Noise characteristics in ceramic-on-ceramic vs. metal-on-polyethylene total hip arthroplasty: a comparative study
- Patrick G. Robinson, Ian Anthony, Sudeep Kumar, Bryn Jones, Andrew Stark, Roland Ingram
- Hip International 2016; 26 (5):492-497. DOI: 10.5301/hipint.5000383
- Level of Evidence:
- None given.
Robinson et al. sent a hip questionnaire (Ingram Squeaky Hip Score) and the Oxford Hip Score to 1,000 patients, of which 509 responded. Patient mean age was 63.7 years with a mean post OP follow up 33 months (6-156 months). 282 patients had ceramic-on-ceramic (CoC) and 227 metal-onpolyethylene (MoP) total hip arthroplasties (THA). In the CoC group 17% of the patients reported noise (55% clicking, 26% grinding, 19% squeaking, 17% crunching, 11% popping) compared to 8% in the MoP group (47% clicking, 21% squeaking, 16% crunching, 5% grinding, 5% popping), although the difference was not significant (p=0.054). Patients with noisy hips had an average of 5 points less in their OHS (Oxford Hip Score), however, the authors state that longer follow up is necessary to link noise to poorly functioning implants.
In the CoC group 42% of noise affected patients frequently/all the time compared to 26% in the MoP group. Occasional noise was reported by 38% and 37%, respectively, and rare emission of noise in 19% and 37%, respectively. Movements causing noise were bending down and standing up, as well as taking the first few steps in both groups and squatting in the CoC group. Bending down and walking was reported to cause the loudest noise in both groups. Almost 30% of CoC and 15% of MoP patients complained of occasional pain during noise. When patients rated the effect of noise on their daily lives on a scale from 0-10 (0=no effect), the CoC group had a median score of 2 (range 0-8) and the MoP group had a median score of 1 (range 0-7). The authors found no relationship between noisy hips and BMI or femoral head size.
According to the authors, noise from THA is an underreported phenomenon, which currently has been focused primarily on squeaking with CoC bearings. However, they found that it should also be considered a potential “complication” with MoP bearings. They conclude that patients should generally be forewarned of possible noise emission from their THA, irrespective of the bearing.
- Questionnaire based study, not validated
- Patient selection criteria not given
- 61% of CoC implanted with THA components previously reported with high incidence of noise generation
- Short term study (CoC 2.5 years, MoP 3.3 years)
- Big age difference between CoC and MoP patients; age had a significant effect on noise reported
- Noise is an underreported phenomenon of uncertain significance.
- Noise is a general issue in THA and not restricted to CoC bearings.
- Study reports squeaking even with MoP THA.
- Patients should be consented of possible noise emission irrespective of bearing surfaces.