Clinical Orthopaedics and Related Research®

, Volume 469, Issue 6, pp 1598–1605

A Squeaky Reputation: The Problem May Be Design-dependent

  • Javad Parvizi
  • Bahar Adeli
  • Justin C. Wong
  • Camilo Restrepo
  • Richard H. Rothman
Symposium: Update on Hard-on-Hard Bearings in Hip Arthroplasty



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.


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Copyright information

© The Association of Bone and Joint Surgeons® 2011

Authors and Affiliations

  • Javad Parvizi
    • 1
  • Bahar Adeli
    • 1
  • Justin C. Wong
    • 1
  • Camilo Restrepo
    • 1
  • Richard H. Rothman
    • 1
  1. 1.The Rothman Institute of Orthopaedics at Thomas Jefferson University HospitalPhiladelphiaUSA

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