I have an unusual situation. I'm only 23 years old, but because of severe hip dysplasia, I had to have a hip replacement. Because of my age, the ceramic-on-ceramic type implant was recommended. I'm nine months post-op and have two problems. First, the hip squeaks and clicks. Second, it also dislocates. I'm going to be seeking advice from several orthopedic surgeons in my area, but I wanted to also ask your group what to do.
Hip dysplasia is a condition in which there is a disruption in the normal relationship between the head of the femur (thigh bone) and the acetabulum (hip socket). Usually, the acetabulum is too shallow or sloping rather than a normal cup shape. It cannot hold the femoral head in place. Hip subluxation (partial dislocation) and even full dislocation can occur.
The condition can be present at birth or develop in the early months to years of life. Conservative (nonoperative) care is possible when this condition is identified early in life. But sometimes, it's not possible to keep the femoral head in good contact with the acetabulum. Then surgery may be required.
Hip replacement is usually not the first procedure used for this problem. An open reduction is a surgical procedure used most often in children two years old or older when hip dysplasia has not been corrected. During this operation, the surgeon removes any abnormal tissues that are keeping the femoral head from fitting inside the acetabulum and cuts any tight ligaments in the joint capsule around the hip joint. The surgeon may perform a tenotomy during the surgery to cut the tightly contracted tendons or muscles in the hip area. This relaxes the tight structures around the hip joint and allows the hip to be placed in the socket.
Other more advanced procedures may be required. An operation called derotational osteotomy may be needed. In this surgical procedure, the femur is cut and rotated to make it easier to keep the femoral head inside the acetabulum. When this procedure is done, the soft tissues loosen up and the forces of the muscles tend to keep the femoral head reduced.
But when all else fails, a hip replacement may be the only way to correct the problem. Ceramic-on-ceramic bearings are used most often on young, active patients but complications such as squeaking or other noises are possible. For a while, it was thought that the ceramic implants had a very low rate of noise-making (less than one per cent). But a recent study showed that when specifically asked about this problem, up to 10 per cent of the patients who were surveyed reported noises. Squeaking was the most common, but there were reports of grinding, popping, and snapping.
Some patients aren't bothered by the noises -- or at least not enough to have a second (revision) operation. But with chronic dislocations, it may be necessary to swap out the ceramic-on-ceramic implant for one that has metal-on-polyethylene (plastic) or even a ceramic-on-polyethylene interface.
The surgeon who has been following you will probably be the best one to advise you. Given your age and the diagnosis of hip dysplasia, there are likely other complicating factors to be considered.
Christopher A. Jarrett, MD, et al. The Squeaking Hip: A Phenomenon of Ceramic-on-Ceramic Total Hip Arthroplasty. In The Journal of Bone and Joint Surgery. June 2009. Vol. 91A. No. 6. Pp. 1344-1349.
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