Arthroscopic evaluation and treatment of a squeaking hip. A case report
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(2020) 21:805
CASE REPORT
Open Access
Arthroscopic evaluation and treatment of a squeaking hip. A case report Jonathan Bellity1, Marc Elkaïm1, Didier Hannouche1,2*
and Rémy Nizard1
Abstract Background: Squeaking of ceramic-on-ceramic total hip arthroplasty is an unexpected complication which occurs in 1- 30% of patients. Revision surgery is required in 0.2% of the cases, when a ceramic fracture is suspected, or in case of severe malposition of the implants, subluxation, or impingement. Hip arthroscopy may be a useful diagnostic and therapeutic option in squeaking hips. Case presentation: A patient presenting with a pain-free squeaking underwent hip arthroscopy to examine the sliding surfaces and the rim of the acetabulum, and to search for signs of impingement. Thorough lavage and debridement of hip synovitis and fibrous tissue was performed. The squeaking noise immediately disappeared after the surgery. The patient was allowed to fully weight bear as tolerated with 2 crutches for 2 weeks. Two years after the arthroscopy, the patient remained symptom-free. Conclusions: The potential reasons for hip squeaking in our patient are discussed. Hip arthroscopy may prove useful as a diagnostic and therapeutic option for some patients presenting with a squeaking ceramic-on ceramic hip replacement. Keywords: Hip, Ceramic, Hip arthroplasty, Squeaking, Arthroscopy
Background Due to outstanding tribological properties, the ceramicon-ceramic (C–C) couple has been accepted as a reliable bearing surface in Total Hip Arthroplasty (THA), especially in young and active patients [1]. However, with the increasing number of C–C prostheses implanted, two complications arose in patients treated with these bearings: fractures of the ceramic and squeaking [2]. Squeaking is a very annoying sound similar to the creaking of a door hinge that occurs during movement of the hip joint. The reported incidence of squeaking varies considerably (from 1 to 30%), and increases in studies where it is enquired specifically. Using the same implant, the incidence of squeaking increased from 3.5% when it was * Correspondence: [email protected] 1 Department of Orthopaedic Surgery, Lariboisière, Hospital, Paris 7 University, Paris, France 2 Department of Orthopaedic Surgery, Geneva University Hospitals & Faculty of Medicine, Avenue Gabrielle Perret Gentil 4, 1205 Geneva, Switzerland
self-reported [3] to 23% when the patients were specifically questioned on noise occurrence [4]. Squeaking is likely to be multifactorial and different hypotheses have been considered to explain this phenomenon, including component positioning, excessive hip range of motion, and larger diameter sizes [4]. It is usually transitory, reproducible only in extreme flexion, and does not influence patients’ satisfaction and outcomes, although patients with non-noisy hips are 1.7 times more likely to report a forgotten joint [5]. Sometimes, it is more permanent and very embarrassing for the patient, occurring also during normal gait. Revision surgery is required in less than
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