The noisy ceramic hip: is component malpositioning the cause?

Noisy ceramics bearing surfaces are a recently recognized problem in total hip arthroplasty. Component malposition as a potential cause has been proposed. Squeaking occurred in 28 (2.7%) of 999 patients undergoing ceramic on ceramic total hip arthroplasty at our institution. Patients were matched, in a 1:2 ratio by anthropometric and demographic variables and also prosthesis size and type. The acetabular position was measured using radiographs and computed tomography. There was no statistically significant difference in cup inclination (P = .25) or version (P = .38) between groups. Four hips that have been revised were available for retrieval analysis. Stripe wear and metal transfer to ceramic components were observed. Etiology of squeaking ceramic total hip arthroplasty remains elusive. Although malposition could be an important contributing factor, the latter cannot be the sole reason based on our findings. Further investigation to elucidate the etiology is warranted.