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Is OXINIUM really better?
In my last post [click here] I reviewed a 1988 scientific paper which raised a number of questions for me.
The last third of the Post looks at one of the new “wonder materials” – Oxinium (TM Smith & Nephew) and in the light of this last scientific article and the other literature I have read I am left wondering:
All forms of hip replacement have problems
– but what really interests me is that I have a Smith & Nephew Birmingham Spectron Cobalt Chrome Total Hip Replacement (THR) – which by the way is bloody painful as I write this – and I think that we all know the issues emerging with Cobalt Chrome – higher levels than normal in the blood & tissues, osteolysis (tissue damage) and bone resorption.
So metal-on-metal is not performing well if you have a DePuy THR – and for lucky low-percentile types like me – the Smith & Nephew Cobalt Chrome is just as nasty it seems…
So what are Smith & Nephew touting now … OXINIUM (Smith & Nephew Registered TM) – which is:
Oxidized Zirconium – which is ZIRCONIA...
Now, according to Wikepedia:
Zirconium dioxide (ZrO2), sometimes known as zirconia (not to be confused with zircon), is a white crystalline oxide of zirconium.
Now didn’t I read somewhere (above) that:
Since this wear was attributed to the zirconia particles… AND
zirconia particles produced marked activation of macrophages and an inflammatory reaction …
So I ask myself a very simple question – why would someone make an articulating surface (hip joint) which is effectively made of a metallic “sand paper” – surely one would have to expect wear – even though it is in theory “diamond hard”?
A few things stand out for me:
- Zirconium may well be bio-compatible like titanium – but according to the scientific paper above oxidised zirconium (zirconia) IS NOT…
- As the Zirconia in the ball joint of the THR wears, surely it will shed zirconia particles – these produced marked activation of macrophages and an inflammatory reaction… AND
- wear was attributed to the zirconia particles…
- AND… wear with Oxinium, while less, may lead to to more inflamatory reaction – less may produce more – will have to research the literature further to see what is said.
So call me a bloody skeptic, but we may well end up with yet another accident going somewhere to happen…
And you will note below:
Smith & Nephew say “excellent fracture toughness like cobalt chrome” – WELL, that answers another of my questions about S&N Birmingham Spectron Cobalt Chrome THR’s – they MUST have “heat treated” the cast Cobalt Chrome alloy as cast Cobalt Chrome according to the literature I have read is brittle – have a look at the post where I highlight the scientific study that shows – click here to go to it. And here is the Scientific Paper Click here.
AND when you heat-treat cast Cobalt Chrome, you decrease the carbide content –
“carbide content can be reduced from a volume percentage of seven down to 0.03.”
So as reduced carbide content reduces toughness, but gives more flexibility (less fractures), it also increases wear, and the rate of release of cobalt and chromium ions into the surrounding bone and tissue – leading to osteolysis, tissue and bone damage, bone resorption and many metabolic problems at higher levels.
So it seems safe to assume (may I?) that the Smith & Nephew Cobalt Chrome THR that I have has heat treated Cobalt Chrome – hence the cobalt chrome damage to my hip tissues and bone.
Note the earlier reference:
Co [i.e. Cobalt; my note] was toxic to osteoblast-like cell lines and inhibited the production of type-I collagen, osteocalcin and alkaline phosphatase…
So cobalt is toxic to the very cells that produce new bone….
Here’s what Smith & Nephew have to say about OXINIUM:
What is the OXINIUM material?
OXINIUM◊ oxidized zirconium is a metallic alloy with a ceramic surface that provides wear resistance without brittleness.
OXINIUM◊ material combines the best of both metal and ceramics.
It is a metal, with excellent fracture toughness like cobalt chrome, (my underlining) but it has a ceramic surface that offers outstanding wear resistance.3
The ceramic is an enhanced surface that is part of the metal substrate rather than an external coating, making it very durable.
Zirconium: a biocompatible metallic element in the same family as titanium.
Zirconia: a ceramic compound, wear-resistant but brittle.
Zr-2.5Nb: a metallic alloy of zirconium, with niobium and oxygen for increased strength.
Quality Control for OXINIUM Components
Extensive research and development indicated four critical control points to ensure a consistent quality product, as follows:
- Raw materials inspection
- Pre-oxidization surface preparation
- Oxidization process
- Post-oxidization surface burnishing
All components undergo inspection to ensure that the ceramic oxide is uniform and the correct thickness. A non-destructive laser measurement technique provides a means for 100% quality assurance inspection of components.
3. M. Long, L. Riester, and G. Hunter, “Nano-hardness measurements of oxidized Zr-2.5Nb and various orthopaedic materials”, Trans. Soc. Biomaterials, 21, 1998, p. 528.
Wear in Total Joint Arthroplasty
With OXINIUM femoral heads, low wear reduces the chances of aseptic loosening and may extend the life of the joint. The OXINIUM material may offer extended joint life through reduced wear and friction.
OXINIUM Hip Implants
- Fracture (ceramic-on-ceramic)
- Metal sensitivity (metal-on-metal)
- More wear and osteolysis (cobalt chrome-on-polyethylene)
Only the OXINIUM-on-XLPE advanced bearing system delivers peak performance without compromise, making it ideal for your patients.If you’re tired of the trade-offs, rethink your options and you will find the answer is black and white.
OXINIUM heads on XLPE liners: no fracture, chipping or squeaking The ceramic surface of OXINIUM heads is not a coating, so it cannot chip or flake. The original metal surface is transformed into a ceramic through thermal processing, providing you with the only unbreakable ceramic on the market that is not a coating.1,2,3
The ceramic surface of OXINIUM heads is integral with the metal alloy which allows OXINIUM heads to provide ceramic wear performance without the risk of fracture.2,4,5 Whether it is fracture, chipping or squeaking that you are concerned about, OXINIUM heads on XLPE liners address all of these concerns.
- Hunter, G., Dickinson, J., Herb, B., et al. (2005). Creation of oxidized zirconium orthopaedic implants. J. ATSM Int., 2 (7).
- Sheth, N., Lementowski, P., Hunter, G., Garino, J. (2008). Clinical Applications of Oxidized Zirconium. J. Surgical Orthopaedic Advances, 17(1).
- Hunter, G. (2001) Adhesion testing of oxidized zirconium. Trans. 27th Ann. Mtg. Soc. Biomaterials, Society for Biomaterials, Minneapolis, MN, 540.
- Hobbs, L., Rosen, V., Mangin, S., et al. (2005). Oxidation microstructures and interfaces in the oxidized zirconium knee. J. Appl. Ceram. Tech., (2), 221-246.
- Sprague, J., Salehi, A. Tsai S., et al., Mechanical behavior of zirconia, alumina, and oxidized zirconium modular heads. In ISTA 2003, vol. 2, edited by S. Brown, I. C Clarke, A. Gustafson, International Society for Technology in Arthroplasty, Birmingham, AL, 2004.
- Hallab, N. (2004). Lympohocyte transformation testing for quantifying metal-implant-related hypersensitivity responses. Dermatitis, 15 (2), 82-92.
- Kovacs, P., Davidson J., Chemical and electrochemical aspects of the biocompatibility of titanium and its alloys. In American Society for Testing and Materials: Medical Applications of Titanium and Its Alloys, pp. 163-178, edited by S. A. Brown, J.E. Lemons, ASTM STP 1272, American Society for Testing and Materials, West Conshohocken, PA 1996.
- Hallab, N., Merritt, K., Jacobs, J. (2001). Metal sensitivity in patients with orthopaedic implants. Journ. Bone Joint Surg., 83 (A), 428-436.
- M arek, M., Pawar, V., Tsai. S., et al. (2006). Galvanic corrosion evaluation of Zr-2.5Nb coupled with orthopaedic alloys. In Medical Device Materials, 3, (pp. 195-201). Materials Park, OH: R. Venugopalan, M. Wu, ASM International Edition.
- N asser, S., Mott, M., Wooley, P. (2006). A prospective comparison of ceramic and oxinium TKA components in metal hypersensitivity patients. Proceedings of the Annual Meeting of the American Academy of orthopaedic Surgeons, (pp. 194) San Diego, CA.
- Lhotka, C., Szekerea, T., Steffan, T., Zhubar, K., and Zweymuller, K. 2003). Four year study of cobalt and chromium blood levels in patients managed with two different metal on metal total hip replacements. J. Ortho Research, 21 (2), 189-195.
OXINIUM heads on XLPE liners: a hypoallergenic
Patients have drastically different tolerances to metal ions. Nickel allergy has been demonstrated in up to 20% of patients with well-functioning implants and up to 55% of patients with poorly functioning implants.
OXINIUM material has no detectable nickel content. Compared to the traditional metal used in hip implants, the zirconium and niobium contained in OXINIUM material are more biocompatible. This makes OXINIUM heads an appropriate choice for patients with metal sensitivities.7,8,9,10,11 Whether it’s metal sensitivity or metal ions you are concerned about, OXINIUM heads on XLPE liners address both of these issues.
OXINIUM heads on XLPE liners: lower risk of osteolysis
Smith & Nephew XLPE acetabular liners produce less wear particles than other cross-linked polyethylenes.12,13,14 When combined with OXINIUM heads, wear debris is further reduced in comparison with standard CoCr heads.
Simulator results utilizing the active high demand patient profile demonstrate that OXINIUM heads outperform CoCr heads on XLPE. OXINIUM heads minimize the material-related risks associated with other advanced bearings, while meeting the requirements of active patients. Whether it is the demands of active patients or prosthesis longevity that you are concerned about, OXINIUM heads on XLPE liners are a great choice.
3 Hunter, G. (2001) Adhesion testing of oxidized zirconium. Trans. 27th Ann. Mtg. Soc. Biomaterials, Society for Biomaterials, Minneapolis, MN, 540.
12 Good, V., Ries, M., Barrack, Rl, et al. (2003). Reduced wear with oxidized zirconium femoral heads. J. Bone Joint Surg., 85 (A suppl 4) 105-110.
13 Ries, M., Scott, M., Jani, S. (2001). Relationship between gravimetric wear and particles generation in hip simulators: conventional compared with cross-linked polyethylene. J. Bone Joint Surg. Am., 83, S116-122.
14 Scott, M., Morrison, M., Mishra, S., Jani, S. (2002). A method to quantify wear particle volume using atomic force microscopy. ORS Transactions, 27, 132.
15 Smith & Nephew. (2008). Smith & Nephew (Internal Report). Parikh, et. al.
16 M .G. Li, Z.K. Zhou, D.J. Wood, S.M. Rohrl, J.L. Loppolo, and B. Nivbrandt. (2006) Low wear with high-cross linked polyethylene especially in combination with Oxinium heads. A RSA evaluation. Trans. Orthop. Res. Soc., 31, 643.
Technorati Tags: ceramic, ceramic-on-metal hip, chromium ions, cobalt chrome, hip implant, hip prosthesis, joint disease, joint replacement, metal ion concentrations, metal wear debris, metal-on-metal hip, Oxinium, Zironium, Zirconia, Oxidised Zirconium, Smith & Nephew, zirconia particles, inflamatory reaction, ceramic wear debris
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Doris Reiff said:
i had my oximium hip replacement in 2010 at the age of 52 and i am finding alot
of pain going down my leg and want to know what this means. i constantly have
to put heat and heat creams on my leg and still the pain is getting worst. please
reply on my e-mail by email@example.com and lets talk. Thank you Doris Reiff
Hip was put in by Dr.Drucker on Staten Island in Staten Island University Hospital
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I had both my knees replaced with Smith and Nephew Oxinimium knees and LOVE them! I’m hoping they last 30 years– since I am in my 50’s. I’ve had a great recovery and am doing more than i have in years! I would like to know how you are doing, and how others are doing with these implants.
Earl, thanks for the post and info. I’m about to get a hip replacement myself and the doctor is recommending Oxinium. I read the scientific article link to your post but that article seemed to be talking about only chromium and titanium combinations. I didn’t see any references there in to the zirconium material. Was there another article that you could refer me to dealing with this?
Thanks very much for your help.
Oxinium is a zirconium oxide. There have been no recent adverse reports and it may be stable like a ceramic. There were earlier problems with knees. Guess I just don’t trust S&N. My ceramic on ceramic hip is made by Zimmer and it is wonderful. But most ceramics are made by one French company.
Why don’t you trust S&N? They are more ethical than most orthopedic companies out there who pay surgeons to use their products. A 30 year knee and hip is a no brainer to me! Ceramic can squeak, crack and break– none of these can happen with Oxinium. Oxinium has been around for 16 years and is the longest lasting hip and knee on the market– the ONLY one approved to last for 30 years by the FDA. In fact, in the latest Australian hip registry, where they monitor every hip that goes in, Oxinium had the lowest revision rate of any hip on the market.
I had a metal on metal hip from s&n which poisoned me and had to be replaced after 3 years. They have never addressed the MOM problems and just hide behind statistics with them – the BHR and the THR equivalent. They have paid plenty of surgeons in the USA and paid the inventor of the BHR over $100 m. But I agree Oxinium seems ok and it was only early problems with the knees that were adverse.