M 2a-Magnum ™

Large Metal Articulation

Design Rationale

Knees s Hips s %XTREMITIES s #EMENT AND !CCESSORIES s 0-) ® s 4ECHNOLOGY

M 2a-Magnum Large Metal Articulation™

(ISTORY OF -ETAL ON -ETAL HOT ISOSTATIC PRESSING ( ()0) AND SOLUTION ANNEALING ( SA ) in
AN ATTEMPT TO IMPROVE HOMOGENEITY AND REDUCE POROSITY
%ARLY METAL ON METAL (MoM) DESIGNS OF THE S AND 3! WORKS TO HOMOGENIZE THE CHROMIUM AND MOLYBDENUM
S WERE ENCOURAGING IN TERMS OF STABILITY AND LOW WEAR RICH INTER DENDRITIC REGIONS AND AS A RESULT MANY OF THE
BUT AS A WHOLE DID NOT MEET EXPECTATIONS DUE TO PRIMITIVE CARBIDES ARE DISSOLVED TO LEAVE A lNER CARBIDE DISTRIBUTION
MANUFACTURING AND IMPROPER CLEARANCE LEVELS 4HEREFORE #ARBIDES ARE VITAL FOR FATIGUE AND WEAR RESISTANCE !CCORDING
MOST METAL ON METAL DESIGNS FELL OUT OF FAVOR UNTIL THE MID to McMinn et al ()0 AND 3! POST PROCESSES MAY LEAD
S $URING THIS TIME "IOMET BEGAN DESIGNING NEW TO INCREASED METAL WEAR GENERATION DUE TO DEPLETION OF
BEARING TECHNOLOGIES WITH INNOVATIVE MATERIALS IMPROVED SURFACE CARBIDES5
MANUFACTURING CAPABILITIES AND OPTIMAL CLEARANCE
4HE -2A -AGNUM™ SYSTEM FEATURES ARTICULATING SURFACES
MADE FROM HIGH CARBON #O#R-O ALLOY CARBON CONTENT
 n PERCENT USING AN @AS CAST MANUFACTURING PROCESS
3YSTEM $ESCRIPTION @!S CAST REFERS TO THE METAL FORMING PROCESS WHERE
4HE -2A -AGNUM™ ,ARGE -ETAL !RTICULATION 3YSTEM OFFERS MOLTEN METAL IS POURED INTO A MOLD COOLED AND SOLIDIlED
OPTIMAL JOINT MECHANIC RESTORATION AND ULTRA LOW WEAR RATES TO TAKE ON THE lNAL SHAPE OF THE MOLD AND NO FURTHER
in vivo2 5NLIKE CERAMIC ON CERAMIC OR TRADITIONAL METAL HEAT TREATMENT IS APPLIED "Y LEAVING THE METAL IN ITS
ON POLYETHYLENE BEARINGS THE - 2A -AGNUM ™ SYSTEM @AS CAST FORM THE LARGER CARBIDES REMAIN INTACT &IGURE  
OFFERS EXCELLENT STABILITY DISLOCATION RESISTANCE DECREASED !CCORDING TO #RAWLY et al @AS CAST MATERIALS HAVE SHOWN
WEAR &IGURE  AND A POTENTIAL MAXIMUM RANGE OF MOTION TO PROVIDE ENHANCED PROTECTION AGAINST ABRASIVE WEAR AND
EXCEEDING ª  4HIS IS ACHIEVED WITH A CONSTANT MM REDUCED OVERALL WEAR RATES COMPARED TO SINGLE OR MULTIPLE
MISMATCH BETWEEN THE HEAD AND CUP WHICH ALLOWS FOR HEAT TREATED MATERIALS
THE MAXIMUM HEAD SIZE TO BE INSERTED INTO THE SMALLEST
POSSIBLE CUP &OR EXAMPLE A HEAD SIZE AS LARGE AS MM
CAN BE INSERTED INTO A MM CUP

As-Cast Cast + Solution Annealed (SA )

Figure 1: Representative of 25 years cumulative metal-on-metal wear

debris vs. 25 years cumulative polyethylene wear debris.1,4

Material
-OST METAL
ON
METAL BEARING SYSTEMS FOR HIP REPLACEMENTS
ARE MANUFACTURED FROM #O#R-O ALLOY MATERIAL (OWEVER
THE PROCESS OF MANUFACTURING METAL
ON
METAL SYSTEMS Carbides Grain Boundary
VARIES !LTHOUGH MANY ORTHOPEDIC MANUFACTURERS USE
A CASTING PROCESS SOME APPLY POST
MANUFACTURING
Figure 2: The Biomet ‘as-cast’ material has a combination of fine
PROCESSES TO THEIR METAL
ON
METAL COMPONENTS KNOWN AS grain size for fatigue resistance and high carbide volume for wear
resistance.
#UP $ESIGN (EAD $ESIGN
4HE - A
-AGNUM CUP IS AN @AS
CAST HIGH CARBON COBALT
2 ™
4HE -2A
-AGNUM™ HEAD IS AN @AS
CAST HIGH CARBON
CHROME MOLYBDENUM #O#R-O ALLOY PRESS
lT DESIGN WITH #O#R-O ALLOY 4HIS IS ESSENTIAL TO MAINTAINING THE FATIGUE
A TITANIUM 003® 0OROUS 0LASMA 3PRAY OUTER SURFACE AND AND WEAR RESISTANCE CHARACTERISTICS OF THE -2A
-AGNUM™
A HIGHLY POLISHED INNER GEOMETRY 4HE EXTERIOR GEOMETRY ARTICULATION !LL -2A
-AGNUM™ HEADS ARE HONED AND
CONTAINS FOUR PAIRS OF PERIPHERAL lNS TO ENHANCE ROTATIONAL BUFFED TO ACHIEVE A STRICT SPHERICAL TOLERANCE OF «IN
STABILITY AND AID INITIAL lXATION &IGURE   4HE OUTER DIAMETER 4HIS SPHERICITY IS MEASURED USING MORE THAN 
OF THE CUP IS FULLY HEMISPHERICAL ª  WITH FOUR RIM INSPECTION POINTS ACROSS THE ENTIRETY OF THE ARTICULATING
INDENTATIONS FOR THE STABLE ATTACHMENT OF THE LOCKING SURFACE WITHIN A TEMPERATURE
CONTROLLED HUMIDITY AND
IMPACTION DEVICE 4HE INTERIOR GEOMETRY IS HONED AND VIBRATION
ISOLATED ENVIRONMENT
BUFFED TO A HIGH POLISH TO ACHIEVE A STRICT SPHERICAL TOLERANCE
OF «IN 7HEN THE APPROPRIATE -2A
-AGNUM™ HEAD AND
CUP ARE COMBINED THE HIGHLY POLISHED SURFACES ALLOW THE
HYDRODYNAMIC mUID lLM LAYER TO BUILD IN A MANNER OPTIMAL
FOR REDUCED WEAR
Figure 3
4APERED )NSERT $ESIGN
(EAD SIZES  AND MM ARE MONOBLOCK AND DO NOT USE
A MODULAR TAPER INSERT DUE TO THE SMALL DIAMETER &IGURE  
(EAD SIZES MM AND LARGER USE A TITANIUM TAPERED INSERT
IDENTICAL IN ANGLE TO THE TRADITIONAL "IOMET® 4YPE  TRUNNION
&IGURE   4HE  TAPER INSERT OPTION IS ALSO AVAILABLE TO
ALLOW FOR OPERATIVE mEXIBILITY 4HESE INSERTS PROVIDE FOR SIX
NECK LENGTH OPTIONS TO RESTORE THE PROPER JOINT MECHANICS
FOR VARYING PATIENT ANATOMY

)N ORDER TO RESIST DEFORMATION FORCES THE CUP IS MANUFACTURED

WITH A MM THICKNESS AT THE DOME AND AN AVERAGE OF
MM THICKNESS AT THE RIM &IGURE   4HIS DESIGN IS SPECIlC
TO THE -2A -AGNUM™ COMPONENT AND ALLOWS FOR THE
Figure 5 Figure 6
MAXIMUM HEAD TO CUP RATIO

Figure 4
M 2a-Magnum Large Metal Articulation ™

-ANUFACTURING 0ROCESSES )MPORTANCE OF #LEARANCE

7HILE CASTING TURNING AND MILLING ARE STANDARD #LEARANCE CAN BE DElNED AS THE SPACE BETWEEN THE
MANUFACTURING PROCESSES FOR MANY ORTHOPEDIC IMPLANTS OUTER DIAMETER OF THE HEAD AND INNER DIAMETER OF THE
THE PRECISE DEMANDS ON METAL
ON
METAL ARTICULATING SURFACES SHELL ALLOWING FOR mUID lLM LUBRICATION IN METAL
ON
METAL
REQUIRE SPECIALIZED hSUPER
lNISHINGv CALLED HONING (ONING ARTICULATIONS )NADEQUATE CLEARANCE INCREASES THE CHANCE
IS A lNAL lNISHING OPERATION CONDUCTED ON THE BEARING OF EQUATORIAL CONTACT AND THE POTENTIAL FOR COMPONENTS
SURFACES WHERE ABRASIVE STONES ARE USED TO REMOVE SMALL TO LOCK TOGETHER AND SEIZE &IGURE   %XCESSIVE CLEARANCE
AMOUNTS OF MATERIAL IN ORDER TO TIGHTEN THE TOLERANCE OF ALL PRODUCES HIGH CONTACT STRESSES AND DISRUPTS mUID LUBRICATION
MAJOR DIMENSIONS !FTER HONING THE HEAD AND INNER DIAMETER
OF THE CUP ARE BUFFED TO A VERY SMOOTH MIRROR lNISH
-AGNUM™ ARTICULATION IS MAINTAINED AT  n
 $IMENSIONAL #ONTROL
&IGURE   %ITHER OF THESE SCENARIOS MAY RESULT IN ELEVATED
WEAR RATES AND CUP LOOSENING 4HE RADIAL CLEARANCE LEVEL
OF THE -2A
MICRONS TO CAPTURE THE IDEAL AMOUNT OF mUID LUBRICATION AND
SPACE FOR DEBRIS REMOVAL &IGURE  
Figure 8:
/NCE THE MANUFACTURING PROCESS IS COMPLETE ALL
M 2 A
-AGNUM ™ COMPONENTS UNDERGO A THOROUGH
INSPECTION PROCESS TO ENSURE PRECISE MANUFACTURING
TOLERANCES HAVE BEEN ACHIEVED -AJOR DIMENSIONS SUCH
AS SPHERICITY ROUNDNESS AND ROUGHNESS ARE VERIlED USING
NON
CONTACTING LIGHT INTERFEROMETRY THROUGH THE USE OF
:YGO0#) ,ASER &IGURE   4HE -2A
-AGNUM™ articulation
Inadequate Clearance
IS MANUFACTURED TO A  MICRON DEVIATION COMPARED TO
s #HANCE OF COMPONENTS LOCKING TOGETHER 8
THE )3/ STANDARD OF  MICRONS 2OUGHNESS 2A VALUE s #REATES HIGH FRICTIONAL TORQUE 9,10
IS A MEASURE OF THE TEXTURE OF A SURFACE QUANTIlED BY s ,EADS TO EARLY LOOSENING AND INCREASED RUN
IN WEAR 9,10
VERTICAL DEVIATIONS !LL -2A
-AGNUM™ COMPONENTS ARE
TESTED TO ENSURE THAT THE 2A VALUE DOES NOT EXCEED
 MICRONS 4HESE KEY MEASUREMENTS ARE NECESSARY Figure 9:
TO MAINTAIN LOW WEAR AND OPTIMAL CLEARANCE FOUND IN
M2A
-AGNUM™ COMPONENTS

Excessive Clearance
s (IGH CONTACT STRESSES 9,10
s 0OOR mUID lLM LUBRICATION DESIGN
s ,EADS TO INCREASED WEAR 9,10

Figure 10:

Optimal Clearance
s !LLOWS PROPER mUID LUBRICATION
Figure 7: Sphericity (roundness) and roughness are checked using s ,OW WEAR AND LOW FRICTIONAL TORQUE 9,10
non-contacting light interferometry through the use of Zygo PCI Laser. s 2OOM FOR REMOVAL OF WEAR DEBRIS
7EAR 4ESTING
7HEN TESTING THE RUN IN WEAR OF HARD BEARINGS A BIPHASIC
PATTERN IS TYPICALLY SEEN WITH A HIGHER INITIAL @RUN IN WEAR
RATE USUALLY LASTING n MILLION CYCLES FOLLOWED BY AN
EXTREMELY LOW LEVEL OF STEADY STATE WEAR THAT IS INVERSELY
PROPORTIONAL TO HEAD SIZE &IGURE  

Metal-on-Metal Steady State Wear Rates7

30
Size mm 3/MC
25
28mm .73

32mm .30 20
Volumetric Wear

38mm .12 15

46mm .18
10 Figure 12: Titanium PPS ® Porous Plasma Spray being applied
56mm .13 through a heated plasma arc.
5
28mm
27.9
ArCom®
0 4HE HEATING EFFECT OF THE 003® PROCESS IS TRANSIENT
Poly
97–98% less wear
ArCom®
Poly
28mm 32mm 38mm 46mm 56mm
LASTING ONLY FOR MILLISECONDS  4HEREFORE THE SUBSTRATE
Device
than ArCom® polyethylene
MATERIAL REMAINS VIRTUALLY UNAFFECTED FATIGUE PROPERTIES
ARE MAINTAINED SUCH THAT SMALL FEMORAL COMPONENTS ARE
Figure 11 POSSIBLE WITH THIS PROCESS AND IMPORTANTLY FOR -2A -AGNUM™
ARTICULATION THE CARBIDE STRUCTURE IS UNAFFECTED
@2UN IN WEAR OCCURS DURING THE TIME WHEN THE
COMPONENTS ARE BEDDING THEMSELVES IN AND EFFECTIVELY "IOMETS 003® COATING HAS IRREGULARLY SHAPED MOLTEN
POLISHING THEMSELVES INTO A CLOSELY CONFORMING CONTACT TITANIUM PARTICLES THAT SPLATTER UPON IMPACTION WITH THE
4HE DEGREE OF THIS WEAR IS DEPENDENT UPON RADIAL CLEARANCE SUBSTRATE SURFACE 4HIS GENERATES A RANDOM DISTRIBUTION
MATERIAL AND MANUFACTURING CAPABILITY SUCH AS CONTROL OF OF PORE SIZE BETWEEN  AND  MICRONS PROVIDING
SPHERICITY TOLERANCE AND SURFACE lNISH A LARGER CONTACT AREA BETWEEN PARTICLES AND SUBSTRATE
&IGURE   4HE LARGER DISTRIBUTION OF PORE SIZE IN CONJUNCTION
WITH THE ENHANCED BIOCOMPATIBILITY OF TITANIUM ALLOWS
IMMEDIATE lXATION VIA MECHANICAL INTERLOCKING AND LONG
0ROVEN &IXATIONˆ003 ® 0OROUS TERM lXATION THROUGH BONE IN GROWTH
0LASMA 3PRAY #OATING
"IOMET WAS THE lRST ORTHOPEDIC COMPANY TO INTRODUCE A
PLASMA SPRAYED PROSTHESIS WITH THE RELEASE OF THE 003®
COATED 4APERLOC® HIP STEM IN 

4HE -2A -AGNUM™ CUP FEATURES "IOMETS 003® COATING

A PROPRIETARY PROCESS THAT IS INSTRUMENTAL TO OUR CLINICAL
SUCCESS "IOMETS PROCESS NOT ONLY HELPS GUARD AGAINST
OSTEOLYSIS BUT ALLOWS BOTH IMMEDIATE AND LONG TERM
lXATIONn "IOMETS PROPRIETARY PLASMA SPRAY APPLICATION
IS UNIQUE IN THAT ONLY THE TITANIUM POWDER USED TO CREATE
THE COATING IS HEATED WHILE THE IMPLANTS SUBSTRATE IS Figure 13: The irregularly shaped titanium particles sprayed onto the
RETAINED AT NEAR AMBIENT TEMPERATURES 4HIS UNIQUE PROCESS substrate result in a wide pore size distribution.
ENABLES THE IMPLANT TO MAINTAIN ITS MECHANICAL PROPERTIES
M 2a-Magnum Large Metal Articulation ™

4HE PRESENCE OF A DISTRIBUTED PORE SIZE INDUCES HIGHER

INITIAL lXATION FOR "IOMETS 003® COATED IMPLANTS IN COM
PARISON TO OTHER COATED DEVICES SUCH AS SINTERED BEAD OR
lBER MESH COATINGS WHICH HAVE MUCH LARGER PORES WITH A
VERY NARROW DISTRIBUTION OF PORE SIZE

"IOMETS 003® COATING HAS BEEN CLINICALLY PROVEN FOR

OVER  YEARS AS SEEN IN A VARIETY OF PUBLISHED CLINICAL
PAPERSnn ! STUDY COMPARING THE SCRATCH lT STABILITY
OF ACETABULAR SHELLS WITH THREE DIFFERENT POROUS COATINGS
CONCLUDED THAT 003® COATED CUPS WERE TWICE AS STRONG IN
RESISTANCE TO RIM FAILURE AS THE BEADED OR lBER MESH CUPS

)ON 2ELEASE
$ESPITE THE POSITIVE CLINICAL HISTORY OF THE -2A -AGNUM™
ARTICULATION THERE HAVE BEEN CONCERNS REGARDING THE
LONG TERM BIOLOGICAL CONSEQUENCES OF METAL ON METAL
WEAR DEBRIS PARTICULARLY THE RELEASE OF COBALT CHROMIUM
IONS INTO THE BODY )ON RELEASE IS NOT LIMITED TO METAL ON
METAL HIPS -ETAL IONS ARE A NATURAL BY PRODUCT OF VIRTUALLY
EVERY METALLIC IMPLANT AND MAY LEAD TO HIGHER THAN NORMAL
LEVELS OF COBALT AND CHROMIUM IN THE BLOODSTREAM .AILS
PLATES SCREWS AND EVEN TOTAL KNEES WILL RELEASE IONS OF
THEIR RESPECTIVE METALS25 -ANY STUDIES CONDUCTED OVER THE
LAST SEVERAL DECADES HAVE SHOWN NO DElNITIVE CORRELATION
OF NEGATIVE HEALTH ISSUES TO ION LEVELS EXHIBITED FROM
METAL ON METAL IMPLANTSn

140
Cancer Incidence

120
100
80 MoM
60 Expected
40
20
0
1

11

13

15
5

Figure 14: Dr. Visuri reported no statistically significant increase in

cancer of any type with either a metal-on-metal or metal-on-polyethylene
articulation hip replacement compared to the expected cancer rate of
the general population at a 16-year follow up.27
#LINICAL 0ERFORMANCE
!UTHOR 4ITLE 0UBLICATION$ATE 3UMMARY

s  PATIENTS
-IDTERM 2ESULTS OF s  YEAR FOLLOW UP
0OLYETHYLENE &REE Journal of Arthroplasty
,OMBARDI ! et al s  SURVIVORSHIP
-ETAL ON -ETAL   n 
Articulation s  METAL LINERS AND  POLY LINERS
s !LL COMPONENTS WELL lXED AND STABLE
s  n MM HEAD DIAMETERS AND VARIOUS
! (IP *OINT CLEARANCE LEVELS STUDIED
3IMULATOR 3TUDY OF s ,OW WEAR ACHIEVED WITH CAREFUL DESIGN
Journal of Arthroplasty
$OWSON $ et al THE 0ERFORMANCE OF AND PROPER mUID LUBRICATION
  n  
-ETAL ON -ETAL *OINTS s ,ARGE HEADS AND LOW DIAMETRICAL
0ART )) $ESIGN CLEARANCES ENSURE THAT JOINT WILL FUNCTION
WITH PROPER mUID lLM LUBRICATION
s  0OROUS 0LASMA 3PRAY 2ING,OC®
&IXATION AND /STEOLYSIS CUPS IMPLANTED
IN 0LASMA 3PRAYED
Journal of Arthroplasty s !VERAGE FOLLOW UP  YEARS
2EINA 2 et al (EMISPHERICAL #UPS
  n   s  REVISION RATE FOR NON CROSSLINKED
WITH (YBRID 4OTAL (IP
!RTHROPLASTY POLY WEAR
s #UPS REMAINED WELL lXED
s ,ONG TERM CLINICAL RESULTS OF -O- HIPS
s 2ETRIEVAL ANALYSIS INDICATED n  MICRONS
4HE 2ATIONALE FOR Clinical Orthopaedics
OF WEAR PER YEAR AFTER INITIAL WEAR IN
#UCKLER * -ETAL ON -ETAL 4OTAL and Related Research
COMPARED TO  n MICRONS PER YEAR
(IP !RTHROPLASTY  n  
OF METAL ON POLYETHYLENE WEAR
s .O ADVERSE PHYSIOLOGIC EFFECTS
References
 +IM 2 et al. -ETAL ON -ETAL 4OTAL (IP !RTHROPLASTY Journal of  !LEXANDER * et al #HOICE OF )NGROWTH #OATING $RAMATICALLY !FFECTS
Arthroplasty     THE 4ORSIONAL 3TABILITY OF #EMENTLESS &EMORAL 3TEMS 0OSTER EXHIBIT
TH !NNUAL /23 -EETING /RLANDO &, -ARCH 
 -C+ELLOP ( et al. )N 6IVO 7EAR OF 4HREE 4YPES OF -ETAL ON -ETAL
(IP 0ROSTHESES $URING 4WO $ECADES OF 5SE Clinical Orthopaedics  "OURNE 2 et al )NGROWTH 3URFACES 0LASMA 3PRAY #OATING
and Related Research.  n  TO 4ITANIUM !LLOY (IP 2EPLACEMENTS Clinical Orthopaedics and
Related Research  n 
 +OMISTEK 2 et al. )N 6IVO #OMPARISON OF (IP 3EPARATION !FTER
-ETAL ON -ETAL OR -ETAL ON 0OLYETHYLENE 4OTAL (IP !RTHROPLASTY  -EDING + et al. -INIMUM 4EN 9EAR &OLLOW UP OF A 3TRAIGHT
Journal of Bone and Joint Surgery n   3TEMMED 0LASMA 3PRAYED 4ITANIUM !LLOY 5NCEMENTED &EMORAL
#OMPONENT IN 0RIMARY 4OTAL (IP !RTHROPLASTY Journal of Bone and
 (EAD 7 et al. -ECHANICAL 0ROPERTIES AND #LINICAL %VALUATION OF
Joint Surgery  n 
)SOSTATIC -OLDED !RCOM 0OLYETHYLENE International Society of
Orthopaedic Surgery and Traumatology 3AN $IEGO #! !UGUST  -C,AUGHLIN * et al 4OTAL (IP !RTHROPLASTY WITH AN 5NCEMENTED
 &EMORAL #OMPONENT %XCELLENT 2ESULTS AT 4EN 9EAR &OLLOW 5P
Journal of Bone and Joint Surgery " n 
 -C-INN $ et al. (IP 2ESURFACING 2ESURRECTED 0RESENTATION
%UROPEAN (IP 3OCIETY  *UNE   (OZACK 7 et al. 0RIMARY #EMENTLESS (IP !RTHROPLASTY WITH A
4ITANIUM 0LASMA 3PRAYED 0ROSTHESIS Clinical Orthopaedics and
 #AWLEY * et al. 7EAR ! 4RIBOLOGICAL 3TUDY OF #OBALT #HROMIUM
Related Research.    
-OLYBDENUM !LLOYS USED IN -ETAL ON -ETAL 2ESURFACING (IP
!RTHROPLASTY TH )NTERNATIONAL #ONFERENCE ON 7EAR OF -ATERIALS  (EAD 7 et al. ! 4ITANIUM #EMENTLESS #ALCAR 2EPLACEMENT
 n    &ALL  0ROSTHESIS IN 2EVISION 3URGERY OF THE &EMUR  9EAR %XPERIENCE
Journal of Arthroplasty   n 
 $ATA ON lLE AT "IOMET "ENCH TEST RESULTS NOT NECESSARILY INDICATIVE
OF CLINICAL PERFORMANCE  (EAD 7 et al. 4HE 0ROXIMAL 0OROUS #OATING !LTERNATIVE FOR 0RIMARY
!RTHROPLASTY Orthopedics   n 
 3QUIRE - et al. !CETABULAR #OMPONENT $EFORMATION WITH 0RESS &IT
&IXATION Journal of Arthroplasty.   n   -ARKEL $ et al )NITIAL 3CRATCH &IT 3TABILITY OF !CETABULAR #UPS
#OMPARISON OF 4HREE 0OROUS #OATING 3YSTEMS. International
 $OWSON $ et al. ! (IP *OINT 3IMULATOR 3TUDY OF THE 0ERFORMANCE
Society of Orthopaedic Surgery and Traumatology   n
OF -ETAL ON -ETAL *OINTS 0ART ) 4HE 2OLE OF -ATERIALS Journal of

Arthroplasty  n 
 +ARAMAT , et al. "LOOD !NALYSIS FOR 4RACE -ETAL ON -ETAL AND
 $OWSON $ et al. ! (IP *OINT 3IMULATOR 3TUDY OF THE 0ERFORMANCE
#ERAMIC ON #ERAMIC "EARINGS IN 4OTAL (IP !RTHROPLASTY !RTICLES OF
OF -ETAL ON -ETAL *OINTS 0ART )) 4HE 2OLE OF MATERIALS Journal of
)NTEREST -ETAL ON -ETAL !RTICULATION 7RIGHT -EDICAL -( 
Arthroplasty  n 

 3MITH 3 et al. 4HE %FFECT OF &EMORAL (EAD $IAMETER 5PON
 4HARANI 2 et al. 4HE 2ISK OF #ANCER &OLLOWING 4OTAL (IP OR +NEE
,UBRICATION AND 7EAR OF -ETAL ON -ETAL 4OTAL (IP 2EPLACEMENTS
!RTHROPLASTY The Journal of Bone and Joint Surgery   n
Proceedings of the Institute of Mechanical Engineers  
 
n 
 6ISURI % et al. #ANCER 2ISK AFTER -ETAL ON -ETAL AND 0OLYETHYLENE
 +EISU + et al. 0RIMARY #EMENTLESS 4OTAL (IP !RTHROPLASTY IN
ON -ETAL 4(! Clinical Orthopedics and Related Research 
/CTOGENARIANS 4WO TO %LEVEN 9EAR &OLLOW 5P Journal of Bone and
n 
Joint Surgery   
 3HAFFER !. et al )NCREASED "LOOD #OBALT AND #HROMIUM AFTER 4OTAL
 -C,AUGHLIN * et al. 4OTAL (IP !RTHROPLASTY IN 9OUNG 0ATIENTS  TO
(IP 2EPLACEMENT Clinical Toxicology and Environmental Health
 9EAR 2ESULTS 5SING AN 5NCEMENTED 3TEM Clinical Orthopaedics
  n 
and Related Research.  n 
 "RODNER 7 et al. %LEVATED 3ERUM #OBALT WITH -ETAL ON -ETAL
 0ARVIZI * et al. 0ROSPECTIVE -ATCHED 0AIR !NALYSIS OF (YDROXYAPATITE
!RTICULATING 3URFACES The Journal of Bone and Joint Surgery "
#OATED AND 5NCOATED &EMORAL 3TEMS IN 4OTAL (IP !RTHROPLASTY
  n 
Journal of Bone and Joint Surgery  n 
 *ACOBS * et al #OBALT AND #HROMIUM #ONCENTRATIONS IN 0ATIENTS
 -C,AUGHLIN * et al. 4OTAL (IP !RTHROPLASTY WITH AN 5NCEMENTED
WITH -ETAL ON -ETAL (IP 2EPLACEMENTS Clinical Orthopedics and
&EMORAL #OMPONENT ! ,ONG 4ERM 3TUDY OF THE 4APERLOC 3TEM.
Related Research  n 
Journal of Arthroplasty   n 
 -AC$ONALD 3 et al. -ETAL ON -ETAL VERSUS -ETAL ON 0OLYETHYLENE
 "OBYN *$ et al 4HE /PTIMAL 0ORE 3IZE FOR THE &IXATION OF
IN 4(! #LINICAL AND -ETAL )ON 2ESULTS OF A 0ROSPECTIVE 2ANDOMISED
0OROUS SURFACED -ETAL )MPLANTS BY THE )NGROWTH OF "ONE Clinical #LINICAL 4RIAL The Journal of Bone and Joint Surgery. (British)   
Orthopaedics and Related Research  n   

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OTHERWISE INDICATED

4HIS MATERIAL IS INTENDED FOR THE SOLE USE AND BENElT OF THE "IOMET SALES FORCE AND
PHYSICIANS )T IS NOT TO BE REDISTRIBUTED DUPLICATED OR DISCLOSED WITHOUT THE EXPRESS
WRITTEN CONSENT OF "IOMET

&OR PRODUCT INFORMATION INCLUDING INDICATIONS CONTRAINDICATIONS WARNINGS PRECAUTIONS

AND POTENTIAL ADVERSE EFFECTS SEE THE PACKAGE INSERT AND "IOMETS WEBSITE

ORTHOPEDICS
One Surgeon. One Patient.
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