Comparison of cobalt chromium, ceramic and pyrocarbon hemiprostheses in a rabbit model: Ceramic leads to more cartilage damage than cobalt chromium

Abstract

Cartilage wear after hemiarthroplasty remains a problem in orthopedic surgery. The main cause of cartilage wear, apart from incongruency of the joint partners, is generally considered to be the tribology of the material surfaces. This study evaluates in 27 rabbits the degree of cartilage wear of the tibia plateau after hemiarthroplasty with proximal interphalangeal prostheses made of three different materials [cobalt chromium (CoCr), pyrocarbon (PyCa), and ceramic (Cer)]. Three months after hemiarthroplasty, the articulating tibial cartilage was histomorphologically examined and degenerative damage was graded using the modified Mankin score. The mechanical capacity of the cartilage was assessed by stress relaxation testing. The biomechanical properties of the cartilage were significantly superior in the CoCr group as compared with the Cer group (p < 0.03), indicating less damage to the articulating cartilage surface. The Mankin score showed significantly lower values in the CoCr compared with Cer group (p = 0.011), whereas no differences were found between PyCa and CoCr or PyCa and Cer. In contrast to earlier reports, in this hemiarthroplasty model, the CoCr alloy showed less cartilage damage than a ceramic surface. Further, in vivo experiments are necessary to elucidate the controversial issue of the most suitable material for hemiarthroplasty.