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Christiaan P. van Lingen Isala Clinics, Department of Orthopaedic Surgery and Traumatology, Zwolle, The Netherlands

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Luigi M. Zagra IRCCS Istituto Ortopedico Galeazzi, Milan, Italy

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Harmen B. Ettema Isala Clinics, Department of Orthopaedic Surgery and Traumatology, Zwolle, The Netherlands

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Cees C. Verheyen Isala Clinics, Department of Orthopaedic Surgery and Traumatology, Zwolle, The Netherlands

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Introduction Large-head metal-on-metal (MoM) bearings were re-popularised in the late 1990s with the introduction of modern hip resurfacing (HR), followed shortly afterward by large metal head total hip arthroplasty (THA). The introduction of

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Feng Xie The Third Affiliated Hospital of Chongqing Medical University, Chongqing, China

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Shuya Sheng Leeds Institute of Rheumatic and Musculoskeletal Medicine (LIRMM), University of Leeds, Leeds, UK

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Jeya Palan Leeds Institute of Rheumatic and Musculoskeletal Medicine (LIRMM), University of Leeds, Leeds, UK

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Hemant G Pandit Leeds Institute of Rheumatic and Musculoskeletal Medicine (LIRMM), University of Leeds, Leeds, UK

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dissatisfaction, and litigation ( 4 ). Hip resurfacing arthroplasty (HRA) is an attractive alternative to standard stemmed THA. HRA are metal-on-metal (MoM) articulations, and various in vitro assessments have confirmed a low wear rate with the use of MoM

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Luigi Zagra Hip Department, IRCCS Istituto Ortopedico Galeazzi, Italy

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Enrico Gallazzi Hip Department, IRCCS Istituto Ortopedico Galeazzi, Italy

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.5% for THA performed. 6 While THA is a successful procedure in most cases, failures are still recorded. Overall, excluding metal-on-metal (MoM) bearings from the analysis, failures due to articulating materials represent around 5% of the total

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Claude B. Rieker Zimmer Biomet, Switzerland

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neutralise the formation of free radicals responsible for oxidation. 22 Vitamin E can be incorporated either by diffusion, or by blending it into PE before the moulding process. Metal-on-metal bearings With a first implantation in 1938 by Wiles

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Bart G. Pijls Department of Orthopaedics, Leiden University Medical Center, Leiden, The Netherlands

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Jennifer M. T. A. Meessen Department of Orthopaedics, Leiden University Medical Center, Leiden, The Netherlands

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Keith Tucker Implant Performance Committee, England and Wales National Joint Registry, ODEP, Beyond Compliance and MHRA Expert Advisory Group for MoM Prostheses, London, UK

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Susanna Stea Istituto Ortopedico Rizzoli, Bologna, Italy

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Liza Steenbergen Dutch Arthroplasty Register (Landelijke Registratie Orthopedische Implantaten, LROI), 's- Hertogenbosch, The Netherlands

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Anne Marie Fenstad The Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway

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Keijo Mäkelä Department of Orthopedics and Traumatology, Turku University Hospital, Turku, Finland

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Ioan Cristian Stoica Foisor Orthopaedics Clinical Hospital, Bucharest, Romania

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Maxim Goncharov VJRR, Russian Scientific Research Institute of Traumatology and Orthopedics, St Petersburg, Russia

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Søren Overgaard Department of Orthopedic Surgery and Traumatology, Odense University Hospital, Odense, Denmark

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Jorge Arias de la Torre Departament de Salut, Agència de Qualitat i Avaluació Sanitàries de Catalunya (AQuAS), Barcelona, Spain
CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
Instituto de Biomedicina (IBIOMED). Universidad de León, León, Spain

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Anne Lübbeke Division of Orthopaedic Surgery and Traumatology, Geneva University Hospitals, Geneva, Switzerland
Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK

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Ola Rolfson Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden

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Rob G. H. H. Nelissen Department of Orthopaedics, Leiden University Medical Center, Leiden, The Netherlands

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Introduction Metal-on-metal (MoM) bearings have been used since the early years of total hip replacement (THR). Early historical MoM prostheses from the 1960s, 1970s and 1980s include the McKee Farrar hip and the Ring hip prostheses. 1

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Dongmei Wu School of Medicine, University of St. Andrews, St. Andrews, Fife, United Kingdom

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Rohan M Bhalekar ExplantLab, The Biosphere, Newcastle Helix, Newcastle-upon-Tyne, United Kingdom

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Jordan S Marsh School of Medicine, University of St. Andrews, St. Andrews, Fife, United Kingdom

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David J Langton ExplantLab, The Biosphere, Newcastle Helix, Newcastle-upon-Tyne, United Kingdom

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Alan J Stewart School of Medicine, University of St. Andrews, St. Andrews, Fife, United Kingdom

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a promising survivorship ( 1 ). CoCr alloys have been widely used in metal-on-metal (MoM) hip replacements, femoral component of total knee replacements (TKR) as well as in the ball portion of shoulder replacements. For example, in mid-2000s

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Michael M. Morlock TUHH Hamburg University of Technology, Hamburg, Germany.

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Robert Hube OCM Clinic Munich, Munich, Germany

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Georgi Wassilew Department for Orthopaedics and Orthopaedic Surgery, University of Greifswald, Greifswald, Germany

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Felix Prange TUHH Hamburg University of Technology, Hamburg, Germany.

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Gerd Huber TUHH Hamburg University of Technology, Hamburg, Germany.

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Carsten Perka Center for Musculoskeletal Surgery, Orthopedic Department, Charité – Universitätsmedizin Berlin, Berlin, Germany

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situation – Metal-on-metal bearings Since dislocation was one of the most frequent revision reasons, larger heads were used more frequently, starting around 2004, to reduce the dislocation risk. 6 Since larger heads generate more wear against

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J R W Crutsen Department of Orthopaedic Surgery, VieCuri Medical Center, Venlo, the Netherlands

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M C Koper Department of Orthopaedic Surgery, Reinier HAGA Orthopaedic Center, Zoetermeer, the Netherlands

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J Jelsma Department of Orthopaedic Surgery and Traumatology, Zuyderland Medical Center, Sittard-Geleen-Heerlen, the Netherlands

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M Heymans Zuyderland Academy, Centre of Knowledge and Information (KIC), Zuyderland Medical Centre, Sittard-Geleen, the Netherlands

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I C Heyligers Department of Orthopaedic Surgery and Traumatology, Zuyderland Medical Center, Sittard-Geleen-Heerlen, the Netherlands
School of Health Professions Education (SHE), Maastricht University, Maastricht, the Netherlands

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B Grimm Luxembourg Institute Health, Human Motion, Orthopaedics, Sports Medicine, Digital Methods (HOSD), Luxembourg, Luxembourg

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N M C Mathijssen Department of Orthopaedic Surgery, Reinier HAGA Orthopaedic Center, Zoetermeer, the Netherlands

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M G M Schotanus Department of Orthopaedic Surgery and Traumatology, Zuyderland Medical Center, Sittard-Geleen-Heerlen, the Netherlands
School of Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands

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cobalt concentrations are often seen after implantation of metal-on-metal (MoM) hip bearings ( 7 ). This can be due to the release of ions from the metal (cobalt–chromium) surface either directly (corrosion) or during sliding under load, which may create

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Keijo T. Mäkelä Turku University Hospital and University of Turku, Finland, and the Finnish Arthroplasty Register

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Ove Furnes Haukeland University Hospital, Bergen, Norway, and the Norwegian Arthroplasty Register

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Geir Hallan Haukeland University Hospital, Bergen, Norway, and the Norwegian Arthroplasty Register

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Anne Marie Fenstad Haukeland University Hospital, Bergen, Norway, and the Norwegian Arthroplasty Register

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Ola Rolfson Sahlgrenska University Hospital and University of Gothenburg, Sweden, and the Swedish Hip Arthroplasty Register

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Johan Kärrholm Sahlgrenska University Hospital and University of Gothenburg, Sweden, and the Swedish Hip Arthroplasty Register

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Cecilia Rogmark Department of Orthopedics, Skåne University Hospital, Department of Clinical Sciences Malmö, Lund University, and the Swedish Hip Arthroplasty Register, Sweden

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Alma Becic Pedersen Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark, and the Danish Hip Arthroplasty Register

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Otto Robertsson The Swedish Knee Arthroplasty Register, Department of Orthopedics, Skåne University Hospital, and Department of Clinical Sciences, Orthopedics, Lund University, Sweden

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Annette W-Dahl The Swedish Knee Arthroplasty Register, Department of Orthopedics, Skåne University Hospital, and Department of Clinical Sciences, Orthopedics, Lund University, Sweden

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Antti Eskelinen Coxa Hospital for Joint Replacement, Tampere, Finland, and the Finnish Arthroplasty Register

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Henrik M. Schrøder Department of Orthopaedic Surgery, Naestved Hospital, Denmark, and the Danish Knee Arthroplasty Register

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Ville Äärimaa Turku University Hospital and University of Turku, Finland, and the Finnish Arthroplasty Register

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Jeppe V. Rasmussen Department of Orthopaedic Surgery, Herlev Hospital, University of Copenhagen, Denmark, and the Danish Shoulder Arthroplasty Register

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Björn Salomonsson Department of Orthopedics, Karolinska Institutet, Danderyds Sjukhus AB, Sweden, and the Swedish Shoulder Arthroplasty Register

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Randi Hole Haukeland University Hospital, Bergen, Norway, and the Norwegian Arthroplasty Register

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Søren Overgaard Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Department of Clinical Research, University of Southern Denmark, and the Danish Hip Arthroplasty Register

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those classified according to fixation technique as cemented, uncemented, and hybrids (uncemented cup/cemented stem). Focus on metal-on-metal hip devices Johanson et al (2010) compared 1638 hip resurfacing arthroplasties in Sweden, Norway and

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Georgios Tsikandylakis Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden
Region Västra Götaland, Sahlgrenska University Hospital, Department of Orthopaedics, Gothenburg, Sweden

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Soren Overgaard The Danish Hip Arthroplasty Register, Aarhus, Denmark
Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Odense, Denmark
Institute of Clinical Research, University of Southern Denmark, Odense, Denmark

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Luigi Zagra Hip Department, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy

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Johan Kärrholm Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden
Region Västra Götaland, Sahlgrenska University Hospital, Department of Orthopaedics, Gothenburg, Sweden
The Swedish Hip Arthroplasty Register, Gothenburg, Sweden

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standard in many countries. 4 Introduction of metal-on-metal articulations, ceramic-on-ceramic and, above all later on, highly cross-linked polyethylene opened the possibility for the use of bigger head sizes, but recent studies have suggested limited

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