Squeaking with ceramic hip replacements

A hip replacement using a ceramic on ceramic bearing articulation has the advantage that this combination has a very low wear rate. This means that the replacement can last a very long time without wearing out. One issue that has been highlighted as a drawback of ceramic hips is that there have been some series reporting audible squeaking from the hip.

Noise from normal hips as well as hip replacements is not uncommon. Normal hips may click or clunk on certain movements and these noises are usually associated with a tendon catching over a muscle. Noise coming from a joint replacement itself is often described as a ‘grinding’ or ‘ratchety’ sensation. Squeaking is a noise rather specific to the ceramic on ceramic articulation. Most of the reports have been associated with a particular design of implant. We have found this occurs very rarely. We did a study of our hip replacements specifically looking at the question of noise ( Journal of Bone and Joint Surgery (Br) 2011;93-B:1017-20) and found that no patients experienced squeaking, but there were a few who were aware of an occasional grinding or clicking.

The cause of squeaking from a ceramic articulation is thought to be related to metal particle transfer onto the ceramic or if there is a lack of fluid lubrication around the hip. This can occur if there is some impingement on the metal rim of the acetabular component (cup). Every hip can impinge at some point at extremes of movement. Most commonly this could occur at extreme flexion of the hip, as for instance, when the knee is brought towards the chest. In general terms there are probably some movement patterns of the hip that become habitual after a hip replacement and it seems wise to avoid extremes of motion where there could be repeated contact of the hip with the pelvis. Usually this can be avoided by turning the hip outwards slightly as the legs comes up into flexion towards the chest. Adopting some of these simple movement patterns will help avoid the hip from impinging and represents a good way of looking after your hip for the longterm.

The low wear rate and published longterm outcomes of ceramic on ceramic bearings continue to be exceptionally good and far outweigh any potential disadvantages.