Clinical Orthopaedics and Related Research®

, Volume 469, Issue 9, pp 2577–2582 | Cite as

Is Metal-on-Metal Squeaking Related to Acetabular Angle of Inclination?

  • Thomas Bernasek
  • David Fisher
  • David Dalury
  • Melissa Levering
  • Kirk Dimitris
Clinical Research



Postoperative audible squeaking has been well documented in ceramic-on-ceramic hip prostheses, and several metal-on-metal (MOM) THA designs, specifically those used for large-head resurfacing and MOM polyethylene sandwich designs, and are attributed to different implant- and patient-specific factors. Current literature does not identify the incidence of squeaking in modular MOM THA or possible etiologic factors.


Our purposes were to (1) identify the incidence of squeaking in modular MOM prostheses in THA; (2) determine whether males or females were more likely to have squeaking; and (3) determine whether the incidence of squeaking relates to acetabular inclination angle.


We retrospectively reviewed the patient records and radiographs of 539 patients (542 hips) from three independent centers who underwent a MOM THA between February 2001 and December 2005. Demographic and implant factors were evaluated, including measurement of cup inclination angles. The minimum followup was 36 months (mean, 76 months; range, 36–119 months).


We identified squeaking in eight of the 542 hips (1.5%); five were in women and two were in men (one patient had bilateral squeaking). The time to onset of patient-reported audible squeaking averaged 23 months (range, 6–84 months). Squeaking was more likely to occur in women (six of eight hips). No hips with 45º or less acetabular inclination squeaked (291 hips); eight of 251 hips (3.2%) with inclination angles greater than 45º squeaked. Patients who reported squeaking had higher inclination angles than those who did not report squeaking.


Our observations suggest an increased frequency of squeaking in female patients and in patients with greater inclination angles with this MOM implant design.


  1. 1.
    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.PubMedCrossRefGoogle Scholar
  2. 2.
    Brockett CL, Harper P, Williams S, Isaac GH, Dwyer-Joyce RS, Jin Z, Fisher J. The influence of clearance on friction, lubrication and squeaking in large diameter metal-on-metal hip replacements. J Mater Sci Mater Med. 2008;19:1575–1579.PubMedCrossRefGoogle Scholar
  3. 3.
    Clarke IC, Manley MT; Implant Wear Symposium 2007 Engineering Work Group. How do alternative bearing surfaces influence wear behavior? J Am Acad Orthop Surg. 2008;16(suppl 1):S86–93.Google Scholar
  4. 4.
    Glaser D, Dennis DA, Komistek RD, Miner TM. In vivo comparison of hip mechanics for minimally invasive versus traditional total hip arthroplasty. Clin Biomech (Bristol, Avon). 2008;23:127–134.CrossRefGoogle Scholar
  5. 5.
    Holloway I, Walter WL, Zicat B, Walter WK. Osteolysis with a cementless second generation metal-on-metal cup in total hip replacement. Int Orthop. 2009;33:1537–1542.PubMedCrossRefGoogle Scholar
  6. 6.
    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.PubMedCrossRefGoogle Scholar
  7. 7.
    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.PubMedCrossRefGoogle Scholar
  8. 8.
    Manley MT, Sutton K. Bearings of the future for total hip arthroplasty. J Arthroplasty. 2008;23(7 suppl):47–50.PubMedCrossRefGoogle Scholar
  9. 9.
    Mendenhall Associates Inc. Hospital resources and implant cost management: a 2009 update. Orthopedic Network News. Vol. 21. Birmingham, AL: Mendenhall Associates Inc; 2010:13–19.Google Scholar
  10. 10.
    Ranawat AS, Ranawat CS. The squeaking hip: a cause for concern-agrees. Orthopedics. 2007;30:738, 743.PubMedGoogle Scholar
  11. 11.
    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.PubMedCrossRefGoogle Scholar
  12. 12.
    Taylor S, Manley MT, Sutton K. The role of stripe wear in causing acoustic emissions from alumina ceramic-on-ceramic bearings. J Arthroplasty. 2007;22(7 suppl 3):47–51.PubMedCrossRefGoogle Scholar
  13. 13.
    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.PubMedCrossRefGoogle Scholar
  14. 14.
    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.PubMedCrossRefGoogle Scholar
  15. 15.
    Willert HG, Buchhorn GH, Fayyazi A, Flury R, Windler M, Koster G, Lohmann CH. Metal-on-metal bearings and hypersensitivity in patients with artificial hip joints: a clinical and histomorphological study. J Bone Joint Surg Am. 2005;87:28–36.PubMedCrossRefGoogle Scholar
  16. 16.
    Woo RY, Morrey BF. Dislocations after total hip arthroplasty. J Bone Joint Surg Am. 1982;64:1295–1306.PubMedGoogle Scholar

Copyright information

© The Association of Bone and Joint Surgeons® 2011

Authors and Affiliations

  • Thomas Bernasek
    • 1
  • David Fisher
    • 2
  • David Dalury
    • 3
  • Melissa Levering
    • 4
  • Kirk Dimitris
    • 5
  1. 1.Florida Orthopaedic InstituteN. TampaUSA
  2. 2.OrthoIndyIndianapolisUSA
  3. 3.Orthopaedic Associates, IncBaltimoreUSA
  4. 4.Foundation for Orthopaedic Research and EducationTampaUSA
  5. 5.Holy Family Memorial Lakeshore OrthopedicsManitowocUSA

Personalised recommendations