Our purpose was to determine whether metal femoral heads scratch with in vivo use, to characterize the scratching that occurs, and to determine whether this scratching affected polyethylene wear. Assessment of 133 consecutive retrieved femoral heads showed that metal femoral heads do scratch with in vivo use, that cobalt-chromium femoral heads are more scratch resistant than titanium alloy heads, and that scratching seems to be time dependent. Profilmetry studies showed that all roughness parameters (average roughness, maximum peak to lowest valley distance, mean peak height above the mean surface line, estimate of small peaks above the main plateau of the surface, and estimate of the depth of the valleys below the mean plateau of the surface with the exception of the symmetry of the profile about its mean line) showed increased roughness with time of use. Cobalt-chromium and Oxinium femoral heads were damaged in a dislocation model. Assessment of these femoral heads in a wear simulator revealed that against conventional polyethylene, a damaged Oxinium femoral head had no more wear than a new cobalt-chromium articulation on the same polyethylene (36.5/million cycles versus 38.4 mm/million). Against cross-linked polyethylene, a damaged Oxinium femoral head had minimal wear (1.5 mm cubed per Mc).