Increase in Benign Squeaking Rate at Five-Year Follow-Up: Results of a Large Diameter Ceramic-on-Ceramic Bearing in Total Hip Arthroplasty

Goldhofer, Markus; Munir, Selin; Levy, Yadin D.; Walter, William K.; Zicat, B.; Walter, William L.

doi:10.1016/j.arth.2017.11.044

Cited by 24 publications

(31 citation statements)

References 24 publications

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“…The prosthetic factors were accepted to be an important part; the designs and materials were different in various brands of prosthesis, or in the same brand but different types of prosthesis [ 9 , 34 ]. For instance, the Stryker Trident PSL cup had an elevated rim to increase the ceramic stabilization but caused more squeaking for impingement between femoral neck and cup [ 35 ]; the design of Delta Motion cup did not permit reinforcement by auxiliary screws, which might impact implant stability under specific conditions and be a potential risk for squeaking [ 36 ]. Moreover, surgical techniques were connected to squeaking.…”

Section: Discussionmentioning

confidence: 99%

Squeaking in fourth-generation ceramic-on-ceramic total hip replacement and the relationship with prosthesis brands: meta-analysis and systematic review

Zhao

Yan

et al. 2018

J Orthop Surg Res

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BackgroundPostoperative squeaking in patients who applied the fourth-generation ceramic bearing in primary hip replacement has not been reported systematically; we aim to study the squeaking incidence in the fourth-generation ceramic bearing and related risk factors for squeaking, and we also attempt to explore the relationship between squeaking and prosthetic brands.MethodsThe PubMed, Embase, and Cochrane library were searched, and 14 articles were finally included. Patients’ demographic data, surgical-related information, and prosthesis data were extracted. The occurrence rate of squeaking was calculated by meta-analysis, and subgroup analysis was performed based on prosthetic brands and follow-up time. Regression analysis was further applied to investigate the relationship between various risk factors and squeaking.ResultsThe squeaking incidence in patients with the fourth-generation ceramic bearing was 3%. Age, gender, body mass index, and abduction and anteversion angles of acetabular cup might have no influence on squeaking. The squeaking incidence was significantly high with the presence of Delta Motion cup (DePuy, Warsaw, Indiana) and Secure-Fit stem (Stryker, Kalamazoo, MI), and the overall incidence of DePuy femoral stem was relatively small except for the Summit femoral stem. And there was no significant difference of squeaking incidence between less than 5-year and more than or equal to 5-year follow-up subgroups.ConclusionsIn our study, squeaking in the fourth-generation ceramic bearing occurred at a rate of 3%; occurrence rate was high when the Delta Motion cup was applied. We hope for more relevant researches to focus on this issue.Electronic supplementary materialThe online version of this article (10.1186/s13018-018-0841-y) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Squeaking in fourth-generation ceramic-on-ceramic total hip replacement and the relationship with prosthesis brands: meta-analysis and systematic review

Zhao

Yan

et al. 2018

J Orthop Surg Res

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“…One possible explanation is that a larger head might reduce the frequency of the resonating waves to the audible range for humans. [20] Goldhofer et al [23] also observed in a cohort of 206 COC hip patients that the rate of squeaking rose from 7.3% at a 2-year follow-up to 17.4% at a 5-year follow-up. They speculated that the etiology of squeaking was most likely multifactorial, including edge loading, greater pelvic anterior tilt with bending and improvements in hip ROMs.…”

Section: Discussionmentioning

confidence: 99%

“…They speculated that the etiology of squeaking was most likely multifactorial, including edge loading, greater pelvic anterior tilt with bending and improvements in hip ROMs. [23] In a number of recent reports, the authors have suggested that the squeaking may be an early sign of ceramic fracture. [24] In our cohort, the patient who suffered a ceramic liner fracture experienced squeaking, however, such fractures were not detected in other squeaking hips, although this may change in long-term follow-up.…”

Section: Discussionmentioning

confidence: 99%

Could larger diameter of 4th generation ceramic bearing increase the rate of squeaking after THA?

Luo

Sun²,

Jin³

et al. 2018

Medicine

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The present study aimed to evaluate the clinical outcomes and bearing-specific complications in a single center of 135 delta ceramic-on-ceramic (COC) total hip arthroplasties (THAs) and explore the occurrence rate of squeaking in 4th generation COC THAs and collate the risk factors for squeaking.We retrospectively analyzed consecutive cohorts of 127 patients (135 hips) who had primary THA with delta COC bearings in our hospital between April 2010 and April 2012. Preoperative Harris hip score (HHS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, and University of California Los Angeles (UCLA) activity score were evaluated preoperatively and postoperatively. We also evaluated ceramic fracture, squeak, mid-term results, and survival.In our study, the final patient final follow-up date was July 31, 2016. The mean preoperative HHS improved from 39.5 to 93.1 points. Mean preoperative UCLA score was 3.2 points, improving to 8.2 points. The mean preoperative total WOMAC score was 55.5 points and the mean total WOMAC score was 13.3 points at the final follow-up. The Kaplan–Meier survival plot of revision for any reason as the end point was 98.5% and survival with ceramic fracture as the end point was 99.2% at a mean of 70 months’ follow-up. One post-operative ceramic liner rim fracture occurred at 50 months after surgery. Thirteen of the 135 hips produced a squeaking sound. There were no significant differences in gender (P = .56), age (P = .20), body mass index (BMI) (P = .11), diagnosis (P = .46), cup inclination (P = .36), or cup anteversion (P = 1.0) between the squeaking and non-squeaking groups. However, the incidence of squeaking in the 36 mm COC femoral head bearings was higher than in the 28 mm size (13.6% vs 2.1%, P = .033).The 4th generation COC bearing performed well and provides an encouraging rate of survival with no osteolysis or loosening. However, we found that a squeaking sound associated with use of the delta ceramic occurred at a rate of 9.6%, with the larger-diameter heads having significantly higher incidence.

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“…The incidence of noise generation has been reported to be elevated with one type of such monoblock ceramic acetabular component. [9][10][11] Fracture of the ceramic insert is a potential complication. The incidence of groin pain has been reported to be greater in THA using large diameter bearings because of soft tissue impingement.…”

Section: Introductionmentioning

confidence: 99%

Large head ceramic-on-ceramic bearing in primary total hip arthroplasty: average 3-year follow-up of a multicentre study

et al. 2019

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Background: Surgeons are increasingly using larger femoral head sizes in total hip arthroplasty (THA) to improve stability and reduce the rate of dislocation, 1 of the leading causes of revision surgery. Large ceramic head sizes up to 48 mm can now be used with monoblock acetabular components. National registries have shown promising results at short-term with large diameter ceramic-on-ceramic THA, with very low revision rates. This study reports on the average 3-year follow up of a press-fit monoblock large diameter acetabular shell with a pre-assembled ceramic liner, with emphasis on the radiographic outcome, complications related to the implantation of the cup, and the patient’s clinical outcome. Methods: 170 hips in 169 patients were reviewed at an average 38 ± 5.8 months following surgery. Results: The radiographic review revealed no acetabular cup loosening, no osteolysis and no cup migration. 1 acetabular cup was revised for malposition. The patient clinical outcome and the satisfaction rate were excellent. At 3 years, 7.1% of patients complained of groin pain and 3.5% spontaneously reported hip joint generated noise. 1 patient sustained a non-recurrent traumatic hip dislocation 2 years post surgery. Conclusions: New technology should be introduced cautiously on the market. This is especially true for the large diameter ceramic monoblock acetabular component used in this study since it involves a new acetabular component design. At short term, we have not identified new modes of failure with this implant. Longer follow-up is still needed to assess the safety of large ceramic bearing in THA.

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Increase in Benign Squeaking Rate at Five-Year Follow-Up: Results of a Large Diameter Ceramic-on-Ceramic Bearing in Total Hip Arthroplasty

Cited by 24 publications

References 24 publications

Squeaking in fourth-generation ceramic-on-ceramic total hip replacement and the relationship with prosthesis brands: meta-analysis and systematic review

Squeaking in fourth-generation ceramic-on-ceramic total hip replacement and the relationship with prosthesis brands: meta-analysis and systematic review

Could larger diameter of 4th generation ceramic bearing increase the rate of squeaking after THA?

Large head ceramic-on-ceramic bearing in primary total hip arthroplasty: average 3-year follow-up of a multicentre study

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