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

Area of Science:

• Orthopedic Surgery
• Biomaterials Science
• Medical Device Technology

Background:

• Ceramic-on-ceramic (CoC) bearings offer the lowest wear rates in total hip arthroplasty (THA).
• Postoperative squeaking remains a concern with CoC THA, particularly with fourth-generation implants.
• Long-term follow-up data on squeaking in fourth-generation CoC THA are limited.

Purpose of the Study:

• To determine the incidence and timing of squeaking in fourth-generation CoC THA after 10 years.
• To analyze the characteristics, association with hip function, and predictive factors of squeaking.
• To develop a nomogram for assessing a patient's risk of experiencing squeaking.

Main Methods:

• Analysis of 726 patients who received primary fourth-generation CoC THA, with a mean follow-up of 11 years.
• Utilized institutional database records and a newly developed questionnaire to assess squeaking.
• Compared hip function using Harris Hip Score and WOMAC score; developed a predictive nomogram using multivariate analysis.

Main Results:

• At 10 years, 16% of patients reported squeaking, with peaks at 0-1 and 8-10 years post-THA.
• Squeaking did not significantly impact Harris Hip Score or WOMAC scores.
• Factors associated with increased squeaking risk included younger age (<46 years), male sex, limited hip range of motion (<50°), and the Corail hip implant.

Conclusions:

• Squeaking is a potential late complication of fourth-generation CoC THA, possibly linked to increased stripe wear.
• A developed nomogram effectively identifies patients at higher risk for squeaking (AUC 77%).
• Surgeons should utilize the nomogram for shared decision-making regarding bearing selection in high-risk patients.