Ceramic Liner Fractures Presenting as Squeaking After Primary Total Hip Arthroplasty

BACKGROUND:Squeaking after ceramic-on-ceramic total hip arthroplasty is a relatively uncommon phenomenon. It usually does not require treatment in the absence of pain, mechanical symptoms, and/or relentless squeaking. The purpose of this investigation was to report on four patients who presented wit...

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Bibliographic Details
Published in:Journal of bone and joint surgery. American volume 2014-01, Vol.96 (1), p.27-31
Main Authors: Abdel, Matthew P, Heyse, Thomas J, Elpers, Marcella E, Mayman, David J, Su, Edwin P, Pellicci, Paul M, Wright, Timothy M, Padgett, Douglas E
Format: Article
Language:English
Subjects:
Adult
Arthroplasty, Replacement, Hip - adverse effects
Ceramics
Equipment Failure Analysis
Female
Hip Prosthesis - adverse effects
Humans
Male
Middle Aged
Noise
Pain, Postoperative - etiology
Reoperation
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Summary:BACKGROUND:Squeaking after ceramic-on-ceramic total hip arthroplasty is a relatively uncommon phenomenon. It usually does not require treatment in the absence of pain, mechanical symptoms, and/or relentless squeaking. The purpose of this investigation was to report on four patients who presented with hip pain and squeaking due to fractured ceramic liners after ceramic-on-ceramic total hip arthroplasty. METHODS:Four patients with painful squeaking after ceramic-on-ceramic total hip arthroplasty were seen at our institution. One patient had a revision for suspected loosening and excessive anteversion of the cup noted on radiographs and magnetic resonance imaging (MRI). The remaining three patients had a revision for audible squeaking with progressive pain. RESULTS:Intraoperatively, the ceramic liners of all four patients were fractured. CONCLUSIONS:Squeaking after ceramic-on-ceramic total hip arthroplasty rarely is a functional issue. However, painful squeaking without notable trauma may indicate fracture of the ceramic liner. Painful squeaking is difficult to evaluate by conventional imaging. When painful squeaking occurs, exploration via surgical revision is recommended in selected patients, as ceramic liner fractures may go unnoticed on radiographs and/or MRI and thus their actual prevalence may be higher than estimated. LEVEL OF EVIDENCE:Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
ISSN:0021-9355
1535-1386
DOI:10.2106/JBJS.M.00737