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Noises Emanating From The Components In Total Joint Replacement

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boivette

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Noises Emanating From The Components In Total Joint Replacement

By B. Sonny Bal MD, MBA, Ian Clarke, PhD, Jonathan Garino, MD and Raj K. Sinha, MD, PhD

Total Joint Replacement has become one of the most successful operations in the World. The excellent results and the widespread availability of the surgery have convinced many potential patients to no longer wait and submit themselves to the operation rather than endure years of pain and limited activity. This trend is expanding the patient base to the category of patients referred to as “younger, active and heavy” and bringing new challenges and in some cases unanticipated demands to the Total Hip Systems in use today. One of these is the issue of noises which are generated under certain conditions by the implants used in these operations. The Orthopedic Implant Companies, independent researchers, health care institutions and others are working together in order to better understand this complex issue as well as to keep you informed of their findings and how they may affect you.

The cause of this condition is related to many factors some of which are related to you such as: weight, height, activity level, muscle tone and others. There are also surgical related issues such as surgical approach, placement of the implants within the bony structure, rehabilitation regime, etc. And finally there are implant selection factors which can influence the frequency of occurrence of this condition.

In the sections that follow we have tried to provide you with some helpful information which we hope will be of assistance if you develop this condition:

  • There are some noises related to the position of your implants in your hip.
These are generally related to some sort of contact between the implants as the patient moves. Several types of noises can result such as squeaking, scratching, mumbling or other such noise. It can occur due to metal on metal and metal on ceramic contact and is likely to result from movements that test the extreme range of motion of the system such as when you are squatting. This type of noise is predictable and can be duplicated easily. Generally, the noise will not go away quickly and may require your physician to perform an evaluation in order to make sure that the components are in proper position and stable.​
  • There can be some clunking, popping and clicking noises in the first few months after surgery.
Clunking, popping and clicking noises tend to be caused by a temporary separation of the ball and the socket in the total hip replacement. It can be created as part of the surgical exposure and its accompanying trauma to the local muscles and the encapsulating tissues of the hip. Stretching, cutting, separating and or other types of necessary surgical trauma to the tissues that provide stability to the joint can temporarily create looseness in the articulation. In addition muscle tone may be less than ideal because of the badly trained muscles of the preoperative condition and all the fluid around the newly placed joint. The noises created under this type of conditions generally are painless and can subside once the capsule and muscles around the hip are fully healed. It occurs in the first few months after surgery and typically disappears progressively.
If this condition persists after 6 months or so, will not improve or has become painful it is important to consult your surgeon as it may indicate other conditions that may require his intervention or additional treatment.​
  • Noises such as crunching, grinding, popping and sanding sometimes are also accompanied by pain.
While this is a very rare occurrence these types of noises and the accompanying severe pain may indicate a serious problem with the total hip components. The noises can be related to a disassembly of the modular components, fragments of bone and or the components themselves in the articulating surface, fracture of the components and/or a combination of these. Noises of this type can indicate a serious condition and should be urgently discussed with your doctor who may require you to have a more complete examination.​
  • Some noises are related to lack of lubrication in the articulation due to rigorous activity.
Noises related to repetitive activity, vigorous activity and/or extended standing can produce high pitch and squeaking noises due to a temporary lack of lubrication in the articulating surface. The sound can be similar to a non-lubricated creaking hinge of a door. It can start when the patient has an increase or change in activity level. Repeated stair climbing may generate or increase the noise (possible noise provoking activities are: mountain climbing, mountain walking, chopping wood, etc.). The duration of the noise is variable and generally occurs as an isolated instance. A duplication of the same conditions may or may not recreate the noise. The noise is generally temporary and usually does not require further action on the part of the patient.​
  • And some noises that do not fit into the four previous categories.
All four previous categories of noises are clearly related to specific activity, specific conditions, and or a combination of these. It is unfortunate that we do not have enough information at this point in time that allows us to identify those types of noises that do not fit into any of the previously mentioned categories.​
Conclusions drawn from current experience:

The benefits of undergoing hip replacement surgery are plentiful and have the ability to return you to a much more active and painless lifestyle. Total Hip Replacement Surgery has been proven to be one of the most effective surgical procedures in the world. As a result of this more than 1,000,000 such surgeries are performed annually around the world. However, as with any major surgery there are some possible complications. Noise generation is one of these and while it is a highly uncommon occurrence it can be a concern.

We hope that this information and our current findings on this condition will be of assistance to you. Our organization plans to regularly update information on this issue as it becomes available in the future.
 
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