Ceramic-on-Ceramic Total Hip: What is All the Noise About?

Ceramic-on-Ceramic Total Hip: What is All the Noise About?

Over the last year, there have been several reports of “squeaking” associated with ceramic-on-ceramic total hips in the United States. The true incidence of this problem is unclear but could be as high as 5% according to some authors. Audible squeaking of the hip, particularly when rising from a seated position, is probably less frequent then this but is a complication that is quite disturbing to the patient. It is thought to be due to a combination of factors which include roughening of the two surfaces of the ceramic-on-ceramic articulation, decreased lubrication of the joint, and maybe influenced by the original position of the joint replacement. For this and other reasons, the use of ceramic-on-ceramic total hips have not enjoyed the same popularity that has been experienced in France and other parts of Europe. 

While ceramic-on-ceramic bearing surfaces have extremely low wear rates in the laboratory, there have been concerns about chipping of the material during insertion of the total hip replacement and now the noise or squeaking phenomenon. The risk of catastrophic breakage of the ceramic ball or liner has decreased to a very acceptably low range. There are new types of ceramic-on-ceramic bearings that are in the pipeline for approval somewhere in the next one to three years. Further observation of this articulation will be needed to determine if the squeaking issues have been solved. 

William P. Barrett, M.D. 

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  1. margus junkur

    i had a total left hip replacement on 9/5/2006- ceramic on ceramic. since late march 2007 the hip has increasingly been squeaking, shifting, and grinding. discomfort and pain is progressively increasing. i don’t know what to do. have seen many specialists
    in the philadelphia area including dr austin of the rothman institute about revision
    this troubles me greatly. any input would be greatly appreciated. thank- you

  2. Dr. William Barrett

    Squeaking in ceramic on ceramic hips can occur in about 5% of cases. While usually not painful it is disturbing if loud. Revision may be necessary. The surgeons at the Rothman Clinic are excellent and have experience with this issue.
    William Barrett, MD

  3. Louis DiFrancesco

    I had a hip replacement about 2-3 years ago. The squeaking noise has become increasingly louder. I have had x-rays and there is apparently no fracture or any other abnormality. Any suggestions, certainly I would rather not have surgery.

  4. julie shertzer

    i had a total left hip replacement almost 4 years ago with a ceramic on ceramic and approximatly 3 weeks ago began the grinding with some discomfort which has now become greater more of a squeak along with the grinding and definately aches more the longer I’m on my leg. Nothing like this had happened at all until the grinding began. I saw my surgeon last week who told me that this is becoming an increased problem with these replacements and the only course of treatment is to have it re-done which does not make me happy at all, but I also don’t want to have pain which is beginning to increase. My surgeon has said he has replaced a few already and there is a black mark inside where the ceramic has rubbed which is definately not normal in other replacements.

  5. John Back

    I have the same “squeeking” from my ceramic hip replacement. It is almost two years old. My Dr. says that my recourse is to have it replaced (!) It isn’t clear who is expected to pay for this proceedure and the ensuing rehab.

    Any idea on where I can find a history of how remediation was handled? The noise is getting VERY irritating.

    jJohn Back

  6. Ed

    I had both hips replaced in 2003 with the stryker trident ceramic on ceramic hips. Ever since the surgery I have had constant, loud squeaking of both hips, pain in the hips (generally when the hip is NON weight bearing???). I also experience the squeakign and popping of each hip. Both the popping and squeaking of each hip occur with each and every step that I take. Whie the pain is intermitent, I wonder whether or not these noises are causing my hips to wear out prematurely.

    Also, do you have any comment on the recent settlement made by hip manufacturers and the US Attorney’s Office in New Jersey, and how this affects patients?

  7. Phillip Boyd

    I had my right hip replacement done in august 2006 with stryker trident ceramic. I am having a “popping” noise along with some soreness every step I take. I don’t understand what is causing this popping and will it continue to get increasingly worse? I had my yearly check up and a representive from stryker trident happend to be there. My doctor introduced me to him and explained my “popping” noise to him, just to let him see or hear the problem, the first thing the representive said was “What, is this an ambush?. I didn’t think much about it at the time, however, I it is begining to concern me now.

  8. Dr. William Barrett

    Dear Phillip,
    Clicking can be due to some separation of the ball and socket and with walking or impingement of the stem vs. the socket. You should discuss this with your orthopedic surgeon.
    William Barrett

  9. Genie Zenowich

    My left THR was in April of 04. I’ve had joint popping sensations from the beginning, but they were once every 2 or 3 weeks. For the past 2 weeks and now, I’m experiencing a joint pop with every step. There is no pain involved, but it’s very annoying. I’m totally afraid to have someone look at it because my hip replacement experience was a nightmare. I have a ceramic Stryker joint and am 54 years old. I have learned to walk with my knees slightly bent at all times since my operated leg is 1 and 1/4 inches longer than my non-operated leg and walking normally caused all sorts of problems in my back and both legs. All problems in the back and non-operated leg have disappeared with the new walking technique. (Been using this technique for 10 months with no negative consequences.) Now, all of a sudden, this major increase in popping and grinding. I really, really, don’t ever want to be cut open again. Is this something I can just run through my denial cycle for a while and maybe it will get better, or is this a get in and get seen right away, or you’re gonna be in big trouble kind of thing? Thanks in Advance for any words to from the wise!
    Genie Z

  10. Becky Ball

    I had a total replacement in 2003, and am getting a revision in the next month due to severe popping that causes huge pain. My Doctor thinks this will ease once I have the surgery, but until then I am taking one percocet per day. He feels I will get addicted to this, but what is the alternative? Pain management is important to me as I am only 45, and life has to go on while waiting for the surgery. Is there any other alternatives? I have taken tylenol 3, but I don’t get relief. Please help!

  11. Ben Taylor

    Had total relacement surgery on my left hip almost 2 years ago with the stryker trident ceramic on ceramic hips. Approximately 7 months ago it began squeaking and I am experiencing pain in the area of the replacement and up my back. When back to the doctor and got xrays. He stated that the replacement was in place, but explained my that I csan have a replacement. What should I do?

  12. Dr. William Barrett

    Dear Ben,
    Thank you for your comments. Squeaking of ceramic-on-ceramic total hips can occur anywhere from 0.2% to 7.0% of patients depending on the study. Things for your surgeon to evaluate are the position of the cup, the stem, the length and off-set of the hip. If the squeaking is intolerable and is associated with pain, consideration of a revision to a non-ceramic-on-ceramic bearing surface could be made. Good Luck!
    William Barrett

  13. Danie Boshoff

    Hi doc. i had both my hips replaced a year apart after my first hip replacement every thing was fine.A year later i had my left hip replacement,the following year my prostesis started to squeek and it broke “ceramic” they replaced it two weeks later the same prostesis broke again,ended up at a nother surgeon he replaced the existing one with a titanium one the noise is gone.My left hip started to squeek about 2 weeks ago and the noise is getting louder i did went for some xrays and also there was nothing wrong the next step was a bone density test shown that the pen in my femar shows a red dot at the tip of the pen do i have to stress about it????
    I live in South Africa i had my first hip replacement at the age of 32yr’s old 6years ago any comment plse.Does this mean a nothe surgery ????

  14. Pauline Cozort

    I had both hips replaced 9 yrs. ago. During the first year my rt. hip “popped” out causing so much pain I couldn’t walk or sit. After 10 min. or so I had to try to sit down and it popped back in. That hasn’t happened since, but the same hip has popped out slightly many times and slid back in. I have recently lost 70 lbs. and have started walking briskly for exercise. I hear popping in my rt. hip with every step I take. I do not hear it when walking normally. I do not have any pain. Does this mean my hip is wearing out? Should I see my Dr. about this?

  15. Dr. William Barrett

    Dear Pauline,
    You should definitly see an orthopedic surgeon and have your hip examined and get an xray. These symptoms can mean many things and they are important to check out.
    William Barrett