A recent article in the press highlighted concerns about the role of manufacturing issues in the failure of the Pinnacle metal on metal hip replacement. The work was done by David Langton and his colleagues in Newcastle. They looked at variability in the clearance of the bearing and found that this was lower than that specified by the manufacturer. Clearance affects the ability of the bearing to remain lubricated under load and when it moves. If the lubrication is insufficient, then the bearing becomes stiff and wear is increased. As we have seen with other metal bearings, this can cause adverse reactions within the joint.