A prospective, randomised controlled trial comparing ceramic-on-metal and metal-on-metal bearing surfaces in total hip replacement

R. Schouten, A. A. Malone, C. Tiffen, C. M. Frampton, G. Hooper


In a double-blinded randomised controlled trial, 83 patients with primary osteoarthritis of the hip received either a ceramic-on-metal (CoM) or metal-on-metal (MoM) total hip replacement (THR). The implants differed only in the bearing surfaces used. The serum levels of cobalt and chromium and functional outcome scores were compared pre-operatively and at six and 12 months post-operatively.

Data were available for 41 CoM and 36 MoM THRs (four patients were lost to follow-up, two received incorrect implants). The baseline characteristics of both cohorts were similar. Femoral head size measured 36 mm in all but two patients who had 28 mm heads. The mean serum cobalt and chromium levels increased in both groups, with no difference noted between groups at six months (cobalt p = 0.67, chromium p = 0.87) and 12 months (cobalt p = 0.76, chromium p = 0.76) post-operatively. Similarly, the mean Oxford hip scores, Western Ontario and McMaster Universities Osteoarthritis index and University of California, Los Angeles activity scores showed comparable improvement at 12 months.

Our findings indicate that CoM and MoM couplings are associated with an equivalent increase in serum cobalt and chromium levels, and comparable functional outcome scores at six and 12-months follow-up.


  • The authors acknowledge the contributions of Ms V. V. Bell and the Christchurch Orthopaedic and Bone Research Association (COBRA). The WISHBONE TRUST (New Zealand Orthopaedic Association) provided funding for the study. Canterbury Health Laboratories (Christchurch, New Zealand) performed metal ion levels analysis.

    No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article.

  • Received February 9, 2012.
  • Accepted July 10, 2012.
View Full Text

Log in through your institution