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Hip arthroplasty can be considered one of the major successes of orthopedic surgery, with more than 350000 replacements performed every year in the United States with a constantly increasing rate. The main limitations to the lifespan of these devices are due to tribological aspects, in particular the wear of mating surfaces, which implies a loss of matter and modification of surface geometry. However, wear is a complex phenomenon, also involving lubrication and friction. The present paper deals with the tribological performance of hip implants and is organized in to three main sections. Firstly, the basic elements of tribology are presented, from contact mechanics of ball-in-socket joints to ultra high molecular weight polyethylene wear laws. Some fundamental equations are also reported, with the aim of providing the reader with some simple tools for tribological investigations. In the second section, the focus moves to artificial hip joints, defining materials and geometrical properties and discussing their friction, lubrication and wear characteristics. In particular, the features of different couplings, from metal-on-plastic to metal-on-metal and ceramic-on-ceramic, are discussed as well as the role of the head radius and clearance. How friction, lubrication and wear are interconnected and most of all how they are specific for each loading and kinematic condition is highlighted. Thus, the significant differences in patients and their lifestyles account for the high dispersion of clinical data. Furthermore, such consideration has raised a new discussion on the most suitable in vitro tests for hip implants as simplified gait cycles can be too far from effective implant working conditions. In the third section, the trends of hip implants in the years from 2003 to 2012 provided by the National Joint Registry of England, Wales and Northern Ireland are summarized and commented on in a discussion.

Preclinical wear evaluation is extremely important in hip replacements, wear being one of the main causes of failure. Experimental tests are attractive but highly cost demanding; thus predictive models have been proposed in the literature, mainly based on finite element simulations. In such simulations, the effect of friction is usually disregarded, as it is considered not to affect the contact pressure distribution. However, a frictional contact could also result in a shift of the location of the nominal contact area, which can thus modify the wear maps. The aim of this study is to investigate this effect in wear prediction for metal-on-metal implants. Wear assessment was based on a purpose-developed mathematical model, extension of a previous one proposed by the same authors for metal-on-plastic implants. The innovative aspect of the present study consists in the implementation of a modified location of the nominal contact point due to friction, which takes advantage of the analytical formulation of the wear model. Simulations were carried out aimed at comparing total and resurfacing hip replacements under several gait conditions. The results highlighted that the adoption of a frictional contact yields lower linear wear rates and wider worn areas, while for the adopted friction coefficient (f=0.2), the total wear volume remains almost unchanged. The comparison between total and resurfacing replacements showed higher scaled wear volumes (wear volume divided by wear factor) for the latter, in agreement with the literature. The effect of the boundary conditions (in vivo versus in vitro) was also investigated remarking their influence on implant wear and the need to apply more physiological-like conditions in hip simulators. In conclusion although friction is usually neglected in numerical wear predictions, as it does not affect markedly the contact pressure distribution, its effect in the location of the theoretical contact point was observed to influence wear maps. This achievement could be useful for increasing the correlation between numerical and experimental simulations, usually based on the total wear volume. In order to improve the model reliability, future studies will be devoted to implement the geometry update by combining the present model to finite element analyses. On the other hand, further experimental investigations are required to get out from the wide dispersion of wear factors reported in the literature.

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