The incidence of noise generation arising from the large-diameter Delta Motion ceramic total hip bearing

Nuffield Orthopaedic Centre, Oxford, Windmill Road, Headington, Oxford OX3 7LD, UK.
Bone and Joint Journal (Impact Factor: 1.96). 02/2013; 95-B(2):160-5. DOI: 10.1302/0301-620X.95B2.30450
Source: PubMed


Noise generation has been reported with ceramic-on-ceramic articulations in total hip replacement (THR). This study evaluated 208 consecutive Delta Motion THRs at a mean follow-up of 21 months (12 to 35). There were 141 women and 67 men with a mean age of 59 years (22 to 84). Patients were reviewed clinically and radiologically, and the incidence of noise was determined using a newly described assessment method. Noise production was examined against range of movement, ligamentous laxity, patient-reported outcome scores, activity level and orientation of the acetabular component. There were 143 silent hips (69%), 22 (11%) with noises other than squeaking, 17 (8%) with unreproducible squeaking and 26 (13%) with reproducible squeaking. Hips with reproducible squeaking had a greater mean range of movement (p < 0.001) and mean ligament laxity (p = 0.004), smaller median head size (p = 0.01) and decreased mean acetabular component inclination (p = 0.02) and anteversion angle (p = 0.02) compared with the other groups. There was no relationship between squeaking and age (p = 0.13), height (p = 0.263), weight (p = 0.333), body mass index (p = 0.643), gender (p = 0.07) or patient outcome score (p = 0.422). There were no revisions during follow-up. Despite the surprisingly high incidence of squeaking, all patients remain satisfied with their hip replacement. Cite this article: Bone Joint J 2013;95-B:160-5.

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    • "Some designs have an offset of the cup, which lateralized the head center related [3]. This last issue might have serious but currently unrecognized drawbacks: • a high risk of squeaking [2] [3]. For Tai et al. [7], this rate is independent of factors such as anteversion or inclination of the cup or demographic data but is secondary to thin insert concept for large head diameter; • an increased risk of edge loading [3] and also greater subluxation effect (with the risk of insert delamination [8]); • a risk of interruption of the lubrication film (also explaining the former complications [9]); • an increase in bearing friction coefficient [10] (even higher than in 48 mm diameter for a metal-on-metal bearing); • an increase in torsion stresses on the Morse taper that may produce a trunion wear on ceramic head [11] [12]. "

    Orthopaedics & Traumatology Surgery & Research 03/2015; 101(3). DOI:10.1016/j.otsr.2015.02.001 · 1.26 Impact Factor
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    • "Indeed recent MoM resurfacing research using AP X-rays suggests that low inclination is beneficial, particularly for small bearings.26 However, in both established8 and contemporary27 CoC bearings, a combination of low inclination and low anteversion led to high incidences of posterior edge loading wear and squeaking. This is the cup orientation at greatest risk of posterior edge loading from muscle action (Fig. 6), and so low inclination should be combined with higher anteversion to provide better coverage of the head throughout the range of motion. "
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