Hard-on-Hard Bearings Are Associated With Increased Noise Generation in Young Patients Undergoing Hip Arthroplasty

Abstract

Background Patient-perceived noise from prostheses after total hip arthroplasty (THA) does occur, yet questions remain including the overall frequency of this finding, demographic and prosthesis-related factors, and the association of noise generation with patient-reported outcomes. Questions/purposes The purposes of this study were (1) to determine the frequency with which patients report noise coming from the hip after THA; (2) to identify patient and prosthesis-related factors associated with noise generation; and (3) to ascertain if noise generation is associated with pain or functional impairment after THA. Methods A five-center study was designed to quantify the degree of residual symptoms and functional deficits in patients undergoing THA. Three centers were academic practices, whereas two centers were private practices that provided training programs for orthopaedic residents and fellows. Each contributing surgeon was fellowship-trained and specialized in joint replacement. Inclusion criteria for this study were (1) men between 18 and 60 years old and women between 18 and 55 years old; (2) patients requiring primary hip surgery as a result of noninflammatory arthritis such as osteoarthritis, traumatic arthritis, or avascular necrosis; (3) a UCLA activity score of 6 or more before they were limited by pain; and (4) patients who had undergone a primary THA within 1 to 4 years before the start of the study and had a minimum of 1 year of clinical followup. Attempts were made to contact all identified patients meeting these inclusion criteria. Data were collected by an independent, third-party survey center blinded to the implant design and bearing surface used who administered questionnaires about residual symptoms, function, and pre-and postoperative activity levels using previously published survey instruments. Patients were specifically queried regarding perceived noise from their THA. We retrospectively identified 1242 eligible patients. Of the 1242 patients, 105 were found to have exclusions during the screening section of the questionnaire: postoperative infection (six THAs), fracture (two), dislocation (seven), or revision (17); limited activity level because of an operation on the opposite hip (34); and premorbid UCLA score of less than 6 (39). In addition, 128 individuals refused to participate, 156 were never available, 108 were not found as a result of a bad address/phone number, 48 were contacted but did not complete the interview, nine Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained. had died, and six had a language barrier. This left 682 of the 1137 eligible patients with completed surveys (60% response rate). The mean age was 50 ± 8 years at the time of surgery with 63% being men, and they were contacted at a mean of 3 ± 1 years postoperatively. Bearing surfaces (femoral head...

Do different types of bearings and noise from total hip arthroplasty influence hip-related pain, function, and quality of life postoperatively?

“…However, in a recent study, noise was found to be associated with pain (Nam et al. 2016). The cause of noise from THAs may be multifactorial, but an association between higher inclination angle and squeaking was found in MoM THAs (Bernasek et al.…”

Current Concepts of Using Large Femoral Heads in Total Hip Arthroplasty

“…However, concerns over noise, squeaking, micro-separation, increased susceptibility in component-to-component impingement and fracture risk still remain controversial. Despite these controversies, more careful monitoring is warranted when using COC articulation in larger heads, because some studies have suggested that stiff ceramic heads may increase stress over the trunnion compared to metallic heads 47) .…”

Results of Primary Total Hip Arthroplasty Using 36 mm Femoral Heads on 1st Generation Highly Cross Linked Polyethylene in Patients 50 Years and Less with Minimum Five Year Follow-up

“…However, concerns of CoC bearing surface's negative property remained 18 19) . Besides problems of squeaking and fracture of ceramic head, some paper reported possibility of increasing stress on trunnion compared with metallic head when using big size of femoral head 20) .…”