Conclusions Current published evidence does not support survivorship differences among commonly used bearing surfaces in patients younger than age 65 years undergoing THA at short- to mid-term followup .
Background  Total hip arthroplasty ( THA )  is increasingly being performed in patients with long life expectancies and active lifestyles .
Newer implant bearing surfaces , with superior wear characteristics , often are used in this cohort with the goal of improving longevity of the prosthesis , but comparisons across the numerous available bearing surfaces are limited , so the surgeon and patient may have difficulty deciding which implants to use .
Questions / purpose sThe purpose of this study was to answer the following question : Is there a short- to mid-term survivorship difference between common THA bearings used in patients younger than age 65 years ?
The squeaking hip: a phenomenon of ceramic-on-ceramic total hip arthroplasty.
BACKGROUND Early reports on modern  ceramic-on-ceramic total hip replacements  have demonstrated excellent clinical and radiographic results with few cases of catastrophic failure , which , in the case of earlier design s , often had been caused by implant fracture . Several reports , however , have noted the presence of audible squeaking . The purpose of the present study was to determine the incidence of squeaking in association with the use of this bearing couple . METHODS During the period from March 2003 to May 2005 , three surgeons performed 159 total hip arthroplasties in 143 patients with use of a ceramic-on-ceramic bearing . One hundred and forty-nine hips ( 131 patients ) were available for review after at least one year of follow-up . These patients were followed prospect ively with use of the modified Hospital for Special Surgery hip score and a patient-administered question naire . Additionally , a control group of sixty hips ( forty-eight patients ) with a metal-on-polyethylene bearing  was matched to the ceramic group on the basis of age , sex , and body mass index to compare the incidence of squeaking and other noises . Radiographic evaluations were performed according to previously established criteria . RESULTS Fourteen ( 10.7 % ) of 131 patients described an audible squeak during normal activities . However , squeaking was reproducible clinical ly in only four patients , and only one patient complained of squeaking before being presented with the question naire . The average Hospital for Special Surgery score improved from 19.8 preoperatively to 38.4 at the time of the latest follow-up , indicating excellent clinical results . Ninety-five percent of the patients had a satisfaction score of > or = 8 of 10 . Three hips dislocated . One of those three hips squeaked and was revised because of recurrent dislocations . One patient was considering revision because of squeaking . In the matched metal-on-polyethylene cohort , there were no cases of squeaking . CONCLUSIONS The squeaking hip is a phenomenon that is unique to total hip replacements with hard-on-hard bearings . The incidence of squeaking in association with ceramic-on-ceramic bearings may be higher than previously reported as < 1 % of the patients in the present study reported this finding before being queried . The causes and implication s of squeaking are yet to be determined . The use of hard-on-hard bearings offers many advantages in terms of wear reduction , especially for young and active patients . Nonetheless , patients considering ceramic-on-ceramic bearings should be counseled with regard to this phenomenon
Conclusions Current published evidence does not support survivorship differences among commonly used bearing surfaces in patients younger than age 65 years undergoing THA at short- to mid-term followup .
Background  Total hip arthroplasty ( THA )  is increasingly being performed in patients with long life expectancies and active lifestyles .
Newer implant bearing surfaces , with superior wear characteristics , often are used in this cohort with the goal of improving longevity of the prosthesis , but comparisons across the numerous available bearing surfaces are limited , so the surgeon and patient may have difficulty deciding which implants to use .
Questions / purpose sThe purpose of this study was to answer the following question : Is there a short- to mid-term survivorship difference between common THA bearings used in patients younger than age 65 years ?