A Squeaky Reputation: The Problem May Be Design-dependent
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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.
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.
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.
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.
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.
- 8.Boutin P, Christel P, Dorlot JM, Meunier A, de RA, Blanquaert D, Herman S, Sedel L, Witvoet J. The use of dense alumina-alumina ceramic combination in total hip replacement. J Biomed Mater Res. 1988;22:1203–1232.Google Scholar
- 29.Matar WY, Restrepo C, Parvizi J, Kurtz SM, Hozack WJ. Revision hip arthroplasty for ceramic-on-ceramic squeaking hips does not compromise the results. J Arthroplasty. 2010;25(6 Suppl):81–86.Google Scholar
- 38.Restrepo C, Post ZD, Kai B, Hozack WJ. The effect of stem design on the prevalence of squeaking following ceramic-on-ceramic bearing total hip arthroplasty. J Bone Joint Surg Am. 2010;92(3):550–557.Google Scholar
- 39.Rodriguez JA, Gonzalez DA, McCook N. Squeaking in total hip replacement: a cause for concern. Orthopedics. 2008;31:874, 877–874, 878.Google Scholar