More patients are complaining of squeaky hip replacement implants. As recently as 2006, the American Association of Orthopedic Surgeons called the recently emerging hip squeaking phenomenon an “underreported medical trend that has stumped the medical community.” “As a surgeon, hearing someone walk, hearing them squeak, it’s a little unsettling,” said Dr. Andy Star, chief of orthopedics at Abington Memorial Hospital. “We are a little anxious about it and we honestly don’t know what to tell the patients.”
Other than going through a second major surgery, there are virtually no options for dealing with the squeaking that doctors are reporting among some patients who received ceramic hip replacements. Reports of noisy joints following hip replacements were very rare before 2003 when the federal Food and Drug Administration (FDA) approved the first ceramic-on-ceramic implant for total hip replacements.
According to the American Academy of Orthopaedic Surgeons, about 235,000 total hip replacements were performed in 2005. The surgery involves substituting deteriorated hip joints with plastic, metal, and ceramic materials that can either be used together or in different combinations. Ceramic has been used in joint replacement surgery since the 1970s; modern medical grade ceramic is harder and scratch-resistant and lab tests indicate it produces less wear and tear and lasts longer. Durability tends to be why total ceramic hips are popular among younger, more active patients. Currently, no medical evidence links the noise to structural problems with the parts and patients complaining of noise report no pain or other physical problems with the implants.
Noise complaints are almost exclusively reported by patients with both ceramic ball and socket combinations and a 2006 study in the Journal of Arthroplasty found 10 out of 143 patients—seven percent—who underwent total ceramic hip replacement from 2003 to 2005 developed squeaking when walking, bending, and even during sexual activity. Another 31 patients reported their new hips made other noises, such as popping and grinding. No squeaks were reported among 48 patients who received hips made of metal and plastic. And, some doctors say they’ve heard of no noise reports from patients with ceramic and plastic or metal combination implants.
Stryker Orthopaedics-manufactured Trident implants account for the majority of complaints and the FDA issued a warning to Stryker last year for manufacturing and quality problems with its ceramic hips, including squeaking. Stryker maintains its product is safe and the FDA warning and a subsequent recall involving ceramic hip parts made at an Ireland plant were not related to squeaking, which it says occurs with less than one percent of its ceramic implants.
No one seems to be able to pinpoint the source of the squeaking; however, some believe decreased lubrication in the joint, mismatch of implant parts, and extreme flexing of the implants may be to blame. Doctors who’ve removed the ceramic implants report evidence of accelerated wear, but durability tests do not indicate pending joint failure.
One study suggests that squeaking occurring when patients bend forward could be managed with different bending techniques. For those who experience squeaking from walking, it seems a second surgery is the only option.
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