Müller reviews the history of metal-on-metal total hip articulations from the 1960s through the 1990s. He argues that polyethylene wear debris, not cement, is the main biologic threat to hip implant longevity. The paper presents laboratory wear data supporting a return to modern metal-on-metal bearings.
The central teaching point is that aseptic loosening after total hip arthroplasty is a biologic, not purely mechanical, phenomenon. Polyethylene wear particles are phagocytosed by macrophages, which release mediators that drive periprosthetic osteolysis and component migration. Recognizing this mechanism is what shifted the field's attention from cement to the bearing surface.
This paper is an early advocacy piece for the 1990s revival of metal-on-metal bearings, supported mainly by retrieval observations and bench wear data rather than controlled clinical outcomes.
Read it critically. It is a single-author historical review, and the author openly acknowledges that local and systemic tolerance to metal wear particles was still unproven. Subsequent experience with adverse reactions to metal debris (pseudotumors, elevated cobalt/chromium ions) tempered this optimism, so the promise here should be weighted against later, harder clinical evidence.
Müller reviews the history of metal-on-metal total hip articulations from the 1960s through the 1990s. He argues that polyethylene wear debris, not cement, is the main biologic threat to hip implant longevity. The paper presents laboratory wear data supporting a return to modern metal-on-metal bearings.
The central teaching point is that aseptic loosening after total hip arthroplasty is a biologic, not purely mechanical, phenomenon. Polyethylene wear particles are phagocytosed by macrophages, which release mediators that drive periprosthetic osteolysis and component migration. Recognizing this mechanism is what shifted the field's attention from cement to the bearing surface.
This paper is an early advocacy piece for the 1990s revival of metal-on-metal bearings, supported mainly by retrieval observations and bench wear data rather than controlled clinical outcomes.
Read it critically. It is a single-author historical review, and the author openly acknowledges that local and systemic tolerance to metal wear particles was still unproven. Subsequent experience with adverse reactions to metal debris (pseudotumors, elevated cobalt/chromium ions) tempered this optimism, so the promise here should be weighted against later, harder clinical evidence.