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.