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Shang Z, Tanzer M, Al Badi H, Hart A. Ceramic-on-Ceramic Total Hip Arthroplasty: I Can Hear You. Arthroplast Today 2023; 23:101203. [PMID: 37745973 PMCID: PMC10517284 DOI: 10.1016/j.artd.2023.101203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 07/10/2023] [Accepted: 07/24/2023] [Indexed: 09/26/2023] Open
Abstract
Background Squeaking is a known complication of ceramic-on-ceramic (CoC) total hip arthroplasty (THA), yet there is a lack of studies specifically quantifying its loudness. The aims of this study were: (1) to determine the incidence of squeaking in CoC THAs at long-term follow-up; (2) to identify risk factors; and (3) to quantify the loudness of the squeaking. Methods A specifically designed prospective questionnaire was used to determine the prevalence, characteristics, and loudness of squeaking in 130 (110 patients) primary THAs with fourth-generation CoC bearings at a mean follow-up of 10.5 years. The loudness of the squeaking was determined by the decibel (dB) scale from the Centers for Disease Control and Prevention. Results Overall, 28% of the CoC hips experienced squeaking. The mean onset was 5.7 years postoperatively, with 39% of the cases having their onset more than 5 years after their THA. Patients with a lower body mass index were more likely to report squeaking (P = .009). The mean loudness of the squeak was 35 dB (range, 10-70 dB) and was loud in 36% of the hips. Patients who developed squeaking early postoperatively had louder squeaking than those with a later onset (P = .007). The loudness of the squeaking sound progressed in 25% of the cases, and these hips had louder squeaking (P = .04). Conclusions Squeaking after CoC THA is not uncommon, can be relatively loud, and increases over time. This needs to be considered in young patients that are candidates for CoC THAs.
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Affiliation(s)
- Zhida Shang
- Jo Miller Orthopaedic Research Laboratory, Division of Orthopaedic Surgery, McGill University, Montreal, Quebec, Canada
| | - Michael Tanzer
- Jo Miller Orthopaedic Research Laboratory, Division of Orthopaedic Surgery, McGill University, Montreal, Quebec, Canada
| | - Hamid Al Badi
- Jo Miller Orthopaedic Research Laboratory, Division of Orthopaedic Surgery, McGill University, Montreal, Quebec, Canada
| | - Adam Hart
- Jo Miller Orthopaedic Research Laboratory, Division of Orthopaedic Surgery, McGill University, Montreal, Quebec, Canada
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Li Z, Niu EL, Fu J, Zhou YG, Chai W, Hao LB, Chen JY, Xu C. A Nomogram That Characterizes a Patient's Odds of Developing Squeaking After Fourth-generation Ceramic-on-ceramic THA. Clin Orthop Relat Res 2023; 481:1322-1336. [PMID: 36749832 PMCID: PMC10263255 DOI: 10.1097/corr.0000000000002573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 01/05/2023] [Indexed: 02/09/2023]
Abstract
BACKGROUND Although ceramic-on-ceramic (CoC) bearings result in the lowest wear rate of any bearing combination, postoperative squeaking remains worrisome. However, data concerning squeaking in long-term follow-up studies are still lacking, especially for fourth-generation CoC THA. QUESTIONS/PURPOSES (1) After keeping the prosthesis in place for 10 years, what percentage of patients treated with fourth-generation CoC THA implants report squeaking, and are there points in time when squeaking occurs more frequently? (2) What are the characteristics, association with hip function, and factors associated with squeaking? (3) Can we create a nomogram that characterizes a patient's odds of experiencing squeaking based on the factors associated with it? METHODS Between January 2009 and December 2011, 1050 patients received primary THAs at our institution, 97% (1017) of whom received fourth-generation CoC THAs because this was the preferred bearing during this period. Of the 1017 eligible patients, 5% (54) underwent THAs performed by low-volume surgeons, 3% (30) were implanted with cemented prostheses, 2% (22) died, 1% (10) were immobile, 1% (six) underwent revision surgery, and 17% (169) were lost to follow-up before 10 years, leaving 726 patients for analysis here at a mean of 11 ± 1 years. In the study cohort, 64% (464) were male and 36% (262) were female, with a mean age of 44 ± 13 years at primary THA. We extracted data about articular noise from follow-up records in our institutional database and used a newly developed questionnaire to ascertain the percentage of patients who reported squeaking at the latest follow-up interval. Although not validated, the questionnaire was modeled on previous studies on this topic. The longitudinal pattern for squeaking was explored to find timepoints when squeaking occurs more frequently. Based on the questionnaire data, we calculated the percentages of frequent, reproducible, and avoidable squeaking. Hip function was evaluated with the Harris Hip Score and WOMAC score and compared between the squeaking and nonsqueaking groups. Factors associated with squeaking, which were examined in a multivariate analysis, were used to develop a nomogram. RESULTS At 10 years, 16% (116 of 726) of patients reported squeaking. Two squeaking peaks were determined, at 0 to 1 year and 8 to 10 years. Frequent, reproducible, and avoidable squeaking accounted for 42% (36 of 86), 20% (17 of 86), and 41% (35 of 86), respectively. The mean Harris Hip Score (93 ± 4 versus 94 ± 5; p = 0.81) and WOMAC score (16 ± 13 versus 15 ± 13; p = 0.23) did not differ between patients with squeaking and those without. After controlling for potential confounding variables such as etiology and head offset, we found that patients younger than 46 years (odds ratio 2.5 [95% confidence interval 1.5 to 5.0]; p < 0. 001), those who were male (OR 2.0 [95% CI 1.1 to 3.5]; p = 0.04), those having a total flexion and extension arc of less than 50° (OR 2.0 [95% CI 1.2 to 3.3]; p = 0.02), and those with the Corail hip implant (OR 4.1 [95% CI 2.1 to 7.7]; p < 0. 001) were more likely to report squeaking. We created a nomogram that can be used at the point of care that can help clinicians identify patients at a higher risk of experiencing squeaking; this nomogram had good performance (area under the receiver operating characteristic curve of 77%). CONCLUSION As a potential late complication, squeaking after fourth-generation CoC THA is of concern and may be related to increased stripe wear. We recommend that surgeons use this nomogram to assess the odds of squeaking before selecting a bearing, especially in patients at high risk, to facilitate shared decision-making and improve patient satisfaction. Future external validation of the model is still needed to enhance its applicability.Level of Evidence Level III, therapeutic study.
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Affiliation(s)
- Zhuo Li
- School of Medicine, Nankai University, Tianjin, PR China
- Department of Orthopedics, The First Medical Center, Chinese PLA General Hospital, Beijing, PR China
| | - Er-Long Niu
- Department of Orthopedics, The First Medical Center, Chinese PLA General Hospital, Beijing, PR China
- 305 Hospital of PLA, Beijing, PR China
| | - Jun Fu
- Department of Orthopedics, The First Medical Center, Chinese PLA General Hospital, Beijing, PR China
- Department of Orthopedics, The Fourth Medical Center, Chinese PLA General Hospital, Beijing, PR China
| | - Yong-Gang Zhou
- Department of Orthopedics, The First Medical Center, Chinese PLA General Hospital, Beijing, PR China
- Department of Orthopedics, The Fourth Medical Center, Chinese PLA General Hospital, Beijing, PR China
| | - Wei Chai
- Department of Orthopedics, The First Medical Center, Chinese PLA General Hospital, Beijing, PR China
- Department of Orthopedics, The Fourth Medical Center, Chinese PLA General Hospital, Beijing, PR China
| | - Li-Bo Hao
- Department of Orthopedics, The First Medical Center, Chinese PLA General Hospital, Beijing, PR China
- Department of Orthopedics, The Fourth Medical Center, Chinese PLA General Hospital, Beijing, PR China
| | - Ji-Ying Chen
- Department of Orthopedics, The First Medical Center, Chinese PLA General Hospital, Beijing, PR China
- Department of Orthopedics, The Fourth Medical Center, Chinese PLA General Hospital, Beijing, PR China
| | - Chi Xu
- Department of Orthopedics, The First Medical Center, Chinese PLA General Hospital, Beijing, PR China
- Department of Orthopedics, The Fourth Medical Center, Chinese PLA General Hospital, Beijing, PR China
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The occurrence of squeaking under wear testing standards for ceramic on ceramic total hip replacements. J Mech Behav Biomed Mater 2023; 138:105616. [PMID: 36565691 DOI: 10.1016/j.jmbbm.2022.105616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 11/22/2022] [Accepted: 12/06/2022] [Indexed: 12/23/2022]
Abstract
Ceramic on ceramic total hip replacement clinical reports may on occasion note a noise or squeaking. There is much debate on whether this is an actual concern, but some medical centres want to avoid any possible negative impact on the patients' wellbeing due to the noise generated. The aim of this study was to determine what sound frequencies can be picked up from hip testing standards for ceramic on ceramic under different lubrication conditions. The ISO-14242-1 (35° cup angle) and ISO-14242-4 (55° cup angle with a 4 mm translational mismatch) standards were used for testing with dry, water and serum lubrication conditions up to 10000 cycles. No sound was detected for water and serum conditions under standard walking (ISO-14242-1) testing. An audible noise with a frequency range of 0.4-0.8 kHz was picked up within 600 cycles under water and edge loading (ISO-14242-4) conditions. All dry testing produced a high pitch squeak when the frequency was higher than 2 kHz. One sample under dry edge loading conditions had an audible noise of 0.8 kHz, considered not as squeaking, as it was not high pitch. Dry testing for both, standard walking (ISO-14242-1) and edge loading (ISO-14242-4) conditions, which resulted in a high pitch noise, had a frequency range of 2-8 kHz and 5-9 kHz respectively. One sample tested with edge loading and serum produced a faint squeak noise after 6000 cycles with a frequency of 7 kHz. Edge loading due to ISO-14242-4 conditions had an increased torque which may be playing a role in increased friction leading to noise. Edge loading conditions were more prone to the generation of audible noise and squeaking whilst under lubricated conditions.
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McCarthy CJ, Mahon J, Sheridan GA, Welch-Phillips A, O'Byrne JM, Kenny PJ. Third and fourth generation ceramic-on-ceramic total hip arthroplasty at a minimum of ten years. J Clin Orthop Trauma 2022; 31:101942. [PMID: 35865324 PMCID: PMC9293759 DOI: 10.1016/j.jcot.2022.101942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 06/17/2022] [Accepted: 07/01/2022] [Indexed: 10/17/2022] Open
Abstract
BACKGROUND Ceramic on Ceramic bearings in Total Hip Arthroplasty (THA) afford a low friction coefficient, low wear rates and extreme hardness. Significant complications include hip squeak, ceramic fracture and poor polyethylene performance in revision procedures due to imbedding of abrasive microscopic ceramic fragments. We report on the results of this bearing at a minimum of 10 years. METHODS A single-centre retrospective review of 449 THAs was performed. Primary outcome measures included aseptic revision and all-cause revision rates at a minimum of 10 years post operatively. Evaluation of functionality was performed with WOMAC and SF-36 scores which were performed pre-operatively and at intervals of 6 months, one year, 2 years, 5 years and 10 years post operatively. RESULTS There was a 6.2% (n = 28) all-cause and 5.3% (n = 24) aseptic revision rate for ceramic on ceramic total hip arthroplasty at minimum of 10 years with a mean time to revision 4.8 years (range 2 months-11.6 years). Notably, there were 2 revisions for ceramic head fracture, one for ceramic liner fracture, 3 for aseptic loosening and 3 revisions for squeaking. Pain of unknown origin was the most common reason for revision. There was an improvement in postoperative WOMAC scores from a mean of 59.8 (range 15-95) pre-operatively to a mean of 15.6 (range 0-78) at 10 years. CONCLUSION This study showed good functional outcomes but high revision rates for CoC THA at a minimum of 10 years. Our rates of ceramic fracture were consistent with other studies.
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Affiliation(s)
- Cathal J. McCarthy
- National Orthopaedic Hospital Cappagh, Dublin, Ireland,Corresponding author. Cappagh National Orthopaedic Hospital, Cappagh Road, Finglas, Dublin 11, D11 EV29, Ireland.
| | - John Mahon
- National Orthopaedic Hospital Cappagh, Dublin, Ireland
| | | | | | - John M. O'Byrne
- National Orthopaedic Hospital Cappagh, Dublin, Ireland,Royal College of Surgeon Ireland, Dublin, Ireland
| | - Paddy J. Kenny
- National Orthopaedic Hospital Cappagh, Dublin, Ireland,Royal College of Surgeon Ireland, Dublin, Ireland
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Moran J, Kahan JB, Gardner E. Correction of a Squeaky Knee After ACL Reconstruction Surgery: A Case Report. JBJS Case Connect 2021; 11:e20.00856. [PMID: 33950635 DOI: 10.2106/jbjs.cc.20.00856] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
CASE We report a squeaking knee complication on weight-bearing and active flexion-extension because of a migrating nonabsorbable FiberWire suture in a 16-year-old boy who underwent anterior cruciate ligament (ACL) reconstruction surgery. Although not physically limiting, the noise caused psychological distress in our patient as a young adult. As the noise did not resolve with nonsurgical treatment, we performed arthroscopic surgical correction and removed loose FiberWire strands protruding from the femoral tunnel which completely eliminated the sound. CONCLUSIONS Squeaking knee complications because of migrating nonabsorbable sutures post-ACL reconstruction surgery do not heal with time and can be corrected surgically.
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Affiliation(s)
- Jay Moran
- Yale School of Medicine, New Haven, Connecticut
| | - Joseph B Kahan
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, Department of Orthopaedics and Rehabilitation, New Haven, Connecticut
| | - Elizabeth Gardner
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, Department of Orthopaedics and Rehabilitation, New Haven, Connecticut
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Bellity J, Elkaïm M, Hannouche D, Nizard R. Arthroscopic evaluation and treatment of a squeaking hip. A case report. BMC Musculoskelet Disord 2020; 21:805. [PMID: 33272241 PMCID: PMC7713320 DOI: 10.1186/s12891-020-03817-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 11/22/2020] [Indexed: 11/22/2022] Open
Abstract
Background Squeaking of ceramic-on-ceramic total hip arthroplasty is an unexpected complication which occurs in 1- 30% of patients. Revision surgery is required in 0.2% of the cases, when a ceramic fracture is suspected, or in case of severe malposition of the implants, subluxation, or impingement. Hip arthroscopy may be a useful diagnostic and therapeutic option in squeaking hips. Case presentation A patient presenting with a pain-free squeaking underwent hip arthroscopy to examine the sliding surfaces and the rim of the acetabulum, and to search for signs of impingement. Thorough lavage and debridement of hip synovitis and fibrous tissue was performed. The squeaking noise immediately disappeared after the surgery. The patient was allowed to fully weight bear as tolerated with 2 crutches for 2 weeks. Two years after the arthroscopy, the patient remained symptom-free. Conclusions The potential reasons for hip squeaking in our patient are discussed. Hip arthroscopy may prove useful as a diagnostic and therapeutic option for some patients presenting with a squeaking ceramic-on ceramic hip replacement.
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Affiliation(s)
- Jonathan Bellity
- Department of Orthopaedic Surgery, Lariboisière, Hospital, Paris 7 University, Paris, France
| | - Marc Elkaïm
- Department of Orthopaedic Surgery, Lariboisière, Hospital, Paris 7 University, Paris, France
| | - Didier Hannouche
- Department of Orthopaedic Surgery, Lariboisière, Hospital, Paris 7 University, Paris, France. .,Department of Orthopaedic Surgery, Geneva University Hospitals & Faculty of Medicine, Avenue Gabrielle Perret Gentil 4, 1205, Geneva, Switzerland.
| | - Rémy Nizard
- Department of Orthopaedic Surgery, Lariboisière, Hospital, Paris 7 University, Paris, France
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Yoon JY, Moon JK, Kim CH, Lee S, Yoon PW. Korean epidemiology and trends in hip joint replacements. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2020. [DOI: 10.5124/jkma.2020.63.8.462] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
This study aimed to analyze the epidemiologic characteristics of patients who underwent hip arthroplasty using the Korean nationwide database and investigate the recent trends in implant fixation methods and bearing surface selection. We aimed to compare clinical characteristics and differences with the results from the registry of other western countries. We analyzed the data collected by the Health Insurance Review and Assessment Service database of Korea from 2007 to 2011 and the Main Surgery Statistical Yearbook from 2014 to 2018, published by the National Health Insurance Service. The number and rate of patients who underwent hip joint arthroplasty per 10,000 persons have been steadily increasing since 2007. There was a big difference in mean age and preoperative diagnosis of patients between the bipolar hemiarthroplasty and total hip arthroplasty groups. Most patients underwent surgery using a cementless biological fixation method, and the cemented fixation method was selectively used for a small portion of old aged osteoporotic patients. In relation to the use of bearing surfaces, the registry data showed that ceramic-ceramic bearings were used at an overwhelmingly high rate (81%) in Korea compared to other countries. The reason was attributable to various factors, such as patient’s age or economic status, differences in the health insurance system between countries, and recently reported complications, such as ceramic fracture or noise.
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Baruffaldi F, Mecca R, Stea S, Beraudi A, Bordini B, Amabile M, Sudanese A, Toni A. Squeaking and other noises in patients with ceramic-on-ceramic total hip arthroplasty. Hip Int 2020; 30:438-445. [PMID: 31328560 DOI: 10.1177/1120700019864233] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Noise in ceramic-on-ceramic (CoC) total hip arthroplasty (THA) is a potential symptom of abnormal bearing wear. Squeaking and other prosthetic hip noises are multi-factorial phenomena that can be analysed and may provide prognostic information. METHODS 46 patients with noisy CoC bearings were investigated using X-ray, computed tomography and joint fluid analysis, and classified into either high or low risk of ceramic liner fracture groups according to previously published guidelines. Noise events from the bearings of 16 high risk cases which were subsequently revised were compared with 30 patients in the low risk control group who did not undergo revision. Noise events were analysed for their physical characteristics using a standardised protocol and classified as either low frequency and short duration 'clicking' or long duration and high frequency 'squeaking'. RESULTS The peak frequency of squeaking during forward walking was significantly higher for patients in the case group who were revised, compared with the control group. The patient-reported onset of squeaking (46 months postoperatively) was earlier than short-noise emissions (82 months). In the standardised sequence of movements, short-noise always occurred more frequently than squeaking. Small heads (28 mm) were more likely to develop short-noise, while large heads (⩾32 mm) were more likely to develop squeaking. DISCUSSION Noise evaluation may provide additional value for predicting failure of CoC bearings, though some questions should be better investigated in a dedicated prospective trial.
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Affiliation(s)
- Fabio Baruffaldi
- Laboratory of Medical Technology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Rosaria Mecca
- Laboratory of Medical Technology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Susanna Stea
- Laboratory of Medical Technology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Alina Beraudi
- Laboratory of Medical Technology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Barbara Bordini
- Laboratory of Medical Technology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Marilina Amabile
- Laboratory of Medical Technology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Alessandra Sudanese
- Orthopaedics-Traumatology and Prosthetic Surgery and Revisions of Hip and Knee Replacement, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Aldo Toni
- Orthopaedics-Traumatology and Prosthetic Surgery and Revisions of Hip and Knee Replacement, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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Yoon BH, Park JW, Cha YH, Won SH, Lee YK, Ha YC, Koo KH. Incidence of Ceramic Fracture in Contemporary Ceramic-on-Ceramic Total Hip Arthroplasty: A Meta-analysis of Proportions. J Arthroplasty 2020; 35:1437-1443.e3. [PMID: 31902618 DOI: 10.1016/j.arth.2019.12.013] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Revised: 12/02/2019] [Accepted: 12/09/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND We performed a proportion meta-analysis of currently available data to determine the prevalence of ceramic fracture for each generation. METHODS A total of 10,571 total hip arthroplasties from 45 studies were included. Proportion meta-analysis with a random-effects model was performed to estimate the prevalence of ceramic fracture. To determine whether the ceramic fractures have a fatigue nature and a risk or latent period for the development, postoperative time lapse, patient age, and body mass index were related with ceramic fracture by metaregression analysis. RESULTS As of postoperative 2.0 to 18.8 years, the rate of ceramic fracture was 0.5% (95% CI, 0.3%-0.8%) in the forte group and 0.2% (95% CI, 0.1%-0.4%) in the delta group (P = .059). The ceramic fracture rate for each component was 0.2% (95% CI, 0.1%-0.3%) for the forte head, 0.1% (95% CI, 0.0%-0.2%) for the delta head (P = .210), 0.2% (95% CI, 0.1%-0.3%) for the forte liner, and 0.2% (95% CI, 0.1%-0.4%) for the delta liner (P = .305). The rate of ceramic fracture per 1000 patient-years was 0.9 (95% CI, 0.5-0.13) in the forte group and 0.5 (95% CI, 0.2-0.8) in the delta group (P = .072). In metaregression analysis, no significant associations were found between prevalence of ceramic fracture and postoperative time lapse, patient age, or body mass index. CONCLUSIONS The rate of ceramic fracture was 0.9/1000 patient-year in the forte group and 0.5/1000 patient-year in the delta group. The results of this study provide baseline data for further studies validating ceramic bearings. LEVEL OF EVIDENCE Level I, meta-analysis.
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Affiliation(s)
- Byung-Ho Yoon
- Department of Orthopaedic Surgery, Inje University College of Medicine, Seoul Paik Hospital, Seoul, South Korea
| | - Jung-Wee Park
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Yong-Han Cha
- Department of Orthopaedic Surgery, Eulji University College of Medicine, Seoul, South Korea
| | - Suk-Hyung Won
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Young-Kyun Lee
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Yong-Chan Ha
- Department of Orthopaedic Surgery, Chung-Ang University College of Medicine, Seoul, South Korea
| | - Kyung-Hoi Koo
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
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Barrow JA, Divecha HM, Panchani S, Boden R, Chitre A, Gambhir A, Porter ML, Board TN. Is patient satisfaction related to patient reported sounds from ceramic on ceramic total hip arthroplasty? A study of 265 hips. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2019; 29:1243-1251. [DOI: 10.1007/s00590-019-02426-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Accepted: 03/26/2019] [Indexed: 12/12/2022]
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Zhao CC, Qu GX, Yan SG, Cai XZ. Squeaking in fourth-generation ceramic-on-ceramic total hip replacement and the relationship with prosthesis brands: meta-analysis and systematic review. J Orthop Surg Res 2018; 13:133. [PMID: 29859126 PMCID: PMC5984797 DOI: 10.1186/s13018-018-0841-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 05/21/2018] [Indexed: 02/06/2023] Open
Abstract
Background Postoperative 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. Methods The 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. Results The 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. Conclusions In 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 material The online version of this article (10.1186/s13018-018-0841-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Chen-Chen Zhao
- Department of Orthopaedic Surgery, Second Affiliated Hospital of Zhejiang University School of Medicine, Jiefang Road 88, Hangzhou, 310009, China.,Orthopaedic Research Laboratory, Zhejiang University, Jiefang Road 88, Hangzhou, China
| | - Guo-Xin Qu
- Department of Orthopaedic Surgery, Second Affiliated Hospital of Zhejiang University School of Medicine, Jiefang Road 88, Hangzhou, 310009, China.,Orthopaedic Research Laboratory, Zhejiang University, Jiefang Road 88, Hangzhou, China
| | - Shi-Gui Yan
- Department of Orthopaedic Surgery, Second Affiliated Hospital of Zhejiang University School of Medicine, Jiefang Road 88, Hangzhou, 310009, China.,Orthopaedic Research Laboratory, Zhejiang University, Jiefang Road 88, Hangzhou, China
| | - Xun-Zi Cai
- Department of Orthopaedic Surgery, Second Affiliated Hospital of Zhejiang University School of Medicine, Jiefang Road 88, Hangzhou, 310009, China. .,Orthopaedic Research Laboratory, Zhejiang University, Jiefang Road 88, Hangzhou, China.
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12
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Kim MW, Kim SM, Chung YY. Total Hip Arthroplasty Using Ceramic-on-ceramic Bearing Surfaces: Long-term Assessment of Squeaking Sounds. Hip Pelvis 2018; 30:18-22. [PMID: 29564293 PMCID: PMC5861021 DOI: 10.5371/hp.2018.30.1.18] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Revised: 01/12/2018] [Accepted: 01/13/2018] [Indexed: 12/12/2022] Open
Abstract
Purpose This study was performed to characterize the natural history of squeaking sounds that occur following total hip arthroplasty (THA) using ceramic-on-ceramic bearing surfaces and its potential correlation with clinical and/or radiological results. Materials and Methods This study included 47 patients who underwent THA between April 1999 and April 2005, and had at least 10 years of follow up from the time of the operation. Squeaking sounds were detected in 10 out of the 47 cases (21.3%). Squeaking-associated factors (i.e., cause, time of onset, inducing motions, and continuity of the sound) were assessed. Results Squeaking sounds: i) were detected an average of 46.2 months after operation, ii) occurred more frequently in patients with a high body mass index (BMI) compared to those with low BMI, and iii) most frequently detected when deep flexion of hip joint followed extension. In all 10 cases, the squeaking sound remained through the follow up period; 6 cases experienced no change in frequency and pitch, 4 cases experienced a decrease in frequency and pitch over time. The cause(s) of changes to squeaking sounds could not be determined. Conclusion The frequency and pitch of the squeaking sounds changed over time in a subset of patients. The squeaking sound did not appear to correlate with clinical results or survival of the prosthesis.
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Affiliation(s)
- Min Wook Kim
- Department of Orthopaedic Surgery, Kwangju Christian Hospital, Gwangju, Korea
| | - Sang Min Kim
- Department of Orthopaedic Surgery, Kwangju Christian Hospital, Gwangju, Korea
| | - Young Yool Chung
- Department of Orthopaedic Surgery, Kwangju Christian Hospital, Gwangju, Korea
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Hannouche D, Zingg M, Miozzari H, Nizard R, Lübbeke A. Third-generation pure alumina and alumina matrix composites in total hip arthroplasty: What is the evidence? EFORT Open Rev 2018; 3:7-14. [PMID: 29657840 PMCID: PMC5890134 DOI: 10.1302/2058-5241.3.170034] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Wear, corrosion and periprosthetic osteolysis are important causes of failure in joint arthroplasty, especially in young patients. Ceramic bearings, developed 40 years ago, are an increasingly popular choice in hip arthroplasty. New manufacturing procedures have increased the strength and reliability of ceramic materials and reduced the risk of complications. In recent decades, ceramics made of pure alumina have continuously improved, resulting in a surgical-grade material that fulfills clinical requirements. Despite the track record of safety and long-term results, third-generation pure alumina ceramics are being replaced in clinical practice by alumina matrix composites, which are composed of alumina and zirconium. In this review, the characteristics of both materials are discussed, and the long-term results with third-generation alumina-on-alumina bearings and the associated complications are compared with those of other available ceramics.
Cite this article: EFORT Open Rev 2018;3:7-14. DOI: 10.1302/2058-5241.3.170034
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Affiliation(s)
- Didier Hannouche
- Department of Orthopaedic Surgery and Traumatology, Geneva University Hospital, Switzerland
| | - Matthieu Zingg
- Department of Orthopaedic Surgery and Traumatology, Geneva University Hospital, Switzerland
| | - Hermes Miozzari
- Department of Orthopaedic Surgery and Traumatology, Geneva University Hospital, Switzerland
| | - Remy Nizard
- Department of Orthopaedic Surgery, AP-HP, Hôpital Lariboisière, Paris University, Paris, France
| | - Anne Lübbeke
- Department of Orthopaedic Surgery and Traumatology, Geneva University Hospital, Switzerland
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Bedard NA, Burnett RA, DeMik DE, Gao Y, Liu SS, Callaghan JJ. Are Trends in Total Hip Arthroplasty Bearing Surface Continuing to Change? 2007-2015 Usage in a Large Database Cohort. J Arthroplasty 2017; 32:3777-3781. [PMID: 28887024 DOI: 10.1016/j.arth.2017.07.044] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 07/25/2017] [Accepted: 07/26/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Bearing surface issues related to trunnionosis or metal-on-metal (MoM) articulations have likely impacted recent trends in bearing surface choice. The purpose of this study is to evaluate trends in total hip arthroplasty (THA) bearing surface use, including 2015 data, with respect to the date of operation and patient demographics. METHODS The Humana dataset was reviewed from 2007 through 2015 to analyze bearing surface usage in primary THA. Four bearing surface types were identified by International Classification of Disease, 10th Revision codes and trended throughout the years: metal-on-polyethylene (MoP), ceramic-on-ceramic (CoC), ceramic-on-polyethylene (CoP), and MoM. Prevalence was analyzed as a function of age and sex. RESULTS Of the 28,504 primary THA procedures, the most commonly used bearing was MoP (46.1%), followed by CoP (33.2%), MoM (17.1%), and ceramic-on-ceramic (3.6%). The use of CoP bearings significantly increased from 6.4% in 2007 to 52.0% in 2015, while MoM bearings decreased during this period. MoP bearings decreased over 2012-2015 (P < .001). CoP usage decreased with age, while MoP bearings increased with a transition occurring at 65-69 years of age. Women were more likely to receive MoP bearings (odds ratio [OR] 1.2), while men were more likely to receive MoM and CoP bearings (OR 1.1). Multivariate logistic regression showed age to be an independent predictor of bearing surface choice with patients 65 and older more likely to receive MoP bearings (OR 3.2). CONCLUSION Bearing surface choice in primary THA has changed tremendously from 2007 to 2015. MoM bearing use has decreased as a result of adverse effects. Age continues to remain a significant factor in bearing surface choice.
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Affiliation(s)
- Nicholas A Bedard
- Department of Orthopedics and Rehabilitation, University of Iowa, Iowa City, Iowa
| | - Robert A Burnett
- Department of Orthopedics and Rehabilitation, University of Iowa, Iowa City, Iowa
| | - David E DeMik
- Department of Orthopedics and Rehabilitation, University of Iowa, Iowa City, Iowa
| | - Yubo Gao
- Department of Orthopedics and Rehabilitation, University of Iowa, Iowa City, Iowa
| | - Steve S Liu
- Department of Orthopedics and Rehabilitation, University of Iowa, Iowa City, Iowa
| | - John J Callaghan
- Department of Orthopedics and Rehabilitation, University of Iowa, Iowa City, Iowa
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Roffe L, FitzPatrick AJ, Rodgers GW, Woodfield TBF, Hooper GJ. Squeaking in ceramic-on-ceramic hips: No evidence of contribution from the trunnion morse taper. J Orthop Res 2017; 35:1793-1798. [PMID: 27736012 DOI: 10.1002/jor.23458] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Accepted: 10/04/2016] [Indexed: 02/04/2023]
Abstract
Squeaking in ceramic-on-ceramic (CoC) total hip arthroplasty (THA) was investigated with an acoustic monitoring device to distinguish between squeaking emanating from the trunnion morse taper (TMT) connection versus the articular surface. 82 patients with implant problems scheduled for revision were selected and acoustic emissions (AE) with simple movements monitored. Five of these patients with CoC implants underwent surgery and their retrieved implant components were analyzed in vitro. In vivo recordings of all 82 patients found audible squeaks produce frequency content across the entire 0-50 kHz spectrum. Of the five CoC implants the in vivo peak frequency range of flexion/extension motions was 0.8 kHz and comparable to the range of in vitro testing (0.2 kHz). In vitro TMT connection motions were very large comparatively, producing a higher average peak frequency range of 22.5 kHz. All retrieved implants showed evidence of wear at the TMT connection. These findings suggest, the TMT connection does not directly cause audible squeaking. Wear occurring at this junction may contribute to debris which disrupt lubrication, increase friction, and produce noise. This observation supports current evidence suggesting that squeaking is from the bearing surface. Our findings are the first to demonstrate that in CoC THA the recordable noise of a hip squeak does not originate nor have contribution from the TMT connection. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:1793-1798, 2017.
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Affiliation(s)
- Lloyd Roffe
- Department of Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago Christchurch, 4345, Christchurch, New Zealand
| | - Anthony J FitzPatrick
- Department of Mechanical Engineering, University of Canterbury, 8140, Christchurch, New Zealand
| | - Geoffrey W Rodgers
- Department of Mechanical Engineering, University of Canterbury, 8140, Christchurch, New Zealand
| | - Tim B F Woodfield
- Department of Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago Christchurch, 4345, Christchurch, New Zealand
| | - Gary J Hooper
- Department of Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago Christchurch, 4345, Christchurch, New Zealand
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Wu GL, Zhu W, Zhao Y, Ma Q, Weng XS. Hip Squeaking after Ceramic-on-ceramic Total Hip Arthroplasty. Chin Med J (Engl) 2017; 129:1861-6. [PMID: 27453238 PMCID: PMC4976577 DOI: 10.4103/0366-6999.186654] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Objective: The present study aimed to review the characteristics and influencing factors of squeaking after ceramic-on-ceramic (CoC) total hip arthroplasty (THA) and to analyze the possible mechanisms of the audible noise. Data Sources: The data analyzed in this review were based on articles from PubMed and Web of Science. Study Selection: The articles selected for review were original articles and reviews found based on the following search terms: “total hip arthroplasty”, “ceramic-on-ceramic”, “hip squeaking”, and “hip noise.” Results: The mechanism of the squeaking remains unknown. The possible explanations included stripe wear, edge loading, a third body, fracture of the ceramic liner, and resonance of the prosthesis components. Squeaking occurrence is influenced by patient, surgical, and implant factors. Conclusions: Most studies indicated that squeaking after CoC THA was the consequence of increasing wear or impingement, caused by prosthesis design, patient characteristics, or surgical factors. However, as conflicts exist among different articles, the major reasons for the squeaking remain to be identified.
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Affiliation(s)
- Guo-Liang Wu
- Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Wei Zhu
- Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Yan Zhao
- Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Qi Ma
- Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Xi-Sheng Weng
- Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
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Hannouche D, Devriese F, Delambre J, Zadegan F, Tourabaly I, Sedel L, Chevret S, Nizard R. Ceramic-on-ceramic THA Implants in Patients Younger Than 20 Years. Clin Orthop Relat Res 2016; 474:520-7. [PMID: 26341897 PMCID: PMC4709277 DOI: 10.1007/s11999-015-4546-9] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2015] [Accepted: 08/26/2015] [Indexed: 01/31/2023]
Abstract
BACKGROUND Poor survival of THA implants in very young patients has been attributed to use of cemented implants, wear of conventional polyethylene, and the presence of morphologic deformities in the proximal femur or in the acetabulum. Few studies have reported the long-term results of ceramic-on-ceramic implants in THAs in patients younger than 20 years. QUESTION/PURPOSES We determined: (1) the proportion of patients who experienced complications related to the ceramic bearing (squeaking, fracture); (2) the survivorship free from loosening and free from revision for any reason; (3) whether patients with osteonecrosis had inferior survivorship compared with patients whose surgical indication was all other diagnoses including sequelae of pediatric hip disorders (developmental dysplasia of the hip, Legg-Calvé-Perthes disease, slipped capital femoral epiphysis); and (4) clinical function. METHODS Between 1979 and 2013, we performed 113 primary THAs in 91 patients younger than 20 years at the time of surgery. Of those, 105 THAs (83 patients) were done with ceramic-on-ceramic bearings (91% of the 91 patients); during that period, a ceramic-on-ceramic bearing couple was indicated in all patients younger than 20 years. In eight patients (eight hips), a cemented polyethylene cup was implanted because the diameter of the acetabulum was smaller than the smallest available ceramic cup (46 mm), or because adequate fixation of a ceramic press-fit cup could not be achieved despite careful reaming of the acetabulum. The most common diagnosis indicating THA was avascular necrosis of the femoral head (56.2%; 59 hips). Thirty-five patients (40 hips) had undergone previous operations before the replacement. Three patients (4%; four hips) died from unrelated causes, nine patients (11%; 13 hips) were lost to followup, and four patients (five hips) had a followup greater than 8.5 years but have not been seen in the last 5 years. Patients were assessed clinically (using the Merle d'Aubigne-Postel score, Hip disability and Osteoarthritis Outcome score (HOOS), and the SF-12(®) Health Survey, and radiographically for signs of radiolucencies, subsidence, or osteolysis on plain films. The mean followup was 8.8 ± 6.1 years (range, 2-34.4 years). RESULTS Five patients experienced transient noise generation, defined as a snap in four patients and squeaking in one. Seventeen hips underwent revision surgery-16 for aseptic loosening and one for septic loosening. The implant survival rate at 10 years with aseptic loosening as the endpoint was 90.3% (95% CI, 82.4%-98.9%). No hip had acetabular or femoral osteolysis. Survivorship in patients with osteonecrosis did not differ from survivorship in patients with other diagnoses. The Merle d'Aubigne-Postel score increased from 10.1 ± 4.0 to 17.6 ± 1.1 (p < 0.01); the mean HOOS score was 79.3 ± 13.8 (range, 50.6-100); the mean SF-12(®) physical and mental component scores were 48.1 ± 7.9 (range, 21.4-57.6), and 47.4 ± 12.2 (range, 24.5-99.4), respectively. CONCLUSIONS We found that patient-reported outcomes scores improved in most patients undergoing THA in this very young study group. Underlying diagnosis did not affect long-term survivorship. However, the revision-free survival rate at 10 years is lower than published estimates in older patients, and with 11% of patients lost to followup, our estimates may represent a best-case scenario. Therefore, we believe THA should be performed as a last resort in this population. LEVEL OF EVIDENCE Level IV, therapeutic study.
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Affiliation(s)
- Didier Hannouche
- Department of Orthopaedic Surgery and Traumatology, AP-HP, Hôpital Lariboisière, Université Paris 7 Denis Diderot, 2 Rue Ambroise Paré, 75010, Paris, France.
| | - Flore Devriese
- Department of Orthopaedic Surgery and Traumatology, AP-HP, Hôpital Lariboisière, Université Paris 7 Denis Diderot, 2 Rue Ambroise Paré, 75010, Paris, France
| | - Jérôme Delambre
- Department of Orthopaedic Surgery and Traumatology, AP-HP, Hôpital Lariboisière, Université Paris 7 Denis Diderot, 2 Rue Ambroise Paré, 75010, Paris, France
| | - Frédéric Zadegan
- Department of Orthopaedic Surgery and Traumatology, AP-HP, Hôpital Lariboisière, Université Paris 7 Denis Diderot, 2 Rue Ambroise Paré, 75010, Paris, France
| | - Idriss Tourabaly
- Department of Orthopaedic Surgery and Traumatology, AP-HP, Hôpital Lariboisière, Université Paris 7 Denis Diderot, 2 Rue Ambroise Paré, 75010, Paris, France
| | - Laurent Sedel
- Department of Orthopaedic Surgery and Traumatology, AP-HP, Hôpital Lariboisière, Université Paris 7 Denis Diderot, 2 Rue Ambroise Paré, 75010, Paris, France
| | - Sylvie Chevret
- Department of Biostatistics and Medical Informatics, AP-HP, Hôpital Saint Louis, Université Paris 7 Denis Diderot, Paris, France
| | - Rémy Nizard
- Department of Orthopaedic Surgery and Traumatology, AP-HP, Hôpital Lariboisière, Université Paris 7 Denis Diderot, 2 Rue Ambroise Paré, 75010, Paris, France
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Levy YD, Munir S, Donohoo S, Walter WL. Review on squeaking hips. World J Orthop 2015; 6:812-820. [PMID: 26601063 PMCID: PMC4644869 DOI: 10.5312/wjo.v6.i10.812] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Revised: 08/21/2015] [Accepted: 09/28/2015] [Indexed: 02/06/2023] Open
Abstract
Squeaking is a well-recognized complication for hard-on-hard bearings. The nature of squeaking is not yet completely understood however it is considered a multifactorial phenomenon. Patient, implant, and surgical factors play a role in squeaking. It is believed that mechanisms damaging the fluid film lubrication in which these bearings function optimally have a critical role. Such mechanisms include edge loading, stripe wear, impingement, third body particles and ceramic fracture. The resonance of metallic parts can produce noise in the human audible range hence the implant metallurgic composition and design may play a role. Implant positioning can facilitate impingement and edge loading enhancing the occurrence of squeaking. The recent introduction of large heads (> 36 mm) 4th generation ceramic-on-ceramic bearing may accentuate the conditions facilitating noise formation; however the current literature is insufficient. Clinically, squeaking may manifest in extreme hip positions or during normal gait cycle however it is rarely associated with pain. Evaluations of patients with squeaking include clinical and radiographic assessments. Computer tomography is recommended as it can better reveal ceramic breakage and implant malposition. The treatments for most squeaking patients include reassurance and activity modification. However for some, noise can be a problem, requiring further surgical intervention. In the occurrence of ceramic fracture, implant failure, extreme components malposition, instability and impingement, surgery should be advised. This review will aim to discuss the current literature regarding squeaking.
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Tai SM, Munir S, Walter WL, Pearce SJ, Walter WK, Zicat BA. Squeaking in large diameter ceramic-on-ceramic bearings in total hip arthroplasty. J Arthroplasty 2015; 30:282-5. [PMID: 25304938 DOI: 10.1016/j.arth.2014.09.010] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Revised: 09/11/2014] [Accepted: 09/12/2014] [Indexed: 02/01/2023] Open
Abstract
We analyzed the results of 206 consecutive total hip arthroplasties performed using large diameter ceramic-on-ceramic bearings. At an average follow-up of 28months, the mean Harris Hip Score improved from 54 to 92. Fifteen (7.3%) hips were noted to squeak. There was no significant difference between silent and squeaking hips with regards to age, weight, height, BMI, range of movement, femoral head diameter, leg length, and offset or center of rotation. No correlation was present between incidence of squeaking and increasing cup inclination and anteversion. 5.2% of cups orientated within Lewinnek's safe zone squeaked. No hips required revision for squeaking. While large diameter ceramic bearings may produce squeaking, our early results of surgery using large head ceramic bearings are encouraging. However, long-term follow-up is required.
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Affiliation(s)
- Stephen M Tai
- Specialist Orthopaedic Group, North Sydney, New South Wales, Australia
| | - Selin Munir
- Specialist Orthopaedic Group, North Sydney, New South Wales, Australia
| | - William L Walter
- Specialist Orthopaedic Group, North Sydney, New South Wales, Australia
| | - Simon J Pearce
- Specialist Orthopaedic Group, North Sydney, New South Wales, Australia
| | - William K Walter
- Specialist Orthopaedic Group, North Sydney, New South Wales, Australia
| | - Bernard A Zicat
- Specialist Orthopaedic Group, North Sydney, New South Wales, Australia
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Lee TH, Moon YW, Lim SJ, Park YS. Meta-analysis of the Incidence and Risk Factors for Squeaking after Primary Ceramic-on-ceramic Total Hip Arthroplasty in Asian Patients. Hip Pelvis 2014; 26:92-8. [PMID: 27536565 PMCID: PMC4971122 DOI: 10.5371/hp.2014.26.2.92] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Revised: 05/08/2014] [Accepted: 05/30/2014] [Indexed: 12/12/2022] Open
Abstract
Purpose The purpose of this study was to assess the squeaking incidence and risk factors after primary ceramic-on-ceramic total hip arthroplasty (THA) in Asian patients using meta-analysis. Materials and Methods We performed a meta-analysis of published data on the squeaking incidence and risk factors from 2000 to 2013. Eight studies in Asians were analyzed for both squeaking incidence and risk factors and 25 studies in Western patients were analyzed for squeaking incidence. The data collected were: patient factors, surgical factors and implantation factors. Results The overall incidence of hip squeaking was 2.7% in Asians and 3.1% in Westerners. This difference was not statistically significant. The only significant risk factor was an increase in the acetabular cup abduction angle. Of the factors, the cup abduction angle was the only significant risk factor for the occurrence rate of squeaking, and the occurrence rate tended to increase with increasing angle. Conclusion The incidence of squeaking in Asians after primary ceramic-on-ceramic THA is 2.7% and is similar to that in Westerners. The increased cup abduction angle is associated with squeaking; therefore, surgeons should be careful not to implant the cup at a too steep abduction angle.
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Affiliation(s)
- Tae-Hun Lee
- Department of Orthopedic Surgery, Pohang St. Mary's Hospital, Pohang, Korea
| | - Young-Wan Moon
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seung-Jae Lim
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Youn-Soo Park
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Owen DH, Russell NC, Smith PN, Walter WL. An estimation of the incidence of squeaking and revision surgery for squeaking in ceramic-on-ceramic total hip replacement: a meta-analysis and report from the Australian Orthopaedic Association National Joint Registry. Bone Joint J 2014; 96-B:181-7. [PMID: 24493182 DOI: 10.1302/0301-620x.96b2.32784] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Squeaking arising from a ceramic-on-ceramic (CoC) total hip replacement (THR) may cause patient concern and in some cases causes patients to seek revision surgery. We performed a meta-analysis to determine the incidence of squeaking and the incidence of revision surgery for squeaking. A total of 43 studies including 16,828 CoC THR that reported squeaking, or revision for squeaking, were entered into the analysis. The incidence of squeaking was 4.2% and the incidence of revision for squeaking was 0.2%. The incidence of squeaking in patients receiving the Accolade femoral stem was 8.3%, and the incidence of revision for squeaking in these patients was 1.3%.
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Affiliation(s)
- D H Owen
- Trauma and Orthopaedic Research Unit, Building 6 Level 1, The Canberra Hospital, PO Box 11, Woden ACT, 2606, and Australian National University Medical School, Level 2, Peter Baume Building 42, Linnaeus Way, Canberra, ACT, 0200, Australia
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