There is a rising concern about squeaking in ceramic-on-ceramic total hip arthroplasty (THA). In pin-on-disc testing of a delta–delta coupling, we reproduced squeaking and observed microcracks on worn surfaces. We used a pin-on-disc machine and made discs and pins by cutting delta ceramic to a diameter of 40 mm (D–D). Cross-linked polyethylene was used for a comparison disc (D–P). We performed the same test using another D–D coupling specimen to confirm reproducibility. Squeaking in the D–D specimen was reproduced in wet conditions, though it was not found in the D–P specimen. Fast Fourier transform analysis showed a peak frequency for squeaking of 2794 Hz. The noise occurred at about 6.6 km of sliding distance. Scanning electron microscopy revealed that the worn surface of the pin in D–D at 10.8 km of sliding distance had some microcracks. However, there was no obvious damage to the worn surface of the pin in D–P at the same sliding distance. We confirmed the reproducibility of these findings, obtaining similar results, including squeaking, from another D–D coupling specimen. Our findings show that squeaking may occur in THA using delta ceramic bearings even if implants are placed to avoid extra-articular impingement of the femoral neck. Although the clinical relevance of microcracks is unknown, they may affect long-term outcomes in THA using delta ceramic bearings.
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Medical editor Katharine O’Moore-Klopf, ELS (East Setauket, New York) provided professional English-language editing of this article.
This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.
Conflict of interest
Authors Kiyokazu Fukui and Kazuhiro Shintani certify that they have no commercial associations (e.g., consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article. Author Ayumi Kaneuji states that he has received payments from Zimmer for providing surgical education, workshops, and lectures about total hip arthroplasty. Author Tadami Matsumoto states that he receives royalties from Zimmer for the APS natural hip implant that he developed for use in total hip arthroplasty and that he receives payments from Zimmer for giving lectures about total hip arthroplasty. Each author certifies that his institution approved the reporting of this case and that all investigations were conducted in conformity with ethical principles of research.
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Fukui, K., Kaneuji, A., Matsumoto, T. et al. Squeaking and microcracks in a delta–delta ceramic coupling: pin-on-disc study. Eur J Orthop Surg Traumatol 26, 299–304 (2016). https://doi.org/10.1007/s00590-016-1748-0
- Delta ceramics
- Total hip arthroplasty