Review Question - QID 4756

The clinical presentation is consistent for prosthesis squeaking following a THA. Squeaking is multifactorial and may include impingement, edge-loading, loss of fluid film lubrication, and third-body particles. Subclinical infection does not play a role in squeaking.

Squeaking is defined as a high-pitched, audible sound occurring during movement of the hip. In ceramic-on-ceramic (COC) hips, the incidence is 0.5-10%. The incidence of revision because of squeaking is 0.5%. Squeaking is less common in metal-on-metal bearing surfaces (4-5%).

Chevilotte et al. reviewed COC bearing surfaces. They found that without lubrication, squeaking occurred with normal gait, high load, stripe wear, material transfer, edge wear and microfractures. In contrast, with lubrication, squeaking only occurred with material transfer.

Finkbone et al. reviewed COC total hip arthroplasty in patients <20-years-old after 52-month (average) follow-up. They found that survival rate was 96% with 1 revision for a loose acetabular component (failure of bone ingrowth). They found no cases of osteolysis, which can theoretically occur because of stripe wear, or femoral neck-on-liner impingement.

Walter et al. reviewed squeaking hips. They found that this phenomenon is associated with (1) walking, bending, rising (cyclical gait movements or extreme flexion), (2) maloriented acetabular components, (3) impingement, (4) third-body particles, (5) edge loading, (6) loss of fluid film lubrication and (7) thin, flexible (titanium) stem.

The video shows squeaking of a left total hip arthroplasty during hip extension from a flexed position. This is consistent with edge loading. Illustration A shows superior edge loading in the walking position. The arrow represents the loading force. The superolateral edge of the liner is in contact with the superior surface of the head. The dark area (area of edge loading) is anteverted with respect to a line of latitude (dark line) on the head. Illustration B shows posterior edge loading in the bending position. The arrow represents the loading force. The posterior edge of the liner is in contact with the superior surface of the head. The shaded area represents the area of edge loading and the dark stripe indicates wear on the femoral head.

Incorrect Answers:
Answers 1,2,3,4: Impingement, edge-loading, loss of fluid film lubrication and third-body particles contribute to squeaking.