CERAMIC-ON-METAL. References: Cat No: version 2

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1 CERAMIC-ON-METAL References: 1. Beaule, P. E., et al. Jumbo femoral head for the treatment of recurrent dislocation following total hip replacement. J.Bone Joint Surg (2002). 84-A: Jolles, B. M., P. Zangger, and P. F. Leyvraz. Factors predisposing to dislocation after primary total hip arthroplasty: a multivariate analysis. J.Arthroplasty (2002) 17: Lachiewicz, P. F. and E. S. Soileau. Dislocation of Primary Total Hip Arthroplasty with 36 and 40 mm Femoral Heads. Clin Orthop Relat Res. (2006). 453: Padgett, D. E., et al. Influence of total hip design on dislocation: a computer model and clinical analysis. Clin.Orthop.Relat Res. 447 (2006) Firkins, P. J., et al. A novel low wearing differential hardness, ceramic-on-metal hip joint prosthesis1. J.Biomech. (2001) 34: Figueiredo-Pina, CG, Yan, Y, Neville, A, and Fisher, J. Analysis of Corrosive Wear in Metal on Metal and Ceramic on Metal Bearings for Hip Prostheses. Poster 1777, 53rd Annual Meeting of the Orthopaedic Research Society, San Diego, California, Nevelos et al. Biomaterials, 1999, 20, Wear of HIPed and Non-HIPed Alumina-Alumina Hip Joints Under Standard and Severe Simulator Testing Conditions. Biomaterials. Aug: 22(16):2191-7, Williams, S., et al. Ceramic-on-Metal Hip Replacements: Part 1 - In Vitro Testing. Engineers and Surgeons: Joined at the Hip. ImechE Conference, London, Schepers, A., MBBCh, et al. Ceramic-on-Metal Hip Replacements: Part 2 - Early Clinical Metal Ion Levels. Engineers and Surgeons: Joined at the Hip. ImechE Conference, London, Min, B. W., et al. Delayed Fracture of a Ceramic Insert With Modern Ceramic Total Hip Replacement. J.Arthroplasty 22.1 (2007): This publication is not intended for distribution in the USA S-ROM and Articul/eze are registered trademarks and Pinnacle, Ceramax, and Ultamet are trademarks of DePuy Orthopaedics, Inc. Biolox Delta is a registered trademark of Ceramtec AG DePuy International Limited. All rights reserved. Cat No: version 2 DePuy International Ltd St Anthony s Road Leeds LS11 8DT England Tel: +44 (0) Fax: +44 (0) Revised: 12/07

2 RECOVERY FUNCTION SURVIVORSHIP DePuy believes in an approach to total hip replacement that places equal importance on recovery, function and survivorship. 3

3 Combining the extremely low wear of ceramic with the toughness of metal, for active, demanding patients. 4 The ceramic-on-metal bearing combination brings a new option for the surgeon within the DePuy high performance bearing range. The use of differential hardness bearings has been common in many different industries, as a solution for optimised wear performance. DePuy has embraced this technology by extensively testing the combination of their Biolox Delta ceramic head and their Ultamet metal liner. 5

4 Smaller cup, bigger head. The inherent strength of Ultamet metal liners allow a smaller Pinnacle acetabular cup to be used in conjunction with a larger diameter Biolox Delta ceramic head. The potential to use a larger head means that ceramic-on-metal bearings can offer superior resistance to dislocation with increased range of motion, reduced wear, and enhanced bone preservation. 1,2,3,4 6

5 Mean wear rates for metal-on-metal, ceramic-on-metal and ceramic-on-ceramic bearing combinations 8 (The ceramic-on-metal combination used was Biolox Delta ceramic heads on Ultamet metal liners) The tribology of a unique low-wear combination. Biolox Delta heads and Ultamet metal liners. Metal Ion release levels for all bearing options 9 (The ceramic-on-metal combination used was Biolox Delta ceramic heads on Ultamet metal liners) The differential hardness bearing improves fluid film lubrication and reduces adhesive wear. 6,8,9 The ceramic-on-metal bearing minimises corrosive wear. 6,8,9 Improved wear performance results in reduced metal ions levels. 5,8,9 8 9

6 Overcoming stripe wear. Microseparation and rim loading can cause stripe wear in ceramic-on-ceramic bearings. 5,7 In-vitro tests have proven that differential hardness achieved through a ceramic-on-metal combination avoids stripe wear. 7,

7 Potential for liner fracture or chipping eliminated. Whilst modern ceramics are very tough there is still a potential for mechanical failure. Use of Ultamet liners and ceramic-on-metal bearings eliminates the potential damage to the ceramic liner. The chipping of the liner caused by prosthesis femoral neck impingement is eliminated by using ceramic-on-metal.10 Possible liner fracture due to extreme trauma is eliminated

8 Ordering Information DePuy High Performance Bearings Polyethylene XL Polyethylene 28 mm 9/10 Biolox Delta Head mm 9/10 Biolox Delta Head Neck Length mm 9/10 Biolox Delta Head Neck Length mm 12/14 Articul/eze Biolox Delta Head mm 12/14 Articul/eze Biolox Delta Head Neck Length mm 12/14 Articul/eze Biolox Delta Head Neck Length +5 Metal-on-metal mm 9/10 Biolox Delta Head Neck Length mm 12/14 Articul/eze Biolox Delta Head Neck Length +8.5 Ceramic-on-metal 28 mm 11/13 S-ROM Biolox Delta Head mm 12/14 Articul/eze Biolox Delta Head Neck Length +12 FUNCTION / INCREASED STABILITY PE 28 XLPE 36 XLPE COM 28 COM 36 LOW WEAR Ceramic-on-ceramic COC mm 11/13 S-ROM Biolox Delta Head Neck Length mm 11/13 S-ROM Biolox Delta Head Neck Length mm 11/13 S-ROM Biolox Delta Head Neck Length mm 12/14 Articul/eze Biolox Delta Head mm 12/14 Articul/eze Biolox Delta Head Neck Length mm 12/14 Articul/eze Biolox Delta Head Neck Length mm 12/14 Articul/eze Biolox Delta Head Neck Length mm 9/10 Biolox Delta Head mm 9/10 Biolox Delta Head Neck Length mm 9/10 Biolox Delta Head Neck Length mm 9/10 Biolox Delta Head Neck Length mm 11/13 S-ROM Biolox Delta Head mm 11/13 S-ROM Biolox Delta Head Neck Length mm 11/13 S-ROM Biolox Delta Head Neck Length mm 11/13 S-ROM Biolox Delta Head Neck Length mm 11/13 S-ROM Biolox Delta Head Neck Length mm Ultamet Alternative Bearing Insert mm Ultamet Alternative Bearing Insert OD 44 mm mm Ultamet Alternative Bearing Insert OD 46 mm mm Ultamet Alternative Bearing Insert OD 48 mm mm Ultamet Alternative Bearing Insert OD 50 mm mm Ultamet Alternative Bearing Insert OD 52 mm mm Ultamet Alternative Bearing Insert OD 54 mm mm Ultamet Alternative Bearing Insert OD 56 mm mm Ultamet Alternative Bearing Insert OD 58 mm mm Ultamet Alternative Bearing Insert OD 60 mm 36 mm Ultamet Alternative Bearing Insert mm Ultamet Alternative Bearing Insert OD 50 mm mm Ultamet Alternative Bearing Insert OD 52 mm mm Ultamet Alternative Bearing Insert OD 54 mm mm Ultamet Alternative Bearing Insert OD 56 mm mm Ultamet Alternative Bearing Insert OD 58 mm mm Ultamet Alternative Bearing Insert OD 60 mm mm Ultamet Alternative Bearing Insert OD 62 mm mm Ultamet Alternative Bearing Insert OD 64 mm mm Ultamet Alternative Bearing Insert OD 66 mm 14 15