The role of patient factors and implant position in squeaking of ceramic-on-ceramic total hip replacements

Abstract

We investigated factors that were thought to be associated with an increased incidence of squeaking of ceramic-on-ceramic total hip replacements. Between June 1997 and December 2008 the three senior authors implanted 2406 primary total hip replacements with a ceramic-on-ceramic bearing surface. The mean follow-up was 10.6 years. The diagnosis was primary osteoarthritis in each case, and no patient had undergone previous surgery to the hip. We identified 74 squeaking hips (73 patients) giving an incidence of 3.1% at a mean follow-up of 9.5 years (4.1 to 13.3). Taller, heavier and younger patients were significantly more likely to have hips that squeaked. Squeaking hips had a significantly higher range of post-operative internal (p = 0.001) and external rotation (p = 0.003) compared with silent hips. Patients with squeaking hips had significantly higher activity levels (p = 0.009). A squeaking hip was not associated with a significant difference in patient satisfaction (p = 0.24) or Harris hip score (p = 0.34). Four implant position factors enabled good prediction of squeaking. These were high acetabular component inclination, high femoral offset, lateralisation of the hip centre and either high or low acetabular component anteversion. This is the largest study to date to examine patient factors and implant position factors that predispose to squeaking of a ceramic-on-ceramic hip. The results suggest that factors which increase the mechanical forces across the hip joint and factors which increase the risk of neck-to-rim impingement, and therefore edge-loading, are those that predispose to squeaking.

Ceramic-on-ceramic bearings in hip arthroplasty

“…Heavier and more active patients have an increased risk of squeaking due to increased mechanical loading. 38 Component orientations associated with impingement or edge loading have been associated with squeaking, thus highlighting again the importance of cup positioning. 38 It follows that an implant design that increases the risk of impingement or edge loading should be associated with higher than normal rates of squeaking, and indeed this has been reported for the Trident device.…”

“…38 Component orientations associated with impingement or edge loading have been associated with squeaking, thus highlighting again the importance of cup positioning. 38 It follows that an implant design that increases the risk of impingement or edge loading should be associated with higher than normal rates of squeaking, and indeed this has been reported for the Trident device. 39 The elevated titanium rim of this device (see Figure 2) reduces the available range of motion, thus increasing the risk of neck to rim impingement and subsequent edge loading.…”

Advantages and disadvantages of ceramic on ceramic total hip arthroplasty: A review

“…Some authors reported that squeaky hips are associated with younger active, heavier, and taller patients [36][37] . Parvizi et al revealed an association with a particular prosthetic design that enabled neck impingement on the metallic rim of the cup 38,39 .…”

Accuracy of Acetabular Component Position in Hip Arthroplasty

“…The advent and popularity of alternative bearing surfaces has been accompanied by new complications such as polyethylene liner fracture, acoustic phenomenon, metal sensitivity, and pseudotumors. Acetabular component position has been implicated as one of several causative factors for each of these complications [21][22][23][24][25] . Higher wear rates in both conventional 26 and hard-on-hard 27 bearings are seen with higher abduction angles.…”