The incidence of noise generation arising from the large-diameter Delta Motion ceramic total hip bearing

Abstract

Noise generation has been reported with ceramic-on-ceramic articulations in total hip replacement (THR). This study evaluated 208 consecutive Delta Motion THRs at a mean follow-up of 21 months (12 to 35). There were 141 women and 67 men with a mean age of 59 years (22 to 84). Patients were reviewed clinically and radiologically, and the incidence of noise was determined using a newly described assessment method. Noise production was examined against range of movement, ligamentous laxity, patient-reported outcome scores, activity level and orientation of the acetabular component. There were 143 silent hips (69%), 22 (11%) with noises other than squeaking, 17 (8%) with unreproducible squeaking and 26 (13%) with reproducible squeaking. Hips with reproducible squeaking had a greater mean range of movement (p < 0.001) and mean ligament laxity (p = 0.004), smaller median head size (p = 0.01) and decreased mean acetabular component inclination (p = 0.02) and anteversion angle (p = 0.02) compared with the other groups. There was no relationship between squeaking and age (p = 0.13), height (p = 0.263), weight (p = 0.333), body mass index (p = 0.643), gender (p = 0.07) or patient outcome score (p = 0.422). There were no revisions during follow-up. Despite the surprisingly high incidence of squeaking, all patients remain satisfied with their hip replacement.

Do Alumina Matrix Composite Bearings Decrease Hip Noises and Bearing Fractures at a Minimum of 5 Years After THA?

“…Although these material improvements would be expected to decrease clinical concerns associated with previous-generation alumina bearings such as ceramic fracture and squeaking, little is known about this new bearing material and intermediateterm effects are unclear [7,15,27]. Therefore, we evaluated complications associated with the use of ceramic-on- ceramic AMC bearings and clinical outcomes including HHS and survivorship.…”

“…Theoretically, these material improvements would be expected to decrease mentioned concerns associated with previousgeneration alumina bearings. However, few short-term clinical results have been published [7,15,27] and several questions remain regarding longer term clinical outcomes after THAs using Delta ceramic bearings.…”

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

“…Stanat and Capozzi [30], in a metaanalysis of 12 studies assessing outcomes after CoC THA, noted the frequency of squeaking to be 2.4%. However, studies assessing noise generation as a whole (inclusive of squeaking) have reported much higher frequency rates [23,24]. In a prospective evaluation of 208 CoC THAs, McDonnell et al [24] noted 11% to report noises other than squeaking, 8% irreproducible squeaking, and 13% reproducible squeaking.…”

“…However, studies assessing noise generation as a whole (inclusive of squeaking) have reported much higher frequency rates [23,24]. In a prospective evaluation of 208 CoC THAs, McDonnell et al [24] noted 11% to report noises other than squeaking, 8% irreproducible squeaking, and 13% reproducible squeaking. Thus, only 69% of patients were noted to have ''silent'' hips in this series of patients.…”

“…In addition, published reports began to note the phenomenon of noise associated with hard-on-hard bearings [1,2,8,14,24]. However, prior reports have been limited by the potential for observer bias, the variability in which noise generation was assessed, and a lack of correlation with patient-reported outcomes.…”