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Larger femoral head
11%
461/4221
Slight clearance of fit between the acetabular cup and the femoral head
16%
682/4221
Minimal surface roughness of the femoral head
3%
120/4221
Complete congruence of fit between the acetabular cup and the femoral head
67%
2848/4221
Minimal surface roughness of the acetabular cup
2%
93/4221
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An ideal fluid film lubrication regime minimizes friction. A larger head size results in a greater development of full-film lubrication due to the increased relative sliding velocity of the larger bearing surfaces. Increased surface roughness inhibits the formation of the film lubrication. The most important factor influencing the predicted lubrication film thickness has been found to be the radial clearance between the ball and the socket. Jin et al report that slight clearance, not complete congruence, is optimal for formation of the optimal fluid film lubrication. They note that full fluid film lubrication may be achieved in these hard/hard bearings provided that the surface finish of the bearing surface and the radial clearance are chosen correctly and maintained. Dumbleton reviewed the literature of metal-on-metal THA and concluded that the current literature does not show any clinical benefit of metal-on-metal compared to metal on poly. Metal-on-metal has been shown to have higher metal ion level in blood, and measurement of these levels is recommended to help identify those at risk of adverse effects from metal on metal prostheses.
3.3
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