[Metal-on-metal pairs for hip prostheses]

Due to engineering deficiencies as well as problems in the basic material, the first generation of metal-on-metal hip prostheses was not up to standard.Furthermore, unsatisfying clinical results led to a decrease in the use of these prostheses.Nevertheless, there were several cases which demonstrated good results in long-term clinical outcome. After distinct improvements in manufacturing and materials, metal-on-metal prostheses have made a come back. This second generation, which are known mainly under the names METASUL and SIKOMET,have been in clinical use for up to 10 years and the good results found in biomechanical set ups seem to be confirmed in clinical trials. However, a possible disadvantage of this second generation of metal-on-metal hip prostheses might be the production of large amounts of particulate wear debris in the nanometer size range. Whether the great number of small size particles with an extended metal surface and the possible distribution of these particles in the body have biological effects on the cells and tissues (such as allergic or toxic reactions) remains unknown. Among the tribological problems, there is currently a discussion on the possible inflammatory effect of these metal particles, which might play a crucial role in longterm, systemic reactions of the body to metal particles.