High prevalence of noise following Delta ceramic-on-ceramic total hip arthroplasty

Bone Joint J. 2017 Jan;99-B(1):44-50. doi: 10.1302/0301-620X.99B1.37612.


Aims: We evaluated the short-term functional outcome and prevalence of bearing-specific generation of audible noise in 301 patients (336 hips) operated on with fourth generation (Delta) medium diameter head, ceramic-on-ceramic (CoC) total hip arthroplasties (THAs).

Patients and methods: There were 191 female (63%) and 110 male patients (37%) with a mean age of 61 years (29 to 78) and mean follow-up of 2.1 years (1.3 to 3.4). Patients completed three questionnaires: Oxford Hip Score (OHS), Research and Development 36-item health survey (RAND-36) and a noise-specific symptom questionnaire. Plain radiographs were also analysed. A total of three hips (0.9%) were revised.

Results: There were 52 patients (54 hips, 17%) who reported noise, and in 25 (48%) of them the noise was frequently heard. In the multiple regression analysis, the only independent risk factor for noise was a specific THA brand, with a threefold increased risk (95% confidence intervals 1.39 to 6.45, p = 0.005) of noise compared with the reference THA brand. Patients with noisy hips had lower median OHS (43 versus 46.5, p = 0.002) and their physical functioning (p = 0.021) subscale in RAND-36 was reduced.

Conclusion: Noise was surprisingly common in this population. Cite this article: Bone Joint J 2017;99-B:44-50.

Keywords: Ceramic-on-ceramic; Delta; Noise; Squeaking; Total hip arthroplasty.

Publication types

  • Evaluation Study

MeSH terms

  • Adult
  • Aged
  • Arthroplasty, Replacement, Hip / adverse effects*
  • Arthroplasty, Replacement, Hip / instrumentation
  • Ceramics*
  • Female
  • Follow-Up Studies
  • Hip Prosthesis*
  • Humans
  • Male
  • Middle Aged
  • Noise*
  • Osteoarthritis, Hip / diagnostic imaging
  • Osteoarthritis, Hip / surgery
  • Periprosthetic Fractures / etiology
  • Periprosthetic Fractures / surgery
  • Prosthesis Design
  • Prosthesis Failure / adverse effects
  • Prosthesis-Related Infections / etiology
  • Prosthesis-Related Infections / surgery
  • Reoperation