OK, it's not something I'm familar with, but perhaps you're dealing with 3 concurrent phenomena:
1) metal-to-metal wear creating metal particles (e.g., a clump of Co & Cr atoms),
2) dissolution of metal particles by saline body fluid, dissolving them in ionic form (e.g., Cr
+3 or Co
+2),
3) possible leaching of more soluble metals from the surface, leaving the surface enriched in the less soluble alloying elements.
Commonly, wear creates roughness which accelerates the wear process. But of course, there are situation such as piston rings in engine cyclinders, in which wear is reduced after 'breaking in.'
The leaching step is similar to the passivation process used for stainless steels. Basically, soaking in nitric acid preferentially dissolves iron and nickel from the surface, leaving a more corrosion resistant, chromium-enriched surface.
As the heat treated vs. as-cast issue, it will depend upon the alloy, but heat treated may be better simply because it provides options for altering microstructure and hardness as desired. There are also coating & surface modification procedures such as nitriding which are possibly described to non-metallurgists as 'heat treatment.'
This article may be useful: 'UNIQUE PROPERTIES REQUIRED OF ALLOYS FOR THE MEDICAL AND DENTAL PRODUCTS INDUSTRY'
I suggest registering on Carpenter Technology's site & getting their medical alloy brochures:
E.g.,
"BioDur® Carpenter CCM® Alloy
[Alloy composition] Single Figures are Maximums [wt.%]
0.10 C, 1.00 Mn, 1.00 Si, 26.00/30.00 Cr, 5.00/7.00 Mo, 1.00 Ni, 0.25 N, 0.75 Fe, Bal. Co
A vacuum induction melted and electroslag remelted nonmagnetic cobalt-chromium-molybdenum alloy exhibiting high strength, corrosion resistance, and wear resistance. High nitrogen, low carbon, wrought version of ASTM F75 cast alloy. Meets the requirements of ASTM F799, ASTM F1537, ISO 5832-4 and ISO 5832-12. Has been used in the orthopedic implant industry."
Found a really interesting paper, lots of microscopy; seems to be a senior thesis (B.S.) by Douglas J. Wood at San Jose State Univ. describing "Co-Cr-Mo alloy ball press fit onto a Ti-6Al-4V alloy 'stem' (i.e., a 'modular' system). Modular hip prostheses have been found to produce wear debris via various wear processes."