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Squeaking: Current knowledge and how to avoid it

  • Modern Concepts in Primary and Revision Total Hip Arthroplasty (TN Board, Section editor)
  • Published:
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Abstract

This review aims to update the reader with current thinking and research related to the well documented phenomenon of squeaking hip arthroplasties. The etiology of squeaking is multifactorial and still not well understood. We aim to share our own experience and views on the combination of factors we believe increases the likelihood of squeaking, along with mechanisms by which the sound may be generated. Recent published findings from other groups are summarized along with an appropriate management algorithm we recommend for this cohort of patients.

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References

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  1. Amstutz HC, Clarke IC. Evolution of hip arthroplasty. In: Amstutz HC, editor. Hip arthroplasty. New York: Churchill Livingstone; 1991.

    Google Scholar 

  2. Charnley J. Low friction arthroplasty of the hip: theory and practice. New York: Springer-Verlag; 1979. p. 10.

    Book  Google Scholar 

  3. Restrepo C, Matar WY, Parvizi J, et al. Natural history of squeaking after total hip arthroplasty. Clin Orthop Relat Res. 2010;468:2340–5.

    Article  PubMed  Google Scholar 

  4. Rothman RH. Noisy ceramic hip: is component malpositioning the problem? Dallas: AAHKS. Dallas; 2006.

    Google Scholar 

  5. Jarrett C, Ranawat AS, Bruzzone M, et al. The squeaking hip: an under-reported phenomenon of ceramic-on-ceramic THA. AAOS. Vol. Paper 198, San Diego, 2007.

  6. Walter WK, Zicat B, O'Sullivan M, Walter WL. Modern ceramic-on-ceramic bearings in total hip arthroplasty - minimum five year follow-up. J Bone Joint Surg Br. 2004;87-B(Suppl III):361–2.

    Google Scholar 

  7. Walter WL, O'Toole GC, Walter WK, et al. Squeaking in ceramic-on-ceramic hips: the importance of acetabular component orientation. J Arthroplasty. 2007;22–4:496–503.

    Article  Google Scholar 

  8. Keurentjes JC, Kuipers RM, Wever DJ, Schreurs BW. High incidence of squeaking in THAs with alumina ceramic on ceramic bearings. Clin Orthop. 2008;466:1438–43.

    Article  PubMed  CAS  Google Scholar 

  9. Back DL, Dalziel R, Young D, Shimmin A. Early results of primary Birmingham hip resurfacings. An independent prospective study of the first 230 hips. J Bone Joint Surg Br. 2005;87:324–9.

    PubMed  CAS  Google Scholar 

  10. Ebied E, Journeaux S. Metal-on-metal hip resurfacing. Curr Orthop. 2002;16:420–5.

    Article  Google Scholar 

  11. Bono JV, Sanford L, Toussaint JT. Severe polyethylene wear in total hip arthroplasty. Observations from retrieved AML PLUS hip implants with an ACS polyethylene liner. J Arthroplasty. 1994;9:119–25.

    Article  PubMed  CAS  Google Scholar 

  12. Mihalko WM, Papademetriou T. Polyethylene liner dissociation with the Harris-Galante II acetabular component. Clin Orthop Relat Res. 2001;386:166–72.

    Article  PubMed  Google Scholar 

  13. Suzuki K, Matsubara M, Morita S, et al. Fracture of a ceramic acetabular insert after ceramic-on-ceramic THA-A case report. Acta Orthop Scand. 2003;74:101–3.

    Article  PubMed  Google Scholar 

  14. Toni A, Traina F, Stea S, et al. Early diagnosis of ceramic liner fracture: Guidelines based on a 12-year clinical experience with 3710 modern ceramic prostheses. Exhibited at the Annual Meeting of the American Academy of Orthopaedic Surgeons, March 22–24, 2006, Chicago, IL. Scientific Exhibit No. 14.

  15. • Parvizi J, Bahar A, Wong JC, et al. A squeaky reputation: the problem may be design dependant. Clin Orthop Relat Res. 2011;469:1589–605. Retrospective review of 1507 CoC patients, all 92 cases of squeaking had an elevated acetabular titanium rim.

    Article  Google Scholar 

  16. Riecker CB, Kottig P, Schon R, et al. Clinical wear performance of metal on metal hip arthroplasties alternative bearing surfaces in total hip replacement. In: Jacobs JJ, Craigs TL, editors. Alternative bearing surfaces in total joint replacement: STP 1346. West Conshohocken, PA: ASTM International; 1998. p. 144–7.

    Chapter  Google Scholar 

  17. Morlock M, Nassutt R, Janssen R, et al. Mismatched wear couple zirconium oxide and aluminium oxide in total hip arthroplasty. J Arthroplasty. 2001;16:1071–4.

    Article  PubMed  CAS  Google Scholar 

  18. Restrepo C, Post ZD, Kai B, Hozack WJ. The effect of stem design on the prevalence of squeaking following ceramic-on-ceramic bearing total hip arthroplasty. J Bone Joint Surg Am. 2010;92:550–7.

    Article  PubMed  Google Scholar 

  19. Smith SL, Dowson D, Goldsmith AA. The lubrication of metal-on-metal total hip joints: a slide down the Stribeck curve. Proc Inst Mech Eng. 2001;215:483–93.

    Article  Google Scholar 

  20. Walter WL, Waters TS, Gillies M, et al. Squeaking hips. J Bone Joint Surg Am. 2008;90 Suppl 4:102–11.

    Article  PubMed  Google Scholar 

  21. • Jeffers JRT, Walter WL. Ceramic-on-ceramic bearings in hip arthroplasty. J Bone Joint Surgery Br. 2012;94:735–45. Recent comprehensive systematic review on the literature concerning CoC hip bearings, including problems encountered and new design concepts.

    Article  CAS  Google Scholar 

  22. Walter WL, Insley GM, Walter WK, Tuke MA. Edge loading in third generation alumina ceramic on ceramic bearings: stripe wear. J Arthroplasty. 2004;19:402–13.

    Article  PubMed  Google Scholar 

  23. • Esposito CI, Walter WL, Roques A, et al. Wear in alumina-on-alumina ceramic total hip replacements. J Bone Joint Surg Br. 2012;94:901–7. Largest CoC retrieval study examining wear with respect to the 2 main types of edge loading, both implicated in squeaking.

    Article  PubMed  CAS  Google Scholar 

  24. Chevillotte C, Trousdale RT, Chen Q, et al. The 2009 Frank Stinchfield Award “hip squeaking”: a biomechanical study of ceramic-on-ceramic bearing surfaces. Clin Orthop Relat Res. 2010;468:345–50.

    Article  PubMed  Google Scholar 

  25. Currier JH, Anderson DE, Van Citters DW. A proposed mechanism for squeaking of ceramic-on-ceramic hips. Wear. 2010;269:782–9.

    Article  CAS  Google Scholar 

  26. Sariali E, Stewart T, Jin ZM, Fisher J. In vitro investigation of friction under edge-loading conditions for ceramic-on-ceramic total hip prosthesis. J Orthop Res. 2010;28:979–85.

    PubMed  Google Scholar 

  27. Swanson TV, Peterson DJ, Seethala R, et al. Influence of prosthetic design on squeaking after ceramic-on-ceramic total hip arthroplasty. J Arthroplasty. 2010;25:36–42.

    Article  PubMed  Google Scholar 

  28. Langdown AJ, Pickard RJ, Hobbs CM, et al. Incomplete seating of the liner with the Trident-acetabular system: a cause for concern? J Bone Joint Surg Br. 2007;89:291–5.

    PubMed  CAS  Google Scholar 

  29. Jarrett CA, Ranawat AS, Bruzzone M, et al. The squeaking hip: a phenomenon of ceramic-on-ceramic total hip arthroplasty. J Bone Joint Surg Am. 2009;91:1344–9.

    Article  PubMed  Google Scholar 

  30. • Sexton SA, Yeung E, Jackson MP, et al. The role of patient factors and implant position in squeaking of ceramic-on-ceramic total hip replacements. J Bone Joint Surg Br. 2011;93:439–42. One of the largest studies to examine patient and implant position factors in determining a predisposition to squeaking.

    Article  PubMed  CAS  Google Scholar 

  31. Biedermann R, Tonnin A, Krismer M, et al. Reducing the risk of dislocation after total hip arthroplasty: the effect of orientation of the acetabular component. J Bone Joint Surg Br. 2005;87:762–9.

    PubMed  CAS  Google Scholar 

  32. Burroughs BR, Murtoglu OK. Bragdon, et al. In vitro comparison of frictional torque and torsional resistance of aged conventional gamma-in-nitrogen sterilized polyethylene articulating against head sizes larger than 32 mm. Acta Orthop. 2006;77:710–8.

    Article  PubMed  Google Scholar 

  33. Bolland BJRF, Culliford DJ, Langton DJ, Millington JPS, Arden NK, Latham JM. High failure rates with a large diameter hybrid metal-on-metal total hip replacement: clinical radiological and retrieval analysis. J Bone Joint Surg Br. 2011;93:608–15.

    PubMed  CAS  Google Scholar 

  34. •• McDonnell SM, Boyce G, Bare J, et al. The incidence of noise generation arising from the large-diameter Delta Motion ceramic total hip bearing. Bone Joint J. 2013;95:160–5. Squeaking in fourth generation CoC bearings was more likely where patients had a greater range of motion, ligamentous laxity, and reduced inclination and anteversion.

    Article  PubMed  Google Scholar 

  35. Choi IY, Kim YS, Hwang KT, Kim YH. Incidence and factors associated with squeaking in alumina-on-alumina THA. Clin Orthop Relat Res. 2010;468:3234–9.

    Article  PubMed  Google Scholar 

  36. Walter WL, Waters TS, Gillies M, et al. The squeaking ceramic hip retrieval, radiographic, acoustic, and finite element analyses. J Bone Joint Surg Br. 2010;92(Suppl):168.

    Google Scholar 

  37. Esposito C, Walter WL, Campbell P, Roques A. Squeaking in metal-on-metal hip resurfacing arthroplasties. Clin Orthop Relat Res. 2010;468:2333–9.

    Article  PubMed  Google Scholar 

  38. Grammatopoulos G, Pandit H, Glyn-Jones S, et al. Optical acetabular orientation for hip resurfacing. J Bone Joint Surg Br. 2010;92:1072–8.

    PubMed  CAS  Google Scholar 

  39. Brockett CL, Harper P, Williams S, et al. The influence of clearance on friction, lubrication and squeaking in large diameter metal-on-metal hip replacements. J Mater Sci:Mater Med. 2008;19:1575–9.

    Article  PubMed  CAS  Google Scholar 

  40. No authors listed. Australian Orthopaedic Association National Joint Replacement Registry, Hip and Knee Arthroplasty Annual Report, 2008. Available at: www.aoa.org.au/jointregistry-pub.asp. Accessed February, 2009.

  41. Jeffers JR, Roques A, Taylor A, Tuke MA. The problem with large diameter metal-on-metal acetabular cup inclination. Bull NYU Hosp Jt Dis. 2009;67:189–92.

    PubMed  Google Scholar 

  42. Leslie I, Williams S, Brown C, et al. Effect of bearing size on the long-term wear, wear debris, and ion levels of large diameter metal-on-metal hip replacements: an in vitro study. J Biomed Mater Res B Appl Biomater. 2008;87:163–72.

    PubMed  Google Scholar 

  43. Glaser D, Komistek RD, Cates HE, Mahfouz MR. Clicking and squeaking: in vivo correlation of sound and separation for different bearing surfaces. J Bone Joint Surg Am. 2008;90 Suppl 4:112–20.

    Article  PubMed  Google Scholar 

  44. • Jack CM, Molloy DO, Walter WL, et al. The use of ceramic-on-ceramic bearings in isolated revision of the acetabular component. Bone Joint J. 2013;95-B:333–8. Results of leaving well fixed femoral stems alone in revision hip surgery, and using ceramic heads with titanium trunnion sleeves coupled with ceramic or polyethylene liners. This method can be used in the rare instance of revising a squeaking hip.

    Article  PubMed  CAS  Google Scholar 

  45. Koo KH, Ha YC, Jung WH, et al. Isolated fracture of the ceramic head after third generation alumina-on-alumina total hip arthroplasty. J Bone Joint Surg Am. 2008;90:329–36.

    Article  PubMed  Google Scholar 

  46. • Walter WL, Kurtz SM, Esposito C, et al. Retrieval analysis of squeaking alumina ceramic-on-ceramic bearings. J Bone Joint Surg Br. 2011;93:1597–601. Multicenter retrieval analysis of squeaking alumina CoC components, revealing increased wear and edge loading as a common factor.

    Article  PubMed  CAS  Google Scholar 

  47. Lusty PJ, Watson A, Tuke MA, et al. Orientation and wear of the acetabular component in third generation alumina-on-alumina ceramic bearings: an analysis of 33 retrievals. J Bone Joint Surg Br. 2007;89:1158–64.

    Article  PubMed  CAS  Google Scholar 

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Conflict of Interest

Arjuna M. Imbuldeniya declares that he has no conflict of interest. Simon J. Pearce declares that he has no conflict of interest. William L. Walter declares that he has no conflict of interest. Bernard A. Zicat declares that he has no conflict of interest. William K. Walter declares that he has no conflict of interest.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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Authors and Affiliations

  1. Specialist Orthopaedic Group, Mater Clinic Suite 1.08, 3-9 Gillies St, North Sydney, New South Wales, 2060, Australia

    Arjuna M. Imbuldeniya, Simon J. Pearce, William L. Walter, Bernard A. Zicat & William K. Walter

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  1. Arjuna M. Imbuldeniya
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  2. Simon J. Pearce
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Correspondence to Arjuna M. Imbuldeniya.

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Imbuldeniya, A.M., Pearce, S.J., Walter, W.L. et al. Squeaking: Current knowledge and how to avoid it. Curr Rev Musculoskelet Med 6, 342–349 (2013). https://doi.org/10.1007/s12178-013-9181-z

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  • DOI: https://doi.org/10.1007/s12178-013-9181-z

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