Comparison of In-Vivo Wear between Polyethylene Inserts articulating against Ceramic and Cobalt-Chrome Femoral Components in Total Knee Prostheses

  • Hinorobu Oonishi
  • S.-C. Kim
  • M. Kyomoto
  • M. Iwamoto
  • M. Ueno
Part of the Ceramics in Orthopaedics book series (CIO)


In the late 1970s, the use of a combination of alumina ceramics and ultra-high molecular weight polyethylene (UHMWPE) was started for total knee prostheses (TKPs) to reduce UHMWPE wear and suppress bone resorption, based on good clinical results in total hip prostheses. In this study, to examine the in vivo efficacy of alumina ceramic bearing surface of TKP, we compared retrieved alumina ceramic TKPs with cobalt-chrome (Co-Cr) alloy TKPs by surface observation and linear wear measurement. In the scanning electron microscopic observations, many scratches due to clinical use were observed only on the retrieved Co-Cr alloy femoral component. The damage in the form of scratches on the articulating surface was linear and produced by rubbing of microscopic asperities against the Co-Cr alloy surface. The linear wear rate of the retrieved Co-Cr alloy TKPs was 0.027–0.358 mm/year. In contrast, the wear of the retrieved alumina ceramic TKPs was stably low and linear; the linear wear rate was estimated to be 0.026 mm/year. The lower wear rate and milder nature of wear observed in TKP with UHMWPE insert and alumina ceramic femoral component combination suggest the possibility of retention of high performance of this TKP even during prolonged clinical use.


Wear Rate Wear Surface Femoral Component Tibial Component Linear Wear 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Naudie DD, Ammeen DJ, Engh GA, et al. Wear and osteolysis around total kneearthroplasty. J Am Acad Orthop Surg 2007;15(1):53–64.PubMedGoogle Scholar
  2. 2.
    Harris WH. The problem is osteolysis. Clin Orthop Relat Res 1995;(311):46–53.Google Scholar
  3. 3.
    Boutin P. Alumina and its use in surgery of the hip. Presse Med 1971;79:639–640.Google Scholar
  4. 4.
    Boutin P, Christel P, Dorlot JM, et al. The use of dense alumina-alumina ceramic combination in total hip replacement. J Biomed Mater Res 1988;22:1203–1232.PubMedCrossRefGoogle Scholar
  5. 5.
    Shikita T, Oonishi H, Hashimoto Y, et al. Wear resistance of irradiated UHMW polyethylenes to Al2O3 ceramics in total hip prostheses. Transactions of the 3rd Annual Meeting of the Society for Biomaterials 3:118, 1977.Google Scholar
  6. 6.
    Oonishi H, Wakitani S, Murata N, et al. Clinical experience with ceramics in total hip replacement. Clin Orthop Relat Res. 2000;(379):77–84.Google Scholar
  7. 7.
    Oonishi H, Hasegawa T. Cementless alumina ceramic total knee prosthesis. Orthopedic Ceramic Implants 1 1981;157–160.Google Scholar
  8. 8.
    Oonishi H, Tsuji E, Mizukoshi T, et al. Wear of polyethylene and alumina in clinical cases of alumina total knee prostheses. Bioceramics 1991;3:137–145.Google Scholar
  9. 9.
    Oonishi H, Fujita H, Itoh S, et al. Surface analysis on retrieved ceramic total knee prosthesis. Key Eng Mater 2002;218–220:499–502.Google Scholar
  10. 10.
    Oonishi H, Fujita H, Itoh S, et al. Development and improvement of ceramic TKP for 19 years and clinical results. Key Eng Mater 2002;218–220:479–482.Google Scholar
  11. 11.
    Nakanishi T, Shikata K, Wang Y, et al. The characteristics of the new material for artificial joints. Key Eng Mater 2006;309–311:1235–1238.CrossRefGoogle Scholar
  12. 12.
    Akagi M, Nakamura T, Matsusue Y, et al. The bisurface total knee replacement: a unique design for flexion. J Bone Joint Surg Am 2000;82(11):1626–1633.PubMedGoogle Scholar
  13. 13.
    Akagi M, Ueo T, Takagi H, et al. A mechanical comparison of 2 posterior-stabilizing designs: Insall/Burstein 2 knee and Bisurface knee. J Arthroplasty 2002;17(5):627–634.PubMedCrossRefGoogle Scholar
  14. 14.
    Akagi M, Kaneda E, Nakamura T, et al. Functional analysis of the effect of the posterior stabilising cam in two total knee replacements. A comparison of the Insall/Burstein and Bisurface prostheses. J Bone Joint Surg Br 2002;84(4):561–565.PubMedCrossRefGoogle Scholar
  15. 15.
    Oonishi H, Kim SC, Ueno M. PE wear in ceramic/PE bearing surface in TKA: 24 year clinical experience. Presented at the 17th Annual Symposium of the International Society for Technology in Arthroplasty, Rome, Italy, September 2004.Google Scholar
  16. 16.
    Oonishi H, Kim SC, Kyomoto M, et al. PE wear in ceramic/PE bearing surface in total knee arthroplasty: Clinical experiences of more than 24 years. In: Benazzo F, Falez F and Dietrich M, editors. Bioceramics and Alternative Bearings in Joint Arthroplasty, 2006.Google Scholar
  17. 17.
    Oonishi H, Kim SC, Kyomoto M, et al. Change in UHMWPE Properties of Retrieved Ceramic Total Knee Prosthesis in Clinical Use for 23 Years. J Biomed Mater Res Appl Biomater 2005;74B:754–759.CrossRefGoogle Scholar
  18. 18.
    Minakawa H, Stone MH, Wroblewski BM, et al. Quantification of third-body damage and its effect on UHMWPE wear with different types of femoral head. J Bone Joint Surg Br 80(5):894–899, 1998.PubMedCrossRefGoogle Scholar
  19. 19.
    Davidson JA, Poggie RA, Mishra AK. Abrasive wear of ceramic, metal, and UHMWPE bearing surfaces from third-body bone, PMMA bone cement, and titanium debris. Biomed Mater Eng 1994;4(3):213–229.PubMedGoogle Scholar

Copyright information

© Steinkopff Verlag 2007

Authors and Affiliations

  • Hinorobu Oonishi
    • 1
  • S.-C. Kim
  • M. Kyomoto
  • M. Iwamoto
  • M. Ueno
  1. 1.H. Oonishi Memorial Joint Replacement Institute 4-48Tominaga HospitalOsaka-ShiJapan

Personalised recommendations