title: Review on squeaking hips.
abstract: Squeaking is a well-recognized complication for hard-on-hard bearings. The nature of squeaking is not yet completely understood however it is considered a multifactorial phenomenon. Patient, implant, and surgical factors play a role in squeaking. It is believed that mechanisms damaging the fluid film lubrication in which these bearings function optimally have a critical role. Such mechanisms include edge loading, stripe wear, impingement, third body particles and ceramic fracture. The resonance of metallic parts can produce noise in the human audible range hence the implant metallurgic composition and design may play a role. Implant positioning can facilitate impingement and edge loading enhancing the occurrence of squeaking. The recent introduction of large heads (> 36 mm) 4(th) generation ceramic-on-ceramic bearing may accentuate the conditions facilitating noise formation; however the current literature is insufficient. Clinically, squeaking may manifest in extreme hip positions or during normal gait cycle however it is rarely associated with pain. Evaluations of patients with squeaking include clinical and radiographic assessments. Computer tomography is recommended as it can better reveal ceramic breakage and implant malposition. The treatments for most squeaking patients include reassurance and activity modification. However for some, noise can be a problem, requiring further surgical intervention. In the occurrence of ceramic fracture, implant failure, extreme components malposition, instability and impingement, surgery should be advised. This review will aim to discuss the current literature regarding squeaking.
authors.affiliation: Yadin David Levy, Selin Munir, William Lindsay Walter, Specialist Orthopaedic Group, Mater Clinic, Sydney, NSW 2065, Australia.
authors.forename: Yadin David
authors.initials: YD
authors.lastname: Levy
authors.affiliation: Yadin David Levy, Selin Munir, William Lindsay Walter, Specialist Orthopaedic Group, Mater Clinic, Sydney, NSW 2065, Australia.
authors.forename: Selin
authors.initials: S
authors.lastname: Munir
authors.affiliation: Yadin David Levy, Selin Munir, William Lindsay Walter, Specialist Orthopaedic Group, Mater Clinic, Sydney, NSW 2065, Australia.
authors.forename: Shane
authors.initials: S
authors.lastname: Donohoo
authors.affiliation: Yadin David Levy, Selin Munir, William Lindsay Walter, Specialist Orthopaedic Group, Mater Clinic, Sydney, NSW 2065, Australia.
authors.forename: William Lindsay
authors.initials: WL
authors.lastname: Walter
keywords: Ceramic-on-ceramic; Edge loading; Lubrication; Metal-on-metal; Squeaking; Total hip arthroplasty