Prevalence of articular noise in ceramic-on-ceramic total hip arthroplasty with short stems

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Purpose: To determine: (1) the prevalence of articular noise in primary ceramic-on-ceramic (CoC) total hip arthroplasty (THA) using 2 different designs of short uncemented stems; (2) risk factors for noise; and (3) the impact of noise on quality of life (QoL), at a minimum follow-up of 5 years. Methods: 70 patients (81 hips) that underwent primary CoC THA with either SMS or Minimax stems (Medacta, Switzerland) between 01 February 2015 and 31 December 2017 were retrospectively reviewed. Clinical assessment included Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), modified Harris Hip Score (mHHS), and a questionnaire on articular noise. Regression analyses were performed to find associations with articular noise. Results: 64 patients (74 hips; 40 SMS, 34 Minimax) were available for clinical assessment at ⩾5 years. There were no significant differences between the SMS and Minimax groups in terms of postoperative WOMAC (93.5 ± 6.7 vs. 90.9 ± 11.8, p = 0.746) and mHHS (94.9 ± 12.7 vs. 95.7 ± 9.7, p = 0.641). The prevalence of articular noise was 23% (9 hips) in the SMS group and 24% (8 hips) in the Minimax group ( p = 1.000). Regression analyses revealed that presence of noise was associated with preoperative WOMAC (OR 1.05; 95% CI, 1.01–1.10; p = 0.023), and tended to be associated with age (OR 0.96; 95%CI, 0.91–1.00; p = 0.060), cup diameter of 58–60 mm (OR 4.43; 95% CI, 0.86–23.44; p = 0.070), and head diameter of 36 mm (OR, 5.29; 95% CI, 0.86–38.10; p = 0.080). Impact of noise on QoL was low for both groups (1.0 ± 1.4 vs. 1.3 ± 2.2, p = 0.862). Conclusions: The present study on primary CoC THA reported an overall prevalence of articular noise of 24% for 2 designs of short stems. Clinical outcomes and satisfaction rates were high for most patients, with noise having little impact on QoL and no noise-related clinical complications being observed. Risk factors for articular noise may be better preoperative WOMAC, younger age, and larger femoral head and cup diameter.

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