ORIGINAL ARTICLE The natural history of ceramic-on-ceramic prosthetic hip squeak and its impact on patients David Owen • Nicholas Russell • Andrew Chia • Malcolm Thomas Received: 22 August 2012 / Accepted: 28 November 2012 Ó Springer-Verlag France 2012 Abstract Background Ceramic-on-ceramic (CoC) total hip arthro- plasty (THA) has been scrutinised for a high incidence of post-operative squeak. The psychological and social con- sequences, and subsequent request for revision surgery are not well documented. Methods Seventy consecutive primary CoC THA oper- ated on by a single surgeon at a single institution were enroled and followed for an average 7.1 years. Information was obtained from routine post-operative review, medical records, mailed questionnaire and periodic phone interview. Results Of 70 THA, 69 were available for follow-up. Seventeen (24.6 %) reported at least one instance of squeak, occurring on average 34.2 months post-opera- tively. Five (7.5 %) recalled being warned preoperatively of squeak as a potential complication. Six reported infre- quent squeak and 11 frequent squeak. Ten were concerned, reporting embarrassment, harassment and anxiety regard- ing the longevity of their THA. One patient was planning revision surgery. Discussion This study demonstrates the highest published prevalence of squeaking CoC THA and highlights the importance of warning patients of this potential complication. Keywords Hip arthroplasty Ceramic-on-ceramic Squeak Revision Introduction A well-reported complication of ceramic-on-ceramic (CoC) total hip arthroplasty (THA) is the development of a squeak or sound originating from the prosthesis. This has been reported as ranging between 0.3 and 20.9 % [1, 2]. There is, however, a paucity of information on the inter- ference of hip squeak with social and psychological func- tioning as well as the level of impact that would cause patients to request revision surgery. We aimed to explore this with a specially designed questionnaire. Materials and methods Seventy consecutive primary CoC THA performed between October 2003 and June 2006 (Stryker Accolade femoral stem and Trident Acetabular cup, Stryker Ortho- paedics) in 69 patients were entered into this study. The minimum follow-up was 1.3 years due to death unrelated to THA. THA was performed for a variety of indications, by a single surgeon at a single centre by a standard posterolat- eral approach. Data were collected by review of medical records, routine post-operative review, mailed question- naire and phone interview. D. Owen Department of Orthopaedics and Trauma, The Canberra Hospital, Yamba Drive, Garran, ACT 2605, Australia N. Russell (&) Department of Orthopaedics and Trauma, Royal Adelaide Hospital, North Terrace, Adelaide, SA 5000, Australia e-mail: ncrussell@gmail.com A. Chia Department of Orthopaedics, The Alfred Hospital, 55 Commercial Road, St. Kilda, VIC 3181, Australia M. Thomas Department of Orthopaedics, Latrobe Regional Hospital, Princess Highway, Traralgon, VIC 3844, Australia 123 Eur J Orthop Surg Traumatol DOI 10.1007/s00590-012-1142-5