The Squeaking Hip: A Phenomenon of Ceramic-on-Ceramic Total Hip Arthroplasty

BackgroundEarly reports on modern ceramic-on-ceramic total hip replacements have demonstrated excellent clinical and radiographic results with few cases of catastrophic failure, which, in the case of earlier designs, often had been caused by implant fracture. Several reports, however, have noted the...

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Bibliographic Details
Published in:Journal of bone and joint surgery. American volume 2009-06, Vol.91 (6), p.1344-1349
Main Authors: Jarrett, Christopher A, Ranawat, Amar S, Bruzzone, Matteo, Blum, Yossef C, Rodriguez, Jose A, Ranawat, Chitranjan S
Format: Article
Language:English
Subjects:
Adult
Aged
Biological and medical sciences
Case-Control Studies
Ceramics
Chi-Square Distribution
Diseases of the osteoarticular system
Equipment Failure Analysis
Female
Follow-Up Studies
Hip Joint - physiopathology
Hip Prosthesis - adverse effects
Humans
Male
Medical sciences
Metals
Middle Aged
Orthopedic surgery
Polyethylenes
Postoperative Complications - etiology
Postoperative Complications - physiopathology
Probability
Prosthesis Design
Range of Motion, Articular
Sensitivity and Specificity
Sound
Surface Properties
Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases
Surveys and Questionnaires
Time Factors
Young Adult
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Summary:BackgroundEarly reports on modern ceramic-on-ceramic total hip replacements have demonstrated excellent clinical and radiographic results with few cases of catastrophic failure, which, in the case of earlier designs, often had been caused by implant fracture. Several reports, however, have noted the presence of audible squeaking. The purpose of the present study was to determine the incidence of squeaking in association with the use of this bearing couple.MethodsDuring the period from March 2003 to May 2005, three surgeons performed 159 total hip arthroplasties in 143 patients with use of a ceramic-on-ceramic bearing. One hundred and forty-nine hips (131 patients) were available for review after at least one year of follow-up. These patients were followed prospectively with use of the modified Hospital for Special Surgery hip score and a patient-administered questionnaire. Additionally, a control group of sixty hips (forty-eight patients) with a metal-on-polyethylene bearing was matched to the ceramic group on the basis of age, sex, and body mass index to compare the incidence of squeaking and other noises. Radiographic evaluations were performed according to previously established criteria.ResultsFourteen (10.7%) of 131 patients described an audible squeak during normal activities. However, squeaking was reproducible clinically in only four patients, and only one patient complained of squeaking before being presented with the questionnaire. The average Hospital for Special Surgery score improved from 19.8 preoperatively to 38.4 at the time of the latest follow-up, indicating excellent clinical results. Ninety-five percent of the patients had a satisfaction score of ≥8 of 10. Three hips dislocated. One of those three hips squeaked and was revised because of recurrent dislocations. One patient was considering revision because of squeaking. In the matched metal-on-polyethylene cohort, there were no cases of squeaking.ConclusionsThe squeaking hip is a phenomenon that is unique to total hip replacements with hard-on-hard bearings. The incidence of squeaking in association with ceramic-on-ceramic bearings may be higher than previously reported as
ISSN:0021-9355
1535-1386
DOI:10.2106/JBJS.F.00970