Metal-on-Metal Bearings

A Clinical Practicum

  • Lynne C. Jones
  • Warren O. Haggard
  • A. Seth Greenwald

Table of contents

  1. Front Matter
    Pages i-x
  2. Introduction

    1. Front Matter
      Pages 1-1
    2. Lynne C. Jones, Warren O. Haggard, A. Seth Greenwald
      Pages 3-11
  3. Clinical

    1. Front Matter
      Pages 21-21
    2. George Grammatopoulos, Hemant Pandit, Adrian Low, David Murray
      Pages 39-62
    3. Nadim J. Hallab, Paul H. Wooley
      Pages 83-106
  4. Biology

    1. Front Matter
      Pages 107-107
    2. Paul H. Wooley, Nadim J. Hallab
      Pages 109-133
    3. H. John Cooper, Joshua J. Jacobs
      Pages 135-151
    4. Thomas W. Bauer
      Pages 153-162
  5. Biomechanics

    1. Front Matter
      Pages 163-163
    2. Peter Thomas, Burkhard Summer, Marc Thomsen, Veit Krenn, Jan Philippe Kretzer
      Pages 165-172
    3. Robin Pourzal, Robert M. Urban, Markus A. Wimmer
      Pages 173-193
  6. Back Matter
    Pages 195-200

About this book


This book addresses the background and significance of the factors potentially influencing the clinical and biological outcomes of metal-on-metal hip implants. Metal-on-metal bearings were introduced and evaluated as an alternative to other bearing couples, particularly metal-on-polyethylene, due to their enhanced wear resistance as determined in laboratory testing. Initially, reports of short-term clinical outcomes were favorable and an increasing number of metal-on-metal prostheses were implanted. Subsequently, isolated case findings describing adverse tissue responses around the articulation became the harbinger of an increasing number of reports describing pseudotumors and other significant lymphocytic-based responses associated with metal-on-metal prostheses. Questions have been raised as to whether this is an implant, design, or patient-specific response. The reasons why some patients have a negative biological response and pathology while others do not remain to be determined, but tens of thousands of patients in the US,  the UK, and around the world are considered to be at risk. Leading researchers and clinicians describe the issues related to the nature of the biological and pathological responses and the protocols that should be followed to determine if an adverse response is occurring. This book is essential reading for researchers, engineers, and orthopaedic surgeons who are involved in the design, evaluation, and implantation of metal-on-metal prostheses.

  • Presents an historical overview of the use of metal-on-metal articulations
  • Collects for the first time the information necessary to assess clinically and biologically relevant patient outcomes
  • Addresses the practical questions that are being raised by surgeons, researchers, and engineers
  • Features contributions by acknowledged leaders in their fields
  • Describes what the clinician needs to know in order to practice evidence-based medicine
  • Projects directions for clinical, biological, and biomechanical research efforts


ALVAL Adverse Tissue Reaction Arthroplasty Bearing Surfaces Materials Histology and Metal-on-Metal Bearings Response Metal Reactivity Bearings Response Metal Sensitivity Bearings Response Metal-on-Metal Metal-on-Metal Bearings Book Metal-on-Metal Bearings Pseudotumor Outcome Studies Metal-on-Metal Bearings Pseudotumor Total Joint Arthroplasty

Editors and affiliations

  • Lynne C. Jones
    • 1
  • Warren O. Haggard
    • 2
  • A. Seth Greenwald
    • 3
  1. 1.Department of Orthopaedic SurgeryJohns Hopkins UniversityBaltimoreUSA
  2. 2.Department of Biomedical EngineeringUniversity of MemphisMemphisUSA
  3. 3.Orthopaedic Research Laboratories Lutheran HospitalCleveland ClinicClevelandUSA

Bibliographic information

Industry Sectors
Materials & Steel
Chemical Manufacturing
Consumer Packaged Goods