The incidence of noise with a new ceramic-on-ceramic bearing in hip replacement : a prospective multicenter analysis of 142 hips


hip arthroplasty ; ceramic ; noise ; alumina toughened zirconia ; Melbourne Orthopaedic Noise Assessment (MONA)

Published online: Oct 08 2021

Thomas Ilchmann, Milan Jovanovic, Thomas-Peter Ranke, Martin Clauss

From the Kantonsspital Baselland, Switzerland


Ceramic-on-ceramic (CoC) bearings are a promising option in hip replacement to avoid wear and permit the use of larger head sizes. Ceramic fracture and noise are the main points of concern. The aim of this study was to evaluate ceramic-related complications and the incidence of noise of a new alumina-toughened zirconia (ATZ) ceramic.

ATZ ceramic was assessed in a multicentre prospective observational study. It included 135 patients (142 hips) who had received THA using an ATZ CoC bearing. The mean follow-up time was 60.6 months. Clinical data and adverse events were documented, and a noise-specific questionnaire (Melbourne Orthopaedic Noise Assessment [MONA]) was used at final follow- up.

There were no ceramic fractures and no dislocations. Clinical results were satisfactory and comparable to published data. In 19 hips (13.4%), noise was recorded in the MONA questionnaire. In 7 of these 19 hips, the noise was perceived at early follow-up and disappeared later. The most frequent noise was squeaking (9 hips). No patient required revision due to noise.

The use of the new ceramic was safe, but the development of noise remained the main disadvantage. CoC with modern ceramic is an option as a bearing surface for the young and active patient.