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A Squeaky Reputation: The Problem May Be Design-dependent

  • Symposium: Update on Hard-on-Hard Bearings in Hip Arthroplasty
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

Squeaking is reportedly a complication in patients having ceramic-on-ceramic total hip implants. The etiology remains unknown and multifactorial with recent studies suggesting a relationship between the audible squeak and implant design. When we evaluated our ceramic-on-ceramic cohort, we noticed squeaking primarily in patients receiving an acetabular system designed with an elevated titanium rim.

Objectives/purposes

We therefore (1) determined the incidence of squeaking among four different ceramic-on-ceramic bearing surfaces used for THA at our institution; (2) evaluated the association between different acetabular designs and the incidence of squeaking; and (3) assessed other potential variables associated with squeaking.

Methods

We retrospectively reviewed 1507 patients having a ceramic-on-ceramic THA between 2002 and 2009; we separately analyzed those receiving an acetabular system with and without an elevated titanium rim. Data were collected through phone-administered questionnaires and retrospective reviews of patient charts for intraoperative findings, followup reports, demographic information, and radiographic findings.

Results

Squeaking occurred in 92 of the 1507 patients (6%). All 92 patients with squeaking received an elevated rim design (1291 patients) or an incidence of 7% with that design. We found no association between squeaking and any other examined factors.

Conclusion

Our findings complement the theory from in vitro studies suggesting that neck impingement on the elevated titanium rim is the probable cause of the increased frequency of squeaking with this design.

Level of Evidence

Level II, prognostic study. See the Guidelines for Authors for a complete description of levels of evidence.

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Author information

Authors and Affiliations

  1. The Rothman Institute of Orthopaedics at Thomas Jefferson University Hospital, 925 Chestnut Street, 5th Floor, Philadelphia, PA, 19107, USA

    Javad Parvizi MD, FRCS, Bahar Adeli BA, Justin C. Wong MD, Camilo Restrepo MD & Richard H. Rothman MD, PhD

Authors
  1. Javad Parvizi MD, FRCS
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  2. Bahar Adeli BA
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  3. Justin C. Wong MD
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  4. Camilo Restrepo MD
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  5. Richard H. Rothman MD, PhD
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Corresponding author

Correspondence to Javad Parvizi MD, FRCS.

Additional information

One of the authors (JP) is a consultant for Stryker Orthopaedics (Mahwah, NJ) and has intellectual properties on SmarTech (Philadelphia, PA); and one of the authors (RHR) is a consultant for and receives royalties from Stryker Orthopaedics.

Each author certifies that his or her institution has approved the human protocol for this investigation and that all investigations were conducted in conformity with ethical principles of research.

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Parvizi, J., Adeli, B., Wong, J.C. et al. A Squeaky Reputation: The Problem May Be Design-dependent. Clin Orthop Relat Res 469, 1598–1605 (2011). https://doi.org/10.1007/s11999-011-1777-2

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  • DOI: https://doi.org/10.1007/s11999-011-1777-2

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