Corrosion and Adverse Local Tissue Reaction in One Type of Modular Neck Stem.

Modular neck stems allow for optimization of joint biomechanics by restoring anteversion, offset, and limb length. A potential disadvantage is the generation of metal ions from fretting and crevice corrosion. We identified 118 total hip arthroplasty implanted with one type of dual-modular femoral component. Thirty-six required revision due to adverse local tissue reaction. Multivariate analysis isolated females and low offset necks as risk factors for failure. Kaplan-Meir analysis revealed small stem sizes failed at a higher rate during early follow-up period. Although the cobalt/chrome levels were higher in the failed group, these tests had low diagnostic accuracy for ALTR, while MRI scan was more sensitive. We conclude that the complications related to the use of dual modular stems of this design outweigh the potential benefits.

Corrosion in artificial saliva of a Ni-Cr-based dental alloy joined by TIG welding and conventional brazing.

STATEMENT OF THE PROBLEM: Fixed prosthesis and partial dental prosthesis frameworks are usually made from welded Ni-Cr-based alloys. These structures can corrode in saliva and have to be investigated to establish their safety. PURPOSE: The purpose of this study was to evaluate the corrosion behavior of joints joined by tungsten inert gas (TIG) welding and conventional brazing in specimens made of commercial Ni-Cr alloy in Fusayama artificial saliva at 37°C (pH 2.5 and 5.5). MATERIAL AND METHODS: Eighteen Ni-Cr base metal specimens were cast and welded by brazing or tungsten inert gas methods. The specimens were divided into 3 groups (base metal, 2 welded specimens), and the composition and microstructure were qualitatively evaluated. The results of potential corrosion and corrosion current density were analyzed with a 1-way analysis of variance and the Tukey test for pairwise comparisons (α=.05). RESULTS: Base metal and tungsten inert gas welded material showed equivalent results in electrochemical corrosion tests, while the air-torched specimens exhibited low corrosion resistance. The performance was worst at pH 2.5. CONCLUSIONS: These results suggest that tungsten inert gas is a suitable welding process for use in dentistry, because the final microstructure does not reduce the corrosion resistance in artificial saliva at 37°C, even in a corrosion-testing medium that facilitates galvanic corrosion processes. Moreover, the corrosion current density of brazed Ni-Cr alloy joints was significantly higher (P<.001) than the base metal and tungsten inert gas welded joints.

Microstructural and mechanical characterization of contemporary lingual orthodontic brackets.

OBJECTIVES: To investigate the composition and the microstructural and mechanical characterization of three different types of lingual brackets. MATERIALS AND METHODS: Incognito™ (3M Unitek), In-Ovation L (DENTSPLY GAC) and STb™ (Light Lingual System, ORMCO) lingual brackets were studied under the scanning electron microscope employing backscattered electron imaging and their elemental composition was analysed by energy-dispersive X-ray microanalysis. Additionally, Vickers hardness was assessed using a universal hardness-testing machine, and the indentation modulus was measured according to instrumented indentation test. Two-way analysis of variance was conducted employing bracket type and location (base and wing) as discriminating variable. Significant differences among groups were allocated by post hoc Student-Newman-Keuls multiple comparison analysis at 95% level of significance. RESULTS: Three different phases were identified for Incognito and In-Ovation L bracket based on mean atomic number contrast. On the contrary, STb did not show mean atomic contrast areas and thus it is recognized as a single phase. Incognito is a one-piece bracket with the same structure in wing and base regions. Incognito consists mainly of noble metals while In-Ovation L and STb show similar formulations of ferrous alloys in wing and base regions. No significant differences were found between ferrous brackets in hardness and modulus values, but there were significant differences between wing and base regions. Incognito illustrated intermediate values with significant differences from base and wing values of ferrous brackets. CONCLUSIONS/IMPLICATIONS: Significant differences exist in microstructure, elemental composition, and mechanical properties among the brackets tested; these might have a series of clinical implications during mechanotherapy.

[Ultra-structural study of Ni-Cr alloys used in joint prosthesis]. / Etude ultra-structurale des alliages Ni-Cr utilisés en prothèse conjointe.

Ni-Cr alloys used in denture set, which have excellent mechanical properties, have a chemical and electrochemical inertia that depends on their composition and their microstructure. The objective of our work was to study the ultrastructure of the Ni-Cr alloy exposed to a free corrosion and a chemical analysis of surface depending on its composition. For this, five electrodes Ni-Cr alloy were prepared at the prosthesis laboratory by varying their composition. An analysis of the ultrastructure of the samples made by Scanning Electron Microscopy (SEM) samples was performed as well as a chemical analysis of their spectra. Prior to any manipulation, analysis by SEM of electrode number 5 (100% new metal) shows an altered surface. The electrode 3 (75% new metal) also presents an uneven surface. After a week in a free corrosion in Meyer solution at pH = 6.5, the electrode 5 shows a widespread intergranular and pitting corrosion. The same electrode 3 (75% new metal) after one week immersion in Ringer's solution at pH 7.9, shows a widespread intergranular and pitting corrosion. After electrochemical testing in Ringer's solution at pH 5, the SEM for electrode 1 (100% recovered metal) shows a very rugged structure with an important crevice corrosion. The composition and terms of shaping the Ni-Cr alloy influence its microstructure and at the same time its electrochemical behavior.

Characterization of wear debris in total elbow arthroplasty.

BACKGROUND: The purpose of this study was to evaluate wear debris in periprosthetic tissues at the time of revision total elbow arthroplasty. Polyethylene, metallic, and bone cement debris were characterized, and the tissue response was quantified. MATERIALS AND METHODS: Capsular and medullary tissue samples were collected during revision surgery. Polyethylene debris was characterized by scanning electron microscopy after tissue digestion. The concentrations of metal and cement debris were quantified by inductively coupled plasma mass spectrometry. Tissue response was graded with a semiquantitative histologic method. RESULTS: Polyethylene particle size varied from the submicron range to over 100 µm. The mean diameter ranged from 0.6 µm to about 1 µm. Particles in the synovial tissues were larger and less abundant than those in tissues from the medullary canal. Cement, titanium alloy, and low levels of cobalt-chrome debris were also present, with cement predominating over metal debris. Histiocyte response was associated with small polyethylene particles (0.5-2 µm), and giant cells were associated with large polyethylene particles (>2 µm). Histiocyte scores positively correlated with the polyethylene particle number and the presence of metal. DISCUSSION: We have shown that periprosthetic tissues of total elbow patients who have undergone revision for loosening and osteolysis contain polyethylene, cement, and metal debris. Although the polyethylene particles were of a size and shape that have been previously shown to result in activation of phagocytic cells, osteolysis after total elbow arthroplasty is a multimodal process. Because of the presence of multiple wear particle sources, a cause-and-effect relationship between polyethylene debris and osteolysis cannot be established with certainty.

Analysis of four dental alloys following torch/centrifugal and induction/ vacuum-pressure casting procedures.

STATEMENT OF PROBLEM: Previous studies have shown casting methodology to influence the as-cast properties of dental casting alloys. It is important to consider clinically important mechanical properties so that the influence of casting can be clarified. PURPOSE: The purpose of this study was to evaluate how torch/centrifugal and inductively cast and vacuum-pressure casting machines may affect the castability, microhardness, chemical composition, and microstructure of 2 high noble, 1 noble, and 1 base metal dental casting alloys. MATERIAL AND METHODS: Two commonly used methods for casting were selected for comparison: torch/centrifugal casting and inductively heated/ vacuum-pressure casting. One hundred and twenty castability patterns were fabricated and divided into 8 groups. Four groups were torch/centrifugally cast in Olympia (O), Jelenko O (JO), Genesis II (G), and Liberty (L) alloys. Similarly, 4 groups were cast in O, JO, G, and L by an inductively induction/vacuum-pressure casting machine. Each specimen was evaluated for casting completeness to determine a castability value, while porosity was determined by standard x-ray techniques. Each group was metallographically prepared for further evaluation that included chemical composition, Vickers microhardness, and grain analysis of microstructure. Two-way ANOVA was used to determine significant differences among the main effects. Statistically significant effects were examined further with the Tukey HSD procedure for multiple comparisons. Data obtained from the castability experiments were non-normal and the variances were unequal. They were analyzed statistically with the Kruskal-Wallis rank sum test. Significant results were further investigated statistically with the Steel-Dwass method for multiple comparisons (α=.05). RESULTS: The alloy type had a significant effect on surface microhardness (P<.001). In contrast, the technique used for casting did not affect the microhardness of the test specimen (P=.465). Similarly, the interaction between the alloy and casting technique was not significant (P=.119). A high level of castability (98.5% on average) was achieved overall. The frequency of casting failures as a function of alloy type and casting method was determined. Failure was defined as a castability index score of <100%. Three of 28 possible comparisons between alloy and casting combinations were statistically significant. The results suggested that casting technique affects the castability index of alloys. Radiographic analysis detected large porosities in regions near the edge of the castability pattern and infrequently adjacent to noncast segments. All castings acquired traces of elements found in the casting crucibles. The grain size for each dental casting alloy was generally finer for specimens produced by the induction/vacuum-pressure method. The difference was substantial for JO and L. CONCLUSIONS: This study demonstrated a relation between casting techniques and some physical properties of metal ceramic casting alloys.

Weight of polyethylene wear particles is similar in TKAs with oxidized zirconium and cobalt-chrome prostheses.

BACKGROUND: The greater lubricity and resistance to scratching of oxidized zirconium femoral components are expected to result in less polyethylene wear than cobalt-chrome femoral components. QUESTIONS/PURPOSES: We examined polyethylene wear particles in synovial fluid and compared the weight, size (equivalent circle diameter), and shape (aspect ratio) of polyethylene wear particles in knees with an oxidized zirconium femoral component with those in knees with a cobalt-chrome femoral component. PATIENTS AND METHODS: One hundred patients received an oxidized zirconium femoral component in one knee and a cobalt-chrome femoral component in the other. There were 73 women and 27 men with a mean age of 55.6 years (range, 44-60 years). The minimum followup was 5 years (mean, 5.5 years; range, 5-6 years). Polyethylene wear particles were analyzed using thermogravimetric methods and scanning electron microscopy. RESULTS: The weight of polyethylene wear particles produced at the bearing surface was 0.0223 +/- 0.0054 g in 1 g synovial fluid in patients with an oxidized zirconium femoral component and 0.0228 +/- 0.0062 g in patients with a cobalt-chrome femoral component. Size and shape of polyethylene wear particles were 0.59 +/- 0.05 microm and 1.21 +/- 0.24, respectively, in the patients with an oxidized zirconium femoral component and 0.52 +/- 0.03 microm and 1.27 +/- 0.31, respectively, in the patients with a cobalt-chrome femoral component. Knee Society knee and function scores, radiographic results, and complication rate were similar between the knees with an oxidized zirconium and cobalt-chrome femoral component. CONCLUSIONS: The weight, size, and shape of polyethylene wear particles were similar in the knees with an oxidized zirconium and a cobalt-chrome femoral component. We found the theoretical advantages of this surface did not provide the actual advantage. LEVEL OF EVIDENCE: Level I, therapeutic study. See the guidelines for Authors for a complete description of levels of evidence.

Investigating the immunologic effects of CoCr nanoparticles.

The increase in metal-on-metal hip arthroplasties has led to concern regarding the effect of raised serum and tissue metal ion levels. Our aim was to determine changes in the integrity and function of cells of the immune system after exposure to CoCr nanoparticles in specific cell culture experiments. Nanometer-sized particles of CoCr were made from a manufacturer's forged CoCr used for metal-on-metal articulations. Primary, murine dendritic cells and T and B lymphocytes then were exposed to these CoCr particles under cell culture conditions and then assayed for viability and proliferation/activation. CoCr nanoparticles did not directly activate dendritic cells or regulate B cells. Although nanoparticles were not directly toxic to resting T cells, Signals 1- and 2-dependent T cell proliferation were reduced. This may explain the observed reduction in CD8+ T cells observed in patients with metal-on-metal implants.

Comparison of Inflammatory Cell-Induced Corrosion and Electrocautery-Induced Damage of Total Knee Implants.

Recently, inflammatory cell-induced corrosion (ICIC), a unique type of damage, has been reported in cobalt-chromium (CoCr) implants, but the mechanism remains poorly understood and controversial because electrocautery damage has also been shown to produce similar findings. This study aimed to distinguish between these two damage mechanisms. Forty-one CoCr primary total knee arthroplasty specimens were collected at time of necropsy. After removal and cleaning, light microscopy was used to identify areas of ICIC-like damage scars. A CoCr knee implant was intentionally damaged by electrocautery from both Bovie and Aquamantys sources using a 3-second hover method with 3 different energy settings for comparison to necropsy findings. Average roughness (Ra), max peak-to-valley height (Rmax), kurtosis (Rk), and skewness (Rsk) measurements were collected to represent the topography on the damaged areas for the CoCr implants. Necropsy implants showed signs of ICIC in 7 of 41 implants (17%) examined. Fe/C ratios of the Bovie electrocautery-damaged knee implant were shown to be statistically higher than those of necropsy-retrieved implants. Median Ra measurements were statistically less (P = 0.008) for Bovie-damaged areas compared to ICIC-dam-aged areas on CoCr. Median Rmax and Ra measurements were statistically less (P = 0.012, P < 0.001, respectively) for Aquamantys-damaged areas compared to ICIC-damaged areas on CoCr. While the visual patterns seen in necropsy-retrieved implants appeared similar to those with the intentionally damaged CoCrMo implant, the contents of the corroded regions are unique. The difference in roughness found on ICIC-damaged and electrocautery-damaged regions also indicates examination of surface topography as another distinguishing feature between the two mechanisms.

Surface and elemental alterations of dental alloys induced by electro discharge machining (EDM).

OBJECTIVES: To evaluate the surface and elemental alterations induced by electro discharge machining (EDM) on the surface of dental cast alloys used for the fabrication of implant retained meso- and super-structures. METHODS: A completed cast model of an arch that received dental implants was used for the preparation of six wax patterns which were divided into three groups (Au, Co and Ti). The wax patterns of the Au and Co groups were invested with conventional phosphate-bonded silica-based investment material and the Ti group with magnesia-based investment material. The investment rings of the Au and Co groups were cast with an Au-Ag alloy (Stabilor G) and a Co-Cr base alloy (Okta C), respectively, while the investment rings of group Ti were cast with cp Ti (Biotan). One casting of each group was subjected to electro discharge machining (EDM); the other was conventionally ground and polished. The surface morphology and the elemental compositions of conventionally and EDM-finished surfaces were studied by SEM/X-ray EDS analysis. Six spectra were collected from each surface employing the area scan mode and the mean value of each element between conventionally and EDM-finished surfaces was statistically analyzed by t-test (a=0.05). Then the specimens of each group were cut perpendicular to their longitudinal axis and after metallographic grinding and polishing the cross-sections studied under the SEM. RESULTS: The EDM surfaces showed a significant increase in C due to the decomposition of the dielectric fluid during spark erosion. Moreover, a significant Cu uptake was noted on these surfaces from the decomposition of the Cu electrodes used for EDM. Cross-sectional analysis showed that all alloys developed a superficial zone (recast layer) varying from 2 microm for Au-Ag to 10 microm for Co-Cr alloy. SIGNIFICANCE: The elemental composition of dental alloy surfaces is significantly altered after EDM treatment.

Effect of impact assembly on the fretting corrosion of modular hip tapers.

The goal of this study was to determine the effect of assembly load and local assembly environmental conditions on the fretting corrosion of modular femoral stem tapers. Femoral head/taper assemblies in both similar (CoCrMo/CoCrMo) and mixed (CoCrMo/Ti-6Al-4V) alloy combinations were evaluated using an electrochemical test method. Specimens were assembled under impact loading and by hand, in both wet and dry conditions. Incremental cyclic loads ranging from 89 to 5,340 N were applied at a frequency of 3 Hz in Ringer's solution at ambient temperature. During the test, both the open circuit potential (OCP) and fretting current (i(fret)) were measured using a saturated calomel electrode (SCE) and counter electrode, respectively. The results were comparable for both mixed and similar alloy couples. Decreases in OCP and increases in i(fret) (indicators of oxide film fracture and repassivation) were seen with increasing load magnitude, often occurring at loads well below those expected clinically. OCP at the 5,340 N cyclic load ranged from -30.4 to -103.7 mV versus SCE for similar alloy couples, and -19.1 to -181.4 mV versus SCE for mixed alloy couples. Mean peak fretting currents ranged from 0.84 to 1.42 microA and 1.06 to 3.12 microA for similar and mixed alloy couples, respectively. The larger current magnitudes and more negative shifts in OCP for mixed alloy couples indicate the difference in oxide film fracture behavior between titanium and cobalt alloys. The load at which OCP began to drop (onset of fretting) was dependent upon the assembly conditions for both material couples. Specimens assembled with impact loads in air showed the highest resistance to fretting. The results of this study indicate that the assembly load and the environment both play a role in the initial stability of modular hip taper connections.

Impact of military metallurgical plant wastes on the population's health risk.

This paper presents the results of water, soil and air analyses taken in the vicinity of a former ferrochromium metallurgical plant. In the past, the area was used for the disposal of waste materials containing smelter slag, dust and other waste products from the manufacture of ferrochromium alloys for the army. Recently, production was abandoned and a project aimed at the liquidation of the dump has been initiated. The project concentrates on the recovery of chromium remains and the utilization of the leftover material as a road construction aggregate. Based on the analyses of ground water, soil and air, a health risk caused by environmental pollution with chromium, especially with Cr(VI), was determined for residential and occupational scenarios. It was found that the level of chromium emissions to the environment constitutes a potential danger of toxic and carcinogenic cases in humans exposed to the emission in the affected area. An increased level in the hazard quotient has been observed in the case of occupational activities. As far as the mutagenic effects are concerned, the occupational inhalation exposure was found to be very high, which may raise extreme concern about carcinogenic risk.

Corrosion behaviour of cobalt-chromium dental alloys doped with precious metals.

Precious metal based dental alloys generally exhibit a superior corrosion resistance, in particular enhanced resistance to pitting and crevice corrosion, compared to non-precious metal based alloys such as CoCr alloys. A new generation of Co-Cr alloys enriched with precious metals (Au, Pt, Ru) have now appeared on the market. The goal of this study was to clarify the effect of the precious metals additions on the corrosion behaviour of such alloys. Various commercial alloys with different doping levels were tested by electrochemical techniques in two different milieus based on the Fusayama artificial saliva and an electrolyte containing NaCl. Open circuit potentials, corrosion currents, polarization resistances, and crevices potentials were determined for the various alloys and completed by a coulometric analysis of the potentiodynamic curves. In addition, the microstructures were characterised by metallography and phase compositions analysed by EDX. The results show that the presence of precious metals can deteriorate the corrosion behaviour of Co-Cr alloys in a significant way. Gold doping, in particular, produces heterogeneous microstructures that are vulnerable to corrosive attack.

Electrochemical study of corrosion in Ni-Cr dental alloys.

The anodic behaviour of Ni-Cr dental alloys used as porcelain substrates has been investigated in both as-cast and thermal treated conditions. Polarization curves and scratching at constant potentials in synthetic salivas have shown that breakdown potentials are not influenced by the elimination of passive films covering the samples. Thermal treatments used to reproduce the microstructure of the alloys in dental crowns have not shown detectable effects on the electrochemical behaviour. Selective corrosion occurs by dissolution of Ni-rich interdendritic regions formed during solidification.

Differences in the fretting corrosion of metal-metal and ceramic-metal modular junctions of total hip replacements.

The use of modular interlocking components is a central design feature of total joint replacements. In this investigation we hypothesized that clinically available ceramic-metal modular connections used in total hip arthroplasty release more metal through fretting corrosion than traditional metal-metal modular connections. This was investigated using an in vitro comparison of ceramic (zirconia, ZrO2) and metal (Co-alloy) femoral-head fretting upon Co-alloy stem components. In vitro fretting corrosion testing consisted of potentiodynamic monitoring and analysis of metal release from zirconia and Co-alloy 28 mm femoral heads with similar surface roughnesses (Ra=0.46 microm) on identical Co-alloy stems at 2.2 kN for 1x10(6) cycles at 2 Hz. In contrast to our original hypothesis, we found greater metal release (approximately 11-fold increase in Co and 3-fold increase in Cr) and potentiodynamic fretting of metal-metal modular junctions when compared to ceramic-metal. Potentiodynamic testing demonstrated that lower initial voltages (-266<153 mV), greater maximum voltage changes (116>56 mV, p<0.05, t-test) and voltage variability (3>0.5 mV, p<0.05, t-test) were associated with the open circuit potentials of Co-alloy on Co-alloy junctions when compared to zirconia on Co-alloy junctions. In this study of a single total hip replacement stem and head design, zirconia heads mated with Co-alloy stems produced less fretting than Co-alloy heads mated with Co-alloy stems. Although further studies are necessary with a variety of implant designs and under different experimental conditions, the evidence presented here should, in part, alleviate concerns of increases in fretting corrosion at modular junctions of ceramic-metal coupled components.

Auger chemical analysis of oxides on Ni-Cr alloys.

Oxides formed on four Ni-Cr dental casting alloys in three temperature domains and in two different atmospheres were chemically analyzed using the Scanning Auger Microprobe. Distributions of Ni and Cr in the oxide layers varied with the alloy; oxidation in air resulted in apparently thicker oxide layers than did oxidation in a reduced oxygen atmosphere.

Etching patterns of Co-Cr alloys for bonded cast restorations.

Resin-bonded bridges may replace missing teeth and act as splints in periodontal treatment. The objective of this study was to investigate the etch pattern after electrolytic etching of selected Co-Cr alloys in hydrochloric acid and to assess the changes in alloy composition after different etching times. The alloys investigated were Vitallium, Wironit, Wironium, Nobilium Hard, and Niranium NN. Alloy specimens were electrolytically etched in a hydrochloric acid solution for 1, 2, 5, and 10 min. The etched specimens were examined in a light microscope and a scanning electron microscope (SEM). Different etching patterns were revealed in the various alloys. Microprobe analyses after the etching of Vitallium showed generally that Co was released and that Cr content increased at the surface.

Artifacts from dental casting alloys in magnetic resonance imaging.

The potential advantage of magnetic resonance imaging (MRI) has been limited by artifacts due to the presence of metallic materials. For quantitative evaluation of the magnitude of artifacts from dental casting alloys and implant materials in MR imaging, 11 dental casting or implant materials were imaged by means of 1.5 T MRI apparatus with three different sequences. Mean and standard deviation of water signal intensity (SI) around the sample in the region of interest (1200 mm(2)) were determined, and the coefficient of variation was compared for evaluation of the homogeneity of the SI. A variety of artifacts with different magnitudes was observed. Only one of the samples, composed mainly of Pd, In, and Sb, showed no artifacts in all imaging sequences. We concluded that selection of specific dental casting alloys according to their elemental compositions could minimize the metal artifacts in MRI; however, titanium alloys currently pose a problem with respect to causing MRI artifacts.

Cellular response to metallic ions released from nickel-chromium dental alloys.

Concerns exist over the potential release of elevated levels of metal ions such as Ni and Be from Ni-Cr dental casting alloys, due to their susceptibility to accelerated corrosion. In this investigation, we evaluated the release of metal ions from four commercial Ni-Cr alloys, representing a range of compositions, in three-day cell culture tests. Metal ion release, as measured by atomic absorption spectroscopy, was correlated to changes in cellular morphology, viability, and proliferation. The results showed that the test alloys and their corrosion products did not affect cellular morphology or viabilities, but did decrease cellular proliferation. The types and amounts of metal ions released, which corresponded to the alloys' reported surface and corrosion properties, also correlated to observed decreases in cellular proliferation after 72 h. Neptune, which caused the smallest decrease in cellular proliferation as compared with control cells, released the lowest amount of corrosion products, due to its corrosion-resistant, high-Cr-Mo-containing, homogeneous surface oxide. The other test alloys, which were susceptible to accelerated corrosion processes, released higher levels of metal ions that correlated to larger decreases in thymidine incorporation. Metal ion levels increased with test time for all alloys but were not proportional to bulk alloy compositions. Ni ions were released at slightly higher than bulk alloy compositions, while Be was released at from four to six times that of bulk alloy compositions. The elevated release of Be ions was associated with reduced cellular proliferation.(ABSTRACT TRUNCATED AT 250 WORDS)

Characterization and comparison of wear debris from failed total hip implants of different types.

Particles of wear debris have been associated with loosening of implants and with osteolysis, but few studies have examined the relationship between characteristics of the implant and clinical variables and the concentration of particles isolated from periarticular tissues. We isolated and quantified particles of wear debris from orthopaedic implants in 123 tissue samples that had been obtained adjacent to a failed total hip prosthesis from eighty-eight patients. The concentration of these particles in the tissue and the size of the particles were then analyzed in relation to patient and implant-related variables. The number of particles ranged from 8.5 x 10(2) to 5.7 x 10(11) per gram of tissue (dry weight). More particles were found adjacent to failed titanium-alloy stems that had a cobalt-chromium-alloy modular head and failed titanium-alloy-backed cups than were found adjacent to all-cobalt-chromium-alloy prostheses. In addition, fewer particles were found adjacent to implants with a twenty-eight-millimeter femoral head than were found adjacent to implants with other femoral head sizes. Univariate analysis also showed correlations between a high concentration of particles and fixation without cement, an implant that had been in situ for a long duration, a young patient age, and an initial clinical diagnosis of avascular necrosis. Biopsy specimens from the proximal femoral membranes had higher concentrations than those from the joint capsules or the acetabular membranes. Although only five specimens were obtained directly from osteolytic lesions, the concentration of particles in those specimens was higher than that in biopsy specimens from other sites. Although many univariate correlations were identified, stepwise correlation regression analysis showed that the composition of the implant and the size of the modular femoral head were most strongly related to the concentration of debris in tissue.