Revision Hip Arthroplasty for Ceramic-on-Ceramic Squeaking Hips Does Not Compromise the Results

doi:10.1016/j.arth.2010.05.002

The Journal of Arthroplasty

Volume 25, Issue 6, Supplement, September 2010, Pages 81-86

https://doi.org/10.1016/j.arth.2010.05.002 Get rights and content

Abstract

Squeaking is a complication that may occur after ceramic-on-ceramic total hip arthroplasty (THA) that can be intolerable enough for some patients to seek revision THA. This prospective case series of 11 hips is the first to report on the results of these patients. All patients underwent isolated head and liner exchange to a metal-on-highly cross-linked polyethylene using the direct lateral approach. Mean age was 45.5 years, and body mass index was 30.0 kg/m². Hips were revised at an average of 40.1 months postindex THA. Retrieval analysis showed 7 of 7 liners/heads with edge loading wear and 5 of 7 liners with signs of neck-rim impingement. Short Form-36 mental dimension, Western Ontario McMaster Osteoarthritis Index, and Harris Hip Score (HHS) showed a statistically significant improvement (P < .05). All squeaking was eliminated after revision THA. There were no morbidities or complications after the revision surgery rendering isolated head-and-liner exchange to a metal-on-highly cross-linked polyethylene a relatively benign procedure.

Section snippets

Method and Materials

All THA patients are prospectively observed at our institution (1999-2008). From this database, a case series was obtained by grouping every THA patient who underwent revision THA surgery for squeaking after obtaining institutional ethics review board approval. Inclusion criteria were revision for squeaking if the index THA was done at our institution and a minimum 1 year follow-up. Patients were excluded if there was a concomitant reason for the revision such as component loosening or if the

Results

All patients reported squeaking on average 14 months (range, 5-20 months) after the index THA. The activities that caused the squeaking varied among the patients, whereas most patients complained about squeaking when walking (8 hips), bending forward (5 hips), standing from a seated position (3 hips), or going up/down stairs (3 hips). Two patients (2 hips) complained of mild to moderate intermittent pain in the groin area, but most of squeaking hips were not painful. In all patients, the

Discussion

The etiology of squeaking post CoC THA is believed to be multifactorial involving patient, surgical, and implant factors 1, 2, 5, 8. Walter et al [1] previously reported that squeaking is associated with an increased acetabular component anteversion. However, we recently published a study that failed to corroborate these findings when no difference was found in a group of squeaking hips and a matched group of nonsqueaking hips with regard to acetabular inclination and version [2]. The measured

Conclusion

In the CoC squeaking hip that can no longer be tolerated by the patient, head-and-liner exchange to a metal-on-highly cross-linked polyethylene is an effective method to eliminate squeaking. The use of larger femoral heads, through the direct lateral approach, results in low dislocation rates and low morbidity rendering the procedure relatively benign with low morbidity.

References (29)

WalterW.L. et al.
Squeaking in ceramic-on-ceramic hips: the importance of acetabular component orientation
J Arthroplasty
(2007)
RestrepoC. et al.
The noisy ceramic hip: is component malpositioning the cause?
J Arthroplasty
(2008)
TaylorS. et al.
The role of stripe wear in causing acoustic emissions from alumina ceramic-on-ceramic bearings
J Arthroplasty
(2007)
WalterW.L. et al.
Edge loading in third generation alumina ceramic-on-ceramic bearings: stripe wear
J Arthroplasty
(2004)
MorlockM. et al.
Mismatched wear couple zirconium oxide and aluminum oxide in total hip arthroplasty
J Arthroplasty
(2001)
HozackW.J. et al.
Relationship between polyethylene wear, pelvic osteolysis, and clinical symptomatology in patients with cementless acetabular components. A framework for decision making
J Arthroplasty
(1996)
LachiewiczP.F. et al.
Modular revision for recurrent dislocation of primary or revision total hip arthroplasty
J Arthroplasty
(2004)
O'BrienJ.J. et al.
Isolated liner exchange in revision total hip arthroplasty: clinical results using the direct lateral surgical approach
J Arthroplasty
(2004)
WadeF.A. et al.
Isolated acetabular polyethylene exchange through the anterolateral approach
J Arthroplasty
(2004)
BoucherH.R. et al.
Dislocation after polyethylene liner exchange in total hip arthroplasty
J Arthroplasty
(2003)

BellamyN.

Pain assessment in osteoarthritis: experience with the WOMAC osteoarthritis index

Semin Arthritis Rheum

(1989)

KennedyJ.G. et al.

Effect of acetabular component orientation on recurrent dislocation, pelvic osteolysis, polyethylene wear, and component migration

J Arthroplasty

(1998)

SieberH.P. et al.

Analysis of 118 second-generation metal-on-metal retrieved hip implants

J Bone Joint Surg Br

(1999)

ToniA. et al.

Early diagnosis of ceramic liner fracture. Guidelines based on a twelve-year clinical experience

J Bone Joint Surg Am

(2006)

Cited by (0)

: One of the authors is a consultant for Stryker Orthopedics (Mahwah, NJ). The implant retrieval program receives institutional funding from National Institutes of Health, Zimmer (Warsaw, Ind), and Stryker.

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