Squeaking in Metal-on-Metal Hip Resurfacing Arthroplasties
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.Get Access
While most reports of audible squeaking in total hip arthroplasty (THA) have focused on ceramic bearings, squeaking can occur in metal-on-metal bearings and may be an important clinical complication to consider during patient followup.
We retrospectively identified 10 patients with squeaking metal-on-metal hip resurfacings.
This study reports acetabular inclination angles and patient satisfaction, and describes two patients with squeaking resurfacings: one was revised and the other is pending revision. The minimum followup time in all 10 patients was 6 months (mean, 52 months; range, 6 to 79 months).
The average time to onset was 11 months (range, 3–22 months). Hips started squeaking after bending, heavy activity, or prolonged periods of walking and the squeaking resolved within a week in all episodes. All hips except one were in the range of 45° ± 10° inclination (median, 48°). One patient who reported squeaking at 6 weeks was revised 6 years postoperatively for a cystic mass. A second patient, now 76 months postoperative, who reports squeaking weekly after walking long distances, is scheduled for revision due to high serum metal ion levels and osteolysis in DeLee and Charnley Zone 1 of the acetabulum.
We cannot conclude whether these complications are related to squeaking. Most patients with squeaking hip resurfacings do not appear to have an adverse response or clinical complication after 6 years. Squeaking in hip resurfacings is a short-term episode that could not be related to acetabular component inclination or decreased patient satisfaction.
Level of Evidence
Level II, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.
- Back DL, Dalziel R, Young D, Shimmin A. Early results of primary Birmingham hip resurfacings. An independent prospective study of the first 230 hips. J Bone Joint Surg Br. 2005;87:324–329. CrossRef
- Bengs BC, Sangiorgio SN, Ebramzadeh E. Less range of motion with resurfacing arthroplasty than with total hip arthroplasty: in vitro examination of 8 designs. Acta Orthop. 2008;79:755–762. CrossRef
- Callaghan JJ, Salvati EA, Pellicci PM, Wilson PD, Jr, Ranawat CS. Results of revision for mechanical failure after cemented total hip replacement, 1979 to 1982. A two to five-year follow-up. J Bone Joint Surg Am. 1985;67:1074–1085.
- Campbell P, Shimmin A, Walter L, Solomon M. Metal sensitivity as a cause of groin pain in metal-on-metal hip resurfacing. J Arthroplasty. 2008;23:1080–1085. CrossRef
- Charnley J. Low Friction Arthroplasty of the Hip: Theory and Practice. New York, NY: Springer-Verlag; 1979.
- De Haan R, Pattyn C, Gill HS, Murray DW, Campbell PA, De Smet K. Correlation between inclination of the acetabular component and metal ion levels in metal-on-metal hip resurfacing replacement. J Bone Joint Surg Br. 2008;90:1291–1297. CrossRef
- de Nies F, Fidler MW. Visual analog scale for the assessment of total hip arthroplasty. J Arthroplasty. 1997;12:416–419. CrossRef
- De Smet K, De Haan R, Calistri A, Campbell PA, Ebramzadeh E, Pattyn C, Gill HS. Metal ion measurement as a diagnostic tool to identify problems with metal-on-metal hip resurfacing. J Bone Joint Surg Am. 2008;90 Suppl 4:202–208. CrossRef
- DeLee JG, Charnley J. Radiological demarcation of cemented sockets in total hip replacement. Clin Orthop Relat Res. 1976;121:20–32.
- Ebied E, Journeaux S. Metal-on-metal hip resurfacing. Curr Orthop. 2002;16:420–425. CrossRef
- Heisel C, Streich N, Krachler M, Jakubowitz E, Kretzer JP. Characterization of the running-in period in total hip resurfacing arthroplasty: an in vivo and in vitro metal ion analysis. J Bone Joint Surg Am. 2008;90 Suppl 3:125–133. CrossRef
- Hing CB, Back DL, Bailey M, Young DA, Dalziel RE, Shimmin AJ. The results of primary Birmingham hip resurfacings at a mean of five years. An independent prospective review of the first 230 hips. J Bone Joint Surg Br. 2007;89:1431–1438. CrossRef
- Hing CB, Young DA, Dalziel RE, Bailey M, Back DL, Shimmin AJ. Narrowing of the neck in resurfacing arthroplasty of the hip: a radiological study. J Bone Joint Surg Br. 2007;89:1019–1024.
- Jarrett CA, Ranawat AS, Bruzzone M, Blum YC, Rodriguez JA, Ranawat CS. The squeaking hip: a phenomenon of ceramic-on-ceramic total hip arthroplasty. J Bone Joint Surg Am. 2009;91:1344–1349. CrossRef
- Keurentjes JC, Kuipers RM, Wever DJ, Schreurs BW. High incidence of squeaking in THAs with alumina ceramic-on-ceramic bearings. Clin Orthop Relat Res. 2008;466:1438–1443. CrossRef
- Lusty PJ, Walter WL, Young D. Posterior and posteroinferior approaches. In: Hozack W, Parvizi J, Bender B, eds. Surgical Treatment of Hip Arthritis: Reconstruction, Replacement and Revision. Philadephia, PA: Elsevier; 2010.
- Mai K, Verioti C, Ezzet KA, Copp SN, Walker RH, Colwell CW, Jr. Incidence of ‘squeaking’ after ceramic-on-ceramic total hip arthroplasty. Clin Orthop Relat Res. 2010;468:413–417. CrossRef
- Pandit H, Glyn-Jones S, McLardy-Smith P, Gundle R, Whitwell D, Gibbons CL, Ostlere S, Athanasou N, Gill HS, Murray DW. Pseudotumours associated with metal-on-metal hip resurfacings. J Bone Joint Surg Br. 2008;90:847–851. CrossRef
- Restrepo C, Parvizi J, Kurtz SM, Sharkey PF, Hozack WJ, Rothman RH. The noisy ceramic hip: is component malpositioning the cause? J Arthroplasty. 2008;23:643–649. CrossRef
- Rodriguez JA. The squeaking hip is a multifactorial concern. Orthopaedics Today. 2008;28:92.
- Rosneck J, Klika A, Barsoum W. A rare complication of ceramic-on-ceramic bearings in total hip arthroplasty. J Arthroplasty. 2008;23:311–313. CrossRef
- Toni A, Traina F, Stea S, Sudanese A, Visentin M, Bordini B, Squarzoni S. Early diagnosis of ceramic liner fracture. Guidelines based on a twelve-year clinical experience. J Bone Joint Surg Am. 2006;88 Suppl 4:55–63. CrossRef
- Tuke MA, Scott G, Roques A, Hu XQ, Taylor A. Design considerations and life prediction of metal-on-metal bearings: the effect of clearance. J Bone Joint Surg Am. 2008;90 Suppl 3:134–141. CrossRef
- Walter LR, Marel E, Harbury R, Wearne J. Distribution of chromium and cobalt ions in various blood fractions after resurfacing hip arthroplasty. J Arthroplasty. 2008;23:814–821. CrossRef
- Walter WL, O’Toole GC, Walter WK, Ellis A, Zicat BA. Squeaking in ceramic-on-ceramic hips: the importance of acetabular component orientation. J Arthroplasty. 2007;22:496–503. CrossRef
- Walter WL, Waters TS, Gillies M, Donohoo S, Kurtz SM, Ranawat AS, Hozack WJ, Tuke MA. Squeaking hips. J Bone Joint Surg Am. 2008;90 Suppl 4:102–111. CrossRef
- Willert HG, Buchhorn GH, Gobel D, Koster G, Schaffner S, Schenk R, Semlitsch M. Wear behavior and histopathology of classic cemented metal on metal hip endoprostheses. Clin Orthop Relat Res. 1996(329 Suppl):S160–S186.
- Squeaking in Metal-on-Metal Hip Resurfacing Arthroplasties
Clinical Orthopaedics and Related Research®
Volume 468, Issue 9 , pp 2333-2339
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- Industry Sectors
- Author Affiliations
- 1. Specialist Orthopaedic Group, Suite 1.08, 3-9 Gillies Street, North Sydney, NSW, 2060, Australia
- 2. Department of Orthopaedic Surgery, J. Vernon Luck Orthopaedic Research Center, The UCLA and Orthopaedic Hospital, Los Angeles, CA, USA
- 3. Finsbury Orthopaedics Ltd, Surrey, UK