Squeaking in Ceramic-on-Ceramic Total Hip Replacements
Todd V. Swanson, MD
While the wear rate with ceramic-on-ceramic total hip replacements is negligible and other problems (including fracture) extremely rare with the use of well-designed components and accurate surgical technique, squeaking in total hip replacements has recently become an issue. Squeaking in total hip replacements is thought to be caused by roughening of the ceramic surface of one or both components, or the presence of 3rd body debris in the space between the ball and socket.
Any impingement between the neck of the femoral component and the ceramic liner of the socket can generate particles of ceramic and/or metal that may lead to squeaking. Partial shucking of the head in and out of the socket may also cause damage to the ceramic surfaces stripe wear. Avoiding these problems is highly dependent on accurately positioning the acetabular and femoral components.
Recently, it has been noted by several authors, including myself, that a particular design of ceramic liner (where the ceramic is protected from chipping by a metal ring which extends past the ceramic) used with a specific femoral component manufactured by the same company has lead to an extremely high risk of squeaking. The squeaking likely occurs due to impingement of the metal femoral neck against the protective metal ring, generating metal debris which enters the interface between the ball and socket and causes a vibration that we hear as a squeak. In my practice, the incidence of significant squeaking in designs without the protective ring is less than 1/2% while the incidence of squeaking in a small group of ceramic hips with this protective ring is >10%, a 20-fold increase. Therefore, many surgeons, including myself, have quit using this acetabular component design.
Ceramic hips require very precise placement of the components to prevent impingement between the femoral and acetabular components. However, if done well, a ceramic hip should wear extremely well without chipping, breakage, or squeaking, and also without the theoretical risks that metal-on-metal hips carry.
Because implant positioning is absolutely critical to the success of a ceramic-on-ceramic total hip replacement, be sure to ask your surgeon how much experience he has with ceramic-on-ceramic hip replacements. Done well, these hips may last your lifetime, even if you are young and active.
Additional reading on squeaking ceramic hips:
» Influences of Prosthetic Design on Squeaking after Ceramic-on-Ceramic Total Hip Arthroplasty AAOS 2009 Poster
» Influences of Prosthetic Design on Squeaking after Ceramic-on-Ceramic Total Hip Arthroplasty AAOS 2009 Handout
» “The Squeaking Hip: A Cause for Concern-Disagrees.” Yang CC et al Orthopedics. 2007 Sep;30(9):739-42
» “Squeaking in a Ceramic on Ceramic Total Hip” Eickman TH et al Proceedings of the 8th BIOLOX Symposium 2003.
» “Squeaking in Ceramic-on-Ceramic Hips; Incidence, Causes and Solutions.” Toole, G. et al 2008.
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My name is Gloria E Torres and I have been told by an orthopedic surgeon that I need a right Hip Replacement. I have osteoarthritis (also osteroporosis). My friend recently had the Anterior Approach and she said recovery is nearly cut in half. My question is the following: I am pondering this approach but am concerned about the ceramic used, etc. I also have seen many ads re DuPuy being sued. Firstly, I am terrified of the operation and secondly I am skeptical regarding the ceramic. I am also suffering from spinal stenosis, 2 degenerated disks and sciatica. I’ve had 3 epidurals which have helped tremendously, but I still get some pain. I believe the spinal stenosis caused the hip pain and the deterioration because before the spinal stenosis episode, I did not have any hip pain. Please counsel me as to what steps I should take. Thank you and looking forward to receiving a reply.
Hi Gloria
Thank you for your note.
Firstly, I think you should be a little more relaxed about this – it is a very routine operation these days and providing you have a good surgeon who is doing lots of these operations then you should have nothing to fear.
There is an inherent failure rate in all medical interventions – artificial hips eventually wear out as do natural hips.
The DePuy ASR and Pinnacle hips have been highlighted and no good surgeon is going to be recommending a poor option these days.
The anterior hip replacement seems to be very good in theory and in practice, I have heard nothing to change my impression of this. Because the muscles are spread apart and not cut, the recovery is much faster initially but over the course of a year there is no real difference in outcomes.
I have had a hip replacement 3 years ago and a revision 3 weeks ago – both the more traditional posterior approach. This latest operation was a huge one but I am recovering really quickly and the main limitation is the fact that I have had two bone grafts and so can only put 60% of my weight on my hip for the first 4 – 6 weeks!
I have selected ceramic on ceramic because my metal on metal hip failed and poisoned me – destroying bone and tissue and making my life miserable. The old system was Smith and Nephew, the revision system is Zimmer and when I have my left hip replaced late this year it will be a Zimmer ceramic on ceramic too.
I think the ceramic on ceramic is the best bet.
In my view – you have little to fear provided you have got a top surgeon – the best predictor is that of this is that they have done hundreds of these operations a year and have a low failure rate. The less operations they do or have done, the less skilled they are likely to be.
While there are lots of horror stories on my Blog – remember that apart from the DePuy and other Metal on Metal Systems, the usual expectation is 95% last 10 – 15 years or more.
All the best.
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