A Nomogram That Characterizes a Patient’s Odds of Developing Squeaking After Fourth-generation Ceramic-on-ceramic THA

Abstract

Background Although ceramic-on-ceramic (CoC) bearings result in the lowest wear rate of any bearing combination, postoperative squeaking remains worrisome. However, data concerning squeaking in long-term follow-up studies are still lacking, especially for fourth-generation CoC THA. Questions/purposes (1) After keeping the prosthesis in place for 10 years, what percentage of patients treated with fourth-generation CoC THA implants report squeaking, and are there points in time when squeaking occurs more frequently? (2) What are the characteristics, association with hip function, and factors associated with squeaking? (3) Can we create a nomogram that characterizes a patient's odds of experiencing squeaking based on the factors associated with it? Methods Between January 2009 and December 2011, 1050 patients received primary THAs at our institution, 97% (1017) of whom received fourth-generation CoC THAs because this was the preferred bearing during this period. Of the 1017 eligible patients, 5% (54) underwent THAs performed by low-volume surgeons, 3% (30) were implanted with cemented prostheses, 2% (22) died, 1%One author (JF) has received funding from the National Natural Science Foundation of China (grant number 82102585) and Military Medical Science and Technology Youth Training Project (grant number 21QNPY110). One author (CX) has received funding from the National Natural Science Foundation of China (grant number 82002323). All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research® editors and board members are on file with the publication and can be viewed on request. Clinical Orthopaedics and Related Research® neither advocates nor endorses the use of any treatment, drug, or device. Readers are encouraged to always seek additional information, including FDA approval status, of any drug or device before clinical use. Ethical approval for this study was obtained from the ethical review board of the Chinese PLA General Hospital (No. 2021-343).

CORR Insights®: A Nomogram That Characterizes a Patient’s Odds of Developing Squeaking After Fourth-generation Ceramic-on-ceramic THA

“…In the current study, Li et al [6] found that 16% (116 of 726) of patients reported squeaking over the 10-year study, with demographic peaks occurring in the first year after surgery and between 8 and 10 years afterward; of those who had squeaking, 42% (36 of 86) reported it frequently. The authors also developed and shared a useful nomogram that can help clinicians identify patients at a higher risk of experiencing squeaking based on factors like age, ROM, and implant offset.…”

Letter to the Editor: A Nomogram That Characterizes a Patient’s Odds of Developing Squeaking After Fourth-generation Ceramic-on-ceramic THA

“…We read with great interest the publication by Li et al, “A Nomogram That Characterizes a Patient’s Odds of Developing Squeaking After Fourth-generation Ceramic-on-ceramic THA” [6]. The authors found that squeaking is a potential late complication after fourth-generation ceramic-on-ceramic (CoC) THA, and they recommend using a nomogram to assess patients’ risk of developing this problem.…”

“…The combination of high acetabular component inclination (>55°) and high anteversion (>25°) seemed to result in increased wear and an increased risk of anterior-superior edge loading. Orientation of the cup and stem with other nomogram parameters may be responsible for the first peak of squeaking; however, for patients who develop late squeaking (the second demographic peak, which accounted for 48% of patients who developed this problem, according to the CORR ® paper [6]), the mechanism is unclear. Stripe wear and edge loading are possible mechanisms for late squeaking.…”

“…Time-dependent changes to edge loading caused by chronological changes of pelvic sagittal tilt may be relevant for late squeaking, but this is speculative. The current study’s squeaking group was relatively young at the time of surgery, but half of the patients in the squeaking group had etiological factors (such as ankylosing spondylitis or developmental hip dysplasia) that may increase the future risk of further posterior pelvic sagittal tilt [6]. Further longitudinal studies are necessary to clarify late squeaking mechanisms that may include time-dependent changes of pelvic sagittal tilt, which may influence edge loading.…”