Age, activity, and native femoral offset are associated with articular noise in ceramic on ceramic total hip arthroplasty (THA) with custom stems

To report the prevalence of articular noise following total hip arthroplasty (THA) with custom stems and ceramic-on-ceramic (CoC) bearings, to determine the risk factors for articular noise, and the effect of articular noise on quality of life (QoL).

A consecutive series of uncemented primary THAs using custom stems implanted between 01/02/ 2014-01/04/2017 were evaluated. The cohort comprised 479 patients (529 hips, 301 males and 228 females), aged 55.9 ± 11.6 with a BMI of 25.8 ± 4.3 kg/m². Postoperative assessment included Oxford hip score (OHS), forgotten joint score (FJS), and a dedicated questionnaire on articular noise. Descriptive statistics were used to summarise the data. Regression analyses were performed to study factors associated with presence of noise.

At a minimum follow-up of five years, 431 patients (476 hips) were available for postoperative assessment. OHS was 45.3 ± 6.1, FJS was 83.6 ± 24.7, and 69 patients (71 hips, 15%) reported articular noise. The impact of noise on QoL was 1.4 ± 2.1. Multivariable analyses confirmed that the presence of articular noise was associated with younger age (OR,0.95; 95%CI,0.93-0.97; p < 0.001), smaller native femoral offset (OR, 0.95; 95%CI,0.90-1.00;p = 0.034), as well as intense (OR, 3.15; 95%CI, 1.15-9.79; p = 0.033) and very intense physical activity (OR, 4.71; 95%CI, 1.52-16.15; p = 0.009).

The prevalence of articular noise following primary THA with custom stems and CoC bearings was 15%, but the impact of noise on QoL was minimal for most patients. Younger, highly active patients should be advised of an increased likelihood of noise from CoC THA, particularly if they have low native femoral offset on preoperative imaging.