title: Ceramic liner fractures presenting as squeaking after primary total hip arthroplasty.
abstract: BACKGROUND
  Squeaking after ceramic-on-ceramic total hip arthroplasty is a relatively uncommon phenomenon. It usually does not require treatment in the absence of pain, mechanical symptoms, and/or relentless squeaking. The purpose of this investigation was to report on four patients who presented with hip pain and squeaking due to fractured ceramic liners after ceramic-on-ceramic total hip arthroplasty.
  
  
  METHODS
  Four patients with painful squeaking after ceramic-on-ceramic total hip arthroplasty were seen at our institution. One patient had a revision for suspected loosening and excessive anteversion of the cup noted on radiographs and magnetic resonance imaging (MRI). The remaining three patients had a revision for audible squeaking with progressive pain.
  
  
  RESULTS
  Intraoperatively, the ceramic liners of all four patients were fractured.
  
  
  CONCLUSIONS
  Squeaking after ceramic-on-ceramic total hip arthroplasty rarely is a functional issue. However, painful squeaking without notable trauma may indicate fracture of the ceramic liner. Painful squeaking is difficult to evaluate by conventional imaging. When painful squeaking occurs, exploration via surgical revision is recommended in selected patients, as ceramic liner fractures may go unnoticed on radiographs and/or MRI and thus their actual prevalence may be higher than estimated.
authors.affiliation: Adult Reconstruction and Joint Replacement Division (M.P.A., T.J.H., D.J.M., E.P.S., P.M.P., and D.E.P.) and Department of Biomechanics (M.E.E. and T.M.W.), Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021. E-mail address for D.E. Pa.
authors.forename: Matthew P
authors.initials: MP
authors.lastname: Abdel
authors.affiliation: Adult Reconstruction and Joint Replacement Division (M.P.A., T.J.H., D.J.M., E.P.S., P.M.P., and D.E.P.) and Department of Biomechanics (M.E.E. and T.M.W.), Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021. E-mail address for D.E. Pa.
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Heyse
authors.affiliation: Adult Reconstruction and Joint Replacement Division (M.P.A., T.J.H., D.J.M., E.P.S., P.M.P., and D.E.P.) and Department of Biomechanics (M.E.E. and T.M.W.), Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021. E-mail address for D.E. Pa.
authors.forename: Marcella E
authors.initials: ME
authors.lastname: Elpers
authors.affiliation: Adult Reconstruction and Joint Replacement Division (M.P.A., T.J.H., D.J.M., E.P.S., P.M.P., and D.E.P.) and Department of Biomechanics (M.E.E. and T.M.W.), Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021. E-mail address for D.E. Pa.
authors.forename: David J
authors.initials: DJ
authors.lastname: Mayman
authors.affiliation: Adult Reconstruction and Joint Replacement Division (M.P.A., T.J.H., D.J.M., E.P.S., P.M.P., and D.E.P.) and Department of Biomechanics (M.E.E. and T.M.W.), Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021. E-mail address for D.E. Pa.
authors.forename: Edwin P
authors.initials: EP
authors.lastname: Su
authors.affiliation: Adult Reconstruction and Joint Replacement Division (M.P.A., T.J.H., D.J.M., E.P.S., P.M.P., and D.E.P.) and Department of Biomechanics (M.E.E. and T.M.W.), Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021. E-mail address for D.E. Pa.
authors.forename: Paul M
authors.initials: PM
authors.lastname: Pellicci
authors.affiliation: Adult Reconstruction and Joint Replacement Division (M.P.A., T.J.H., D.J.M., E.P.S., P.M.P., and D.E.P.) and Department of Biomechanics (M.E.E. and T.M.W.), Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021. E-mail address for D.E. Pa.
authors.forename: Timothy M
authors.initials: TM
authors.lastname: Wright
authors.affiliation: Adult Reconstruction and Joint Replacement Division (M.P.A., T.J.H., D.J.M., E.P.S., P.M.P., and D.E.P.) and Department of Biomechanics (M.E.E. and T.M.W.), Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021. E-mail address for D.E. Pa.
authors.forename: Douglas E
authors.initials: DE
authors.lastname: Padgett
mesh_terms: D000328:Adult; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects*; D002516:Ceramics; D019544:Equipment Failure Analysis; D005260:Female; D006622:Hip Prosthesis / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009622:Noise; D010149:Postoperative Pain / Q000209:etiology*; D012086:Reoperation