A 54-year-old man with avascular necrosis of the femoral head undergoes total hip arthroplasty with a ceramic-on-ceramic bearing. Two years later he reports an audible squeaking from the hip on walking but has no pain and normal radiographs. What is the most appropriate initial management?
- A Reassurance and observation if the patient is asymptomatic apart from the noise ✓
- B Immediate revision to a metal-on-polyethylene bearing
- C Serial serum cobalt and chromium levels every 6 months
- D Arthroscopic synovectomy of the hip
Correct answer: A. Reassurance and observation if the patient is asymptomatic apart from the noise
Explanation
Squeaking is a recognised phenomenon of hard-on-hard ceramic bearings, attributed to stripe wear and fluid film vibration. In the absence of pain, functional limitation or radiographic change, observation is appropriate because the complication rate of revision surgery exceeds the morbidity of the noise itself. Revision is reserved for painful or functionally limiting squeaking. Cobalt-chromium monitoring applies to metal bearings, not ceramics.
Reference: Miller's Review of Orthopaedics, 8th ed.
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