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High Incidence of Squeaking in THAs with Alumina Ceramic-on-ceramic Bearings

  • Original Article
  • Hip
  • Published:
Clinical Orthopaedics and Related Research

Abstract

Ceramic-on-ceramic bearings in THA are a popular alternative to overcome wear concerns in traditional metal-polyethylene bearings. However, squeaking is a potentially worrisome phenomenon in ceramic-on-ceramic THAs which we observed in some of our patients. We reviewed all 42 patients who underwent 43 ceramic-on-ceramic noncemented THAs during the time of the study. Squeaking, defined as a reproducible sound of squeaking, clicking, or grating, occurred in nine of 43 implants (20.9%). Standard radiographs were normal. We used CT imaging to determine cup anteversion and inclination angles, comparing the squeaking hips with those of a randomly selected control group, but found no differences. We then hypothesized specific design features (stem size, cup size, head size, and neck length of the head) would be risk factors for squeaking. We found a difference in neck length between squeaking and nonsqueaking implants. A neck length of −4 mm or shorter resulted in a relative risk of 5.56 (95% confidence interval, 1.14–27.01) for squeaking. We found a high incidence of squeaking in our population, and we believe this phenomenon is an underreported side effect of these types of bearings. A short neck length of the femoral implant was a risk factor for squeaking in ceramic-on-ceramic THA.

Level of Evidence: Level III, therapeutic study.

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Acknowledgments

We thank Jan Hendriks, medical statistician, for advice and Han Bakens, orthopaedic surgeon, for performing some of the THAs.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Slingeland Hospital, Doetinchem, The Netherlands

    J. C. Keurentjes MD, R. M. Kuipers MD & D. J. Wever MD, PhD

  2. University Hospital Nijmegen, Th. Craanenlaan 7, Postbus 9101, 6500 HB, Nijmegen, The Netherlands

    J. C. Keurentjes MD

  3. Department of Orthopaedic Surgery, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands

    B. W. Schreurs MD, PhD

Authors
  1. J. C. Keurentjes MD
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  2. R. M. Kuipers MD
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  3. D. J. Wever MD, PhD
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  4. B. W. Schreurs MD, PhD
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Correspondence to J. C. Keurentjes MD.

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Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

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

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Keurentjes, J.C., Kuipers, R.M., Wever, D.J. et al. High Incidence of Squeaking in THAs with Alumina Ceramic-on-ceramic Bearings. Clin Orthop Relat Res 466, 1438–1443 (2008). https://doi.org/10.1007/s11999-008-0177-8

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  • DOI: https://doi.org/10.1007/s11999-008-0177-8

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