Incidental discovery of an undisplaced ceramic liner fracture at total hip arthroplasty revision for squeaking.

Squeaking has been reported after ceramic-on-ceramic total hip arthroplasty (THA), but its pathomechanics is not fully understood. Impaired lubrication is suspected to be the main reason. The management of patients impacted by this phenomenon is not well defined and, as it is not considered to be cause for alarm, revision is not strongly recommended. Here, we describe a ceramic insert fracture discovered during revision surgery performed to correct severe squeaking. Preoperative investigation (plain X-rays, ultrasound and computed tomography) did not reveal ceramic fracture or definite component malposition. To date, there are no other published cases of incidental discovery of a bearing component fracture during revision of ceramic-on-ceramic hip replacement due to squeaking. We believe that squeaking is not a trivial phenomenon and recommend careful management of patients suffering with this symptom.