualizing the surface stability of femoral heads. It is based on CAD-assisted Raman spectroscopy to quantitatively assess the phase transformation observed in ZTA retrievals. Using a series of independent analytical probes, an evaluation of the microscopic mechanisms responsible for the polymorphic transformation is also provided. An outline is given of the possible ways in which the current hydrothermal simulation standard for artificial joints can be improved in an attempt to reduce the gap between in vitro simulation and reality.

Mechanistic Study of the Wear of Ceramic Heads by Metallic Stems in Modular Implants

Titanium-based and cobalt–chrome alloys as well as some ceramics have been widely used in orthopaedic applications as these materials can significantly enhance the quality of human life as implant materials. However, the in vivo performance of some large-diameter metal-on-metal joints is unsatisfactory, and concerns have been expressed over the wear behaviour of the materials and released metal ions affecting local tissue and more distant organs. The longevity of these materials is highly influenced by their mechanical properties and this has driven the development of alternative ceramic components with greatly improved tribological performance. Even these novel materials are not immune to damage, for instance in some devices alumina-based ceramic components articulate with titanium alloy counterfaces (e.g. in the taper connections of titanium alloy stems and zirconia-toughened alumina femoral heads in modern modular designs) and damage has been reported of the harder ceramic surface by the softer titanium alloy component. In such contacts, the chemically inert ceramic component is not expected to corrode, so the electrochemical damage mechanisms often suggested for metal–metal contacts are not appropriate. This study attempts to understand why this wear might occur by investigating bulk and surface mechanical properties (such as hardness and Young’s modulus) of a number of hip implants and test samples using a Hysitron Triboindenter. AFM images were also obtained to determine the contact area and hence, pile-up correction factors for the metallic material. It was found that the alumina ceramic heads were generally subject to chemomechanical softening after exposure to water for an extended period whilst titanium alloy oxidised preferentially generating a hard oxide surface which was not softened by water. Furthermore, the oxidised titanium showed significantly higher hardness values therefore damaging the chemomechanically softened alumina material.

Tensor-resolved Raman spectroscopic analysis of wear-induced residual stress fields in long-term alumina hip-joint retrievals

Polarized Raman spectroscopy was applied to evaluate the full set of stress tensor components in the wear-induced residual stress fields on two long-term (>20 y) (monolithic) alumina (Al2O3) femoral head retrievals coupled to polyethylene liners. The tensor-resolved residual stress state stored onto the Al2O3 ceramic head surface was found to retain “memory” of the sliding conditions in vivo and of the wear-induced consumption of the polyethylene counterpart. The evolution of tensor-resolved residual stress motifs in the three-dimensional space was examined, and key features, including exceptionally high shear stresses in one case, were uncovered. The effect of such a body of concurrent complications and malfunctioning are neither easily reproducible by in vitro simulations nor obviously obtainable through merely computational approaches. It is demonstrated here that our latest developments of Raman spectroscopic algorithms could contribute to link the joint performance with the micromechanical features that occur in real in vivo situations.

Wear and surface degradation of commercial ZTA femoral heads under boundary lubrication conditions

The effect of frictional sliding on the surface degradation of commercially available zirconia-toughened alumina (ZTA) femoral heads was studied using a pin-on-ball wear tester under three different lubricating conditions: dry, water, and squalene. Water and squalene were employed under boundary lubrication regimes. Despite the unique (non-standard) character of this apparatus, standard loading conditions could be applied, which effectively determined dynamic friction coefficients as basic material properties. Two types of surface degradation were observed: (i) the polymorphic tetragonal-to-monoclinic (t→m) transformation of the zirconia (ZrO2) dispersoids, and (ii) the off-stoichiometry drift caused by oxygen vacancy formation within the alumina matrix. Scanning laser microscopy (SLM), Raman spectroscopy (RS), scanning electron microscopy (SEM), cathodoluminescence (CL), and X-ray photoelectron spectroscopy (XPS) were utilized to evaluate the fractions of transformed zirconia phase and the stoichiometric evolution of the oxygen sub-lattice at the surface of wear-tested ZTA components. Wear tracks on the surface of the femoral heads were only detected under dry conditions. Dry wear also showed the highest frictional forces and the most pronounced formation of oxygen vacancies among the tested conditions. Conversely, equivalent or greater amounts of the t→m transformation were observed with water and squalene lubrication when compared to the dry wear condition.

Chemistry-driven structural alterations in short-term retrieved ceramic-on-metal hip implants: Evidence for in vivo incompatibility between ceramic and metal counterparts.

Ceramic-on-metal (CoM) hip implants were reported to experience lower wear rates in vitro as compared to metal-on-metal (MoM) bearings, thus hinting metal-ion release at lower levels in vivo. In this article, we show a spectroscopic study of two short-term retrieval cases of zirconia-toughened alumina (ZTA) femoral heads belonging to CoM hip prostheses, which instead showed poor wear performances in vivo. Metal contamination and abnormally high fractions of tetragonal-to-monoclinic (t→m) polymorphic transformation of the zirconia phase could be found on both ZTA heads, which contrasted with the optimistic predictions of in vitro experiments. At the molecular scale, incorporation of metal ions into the ceramic lattices could be recognized as due to frictionally assisted phenomena occurring at the ceramic surface. Driven by abnormal friction, diffusion of metal ions induced lattice shrinkage in the zirconia phases, while residual stress fields became stored at the surface of the femoral head. Diffusional alterations destabilized the chemistry of the ceramic surface and resulted in an abnormal increase in t→m phase transformation in vivo. Frictionally driven metal transfer to the ceramic lattice thus hinders the in vivo performance of CoM prostheses. © 2016 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 105B: 1469-1480, 2017.

Chemically driven tetragonal-to-monoclinic polymorphic transformation in retrieved ZTA femoral heads from dual mobility hip implants

Two short-term (two and nine months) retrieved zirconia-toughened alumina (ZTA) femoral heads and nine pristine femoral heads from the same manufacturer have been investigated with respect to their surface stability by means of confocal Raman spectroscopy. Quantitative estimations of monoclinic volume fraction have been carried out in both non-wear and main wear zones of the retrieved heads, which invariantly showed high volume fractions of monoclinic polymorph. In-depth (sub-surface) profiles, non-destructively collected in the main wear zones with the Raman probe in confocal configuration, indeed confirmed that polymorphic transformation was extended down to 100μm below the bearing surface of the femoral heads. Acceleration of tetragonal-to-monoclinic transformation rate leads to unexpectedly high fractions of monoclinic phase within very short-term in-vivo exposures. Phase transformation in-vivo is much more marked than what one could actually predict according to simply simulating a hydrothermal environment in-vitro and could not be simply ascribed to the mechanical stress fields generated during normal service at the bearing surface. Instead, the chemical consequences of metal contamination on the ZTA femoral head surface are shown to play the most detrimental role in phase destabilization.

May the surface roughness of the retrieved femoral head influence the wear behavior of the polyethylene liner?

This study was aimed at determining the surface degradation occurred on retrieved ceramic and metallic heads, as well as the influence of the head surface quality on the wear of the polyethylene counterface. To this purpose, 14 ceramic and 14 metallic femoral heads retrieved at revision surgery were examined. Scanning electron microscopic analysis provided visual evidence that some metallic heads presented crescent wear more often than the ceramic ones; the former showed a higher volumetric loss (as determined by Coordinate Measuring Machine) than the latter, but less negative Rsk values. This apparent lack of correlation between volumetric loss (i.e., wear factor) and roughness data may be explained by considering that they are two temporally variant parameters. No significant differences were observed between the Ra values of the two sets of femoral heads. The cups articulating against metal heads were characterized by higher mean wear volumes than those articulating against alumina although this difference was not statistically significant; metal heads displayed significantly higher mean wear volumes than alumina heads. The micro-Raman analysis of the cup articulated against the most worn alumina femoral head showed an orthorhombic into monoclinic phase transformation that was not observed in the cups coupled to metal heads. The obtained results showed that the surface finishing of the femoral head (in terms of Rsk values) determined the morphological changes experienced by the ultra-high-molecular-weight polyethylene crystalline phase at the molecular level. © 2015 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 104B: 1374-1385, 2016.

DYNAMIC CONTACT ANALYSIS OF TOTAL HIP PROSTHESIS DURING STUMBLING CYCLE

The estimation of the hip joint contact stresses and contact pressure distribution during stumbling activities is a critical task for selecting the best material pair in the hip prosthesis design. This paper utilizes a three-dimensional finite element model of acetabular component to analyze the dynamic stumbling activity using ANSYS®. The present study investigates the maximum von Mises stress, contact pressure and deformation developed for different combinations of materials under the stumbling load condition. The different combination of bearing couplings considered for the analysis are metal in contact with plastic, metal on metal, metal on ceramic, ceramic on plastic, ceramic on metal and ceramic on ceramic combinations. The results concluded that the Alumina femoral head paired with ultra-high molecular weight polyethylene (UHMWPE) cup reduces the maximum von Mises stress and maximum contact pressure developed between the interface regions when compared with other combinations. The obtained results are compared with the result of Hai-bo-Jiang et al., for available combinations, and higher correlation of 92% was found between the two results.

Torsional wear behaviours of TiO2/PMMA film against Ti6Al4V alloy and alumina femoral head ball in dry condition

The torsional fretting wear tests of Ti6Al4V alloy flat against alumina femoral ball in dry condition were carried out on a new high-precision torsional fretting-wear tester. The TiO2/P-methoxymethamphetamine (PMMA)/Ti6Al4V pair showed higher contact stiffness, friction torque, wear damage and material transfer than that of the presentation of TiO2/PMMA/Al2O3 pairs. The mechanisms of torsional wear under different counterbodies were discussed in detail. The mechanisms of torsional fretting wear of aluminium alloy are mainly oxidative wear, abrasive wear and delamination in the three fretting regimes. The torsional fretting running regimes transferred from partial slip regime (PSR) to SR were analysed; however, the mixed fretting regime was never appeared in this test. In PSR (lower angular displacement amplitudes), only a dint was found after the tests. The kinetics behaviours and damage mechanism of Ti6Al4V alloy under different angular displacement amplitudes with friction torque and dissipation energy, which are strongly dependent upon the imposed angular displacement amplitudes and presented in three stages, were discussed in detail.

Are asymmetric metal markings on the cone surface of ceramic femoral heads an indication of entrapped debris?

BackgroundThe probability of in vivo failure of ceramic hip joint implants is very low (0.004-0.05%). In addition to material flaws and overloading, improper handling during implantation can induce fractures of the ceramic ball head in the long term. Identifying the causes of an in vivo fracture contributes to improved understanding and potentially to further reduction of the fracture probability for patients. Asymmetric metal markings on the cone surface of in vivo ball head fractures have been reported. The question, therefore, is whether asymmetric loading is the sole cause or whether additional factors, specifically contamination entrapped in the taper fit, also contribute or are even the main cause.MethodsThe influence of the asymmetric physiological load configuration on resulting metal markings in the cone surface of an alumina femoral ball head with and without biological contaminants was investigated. Static and cyclic tests on ball heads were carried out in a load configuration of 0° (axisymmetric) and 40° in a physiological environment. The analysis of the metal marking was carried out to gain a better understanding of the processes that contribute to the generation of metal marking. Fractography was carried out to determine the fracture initiation of failed ball heads.ResultsDifferent types and sizes of residuals entrapped in the conical surface are shown to yield strongly asymmetric metal marking patterns. All heads tested without contaminants exhibited an almost homogenous distribution of residual metal markings around the circumference of the ceramic cone surface at the proximal end of the bore hole. The failure of ball heads that contained entrapped contaminants revealed a common fracture pattern. The site of fracture initiation on two of the failed heads was in the entrance region of the bore hole on the superior half of the head.ConclusionAsymmetric metal markings observed on the ball heads tested in this investigation are most probably caused by the presence of contaminants entrapped in the taper fit. Homogenous metal mark distributions around the circumference indicate proper assembly of the ball head without entrapped contaminants. It should, however, be noted that different taper designs may possibly result in different marking patterns.