Hip Replacement Squeaking: Causes & When to Contact Your Surgeon

Squeaking Is Not Normal

A well-functioning total hip arthroplasty (THA) should be silent. Audible squeaking, clicking, or grinding warrants evaluation.

Potential Causes

• Bearing surface interaction: Ceramic-on-ceramic (CoC) most associated with squeaking (1–10%); ceramic-on-polyethylene, metal-on-polyethylene less so.
• Component malposition: Excessive acetabular inclination/anteversion → edge loading, stripe wear.
• Insufficient lubrication: Loss of fluid film (starvation) in CoC — dehydration, synovial fluid changes.
• Third-body particles: Bone cement, metal debris, ceramic fracture fragments.
• Impingement: Neck-cup or liner-cup contact at extremes of motion.
• Loosening / instability: Micromotion at taper or bone-implant interface.

When to Seek Evaluation

• Any new, persistent, or worsening noise.
• Associated pain, instability, reduced ROM, swelling.
• Even if asymptomatic — baseline documentation helps track progression.

Workup

1. History: Onset, triggers, activity correlation.
2. Exam: Gait, ROM, impingement signs, neurovascular.
3. X-rays (AP pelvis, lateral hip, cross-table): Component position, osteolysis, loosening signs.
4. Advanced: CT/MRI (metal artifact reduction), ultrasound (fluid collection), serum metal ions (if metal bearing).

Management

• Observation: If asymptomatic, well-positioned, stable — monitor q6–12mo.
• Activity modification: Avoid extreme flexion/rotation.
• Revision surgery: For painful squeaking, malposition, loosening, ceramic fracture, adverse local tissue reaction (ALTR). Bearing exchange (to CoP or MoP) often resolves squeaking.

Don't ignore a squeaky hip. Early assessment preserves revision options and outcomes.