Aluminia ceramic on ceramic (COC) bearing surfaces have been used for 35 years in total hip arthroplasty (THA). Studies report 85% survival at a minimum follow-up of 18.5 years. Nonetheless, an audible noise is a finding associated with COC bearings with incidence rates of 2–10%. This study aims to determine the prevalence of noise and evaluate its effect on patients.

All patients who had a COC THA from August 2003 to December 2010 were contacted and asked to complete a standardised questionnaire. This asked about the presence and characteristics of a noise and if associated with activities, pain and whether this phenomenon should be mentioned preoperatively.

Four consultant surgeons performed 282 consecutive primary COC THAs in 258 patients. (Male=122, Female=136 mean age 68.5; age range 28–88). In all cases, the same brand of ceramic acetabular component and stems were implanted. 11.0% had a noise, of which 5.5% had a squeak. Pain was experienced in 38.7% of patients in hips that made a noise. There was no trauma and one dislocation in this group. In this study, 85% of noises occur during weight-bearing although no patients have reduced daily activities as a result of the noises. Of all the patients, 55.0% stated they would have preferred to have known about a noisy hip possibility before consenting but none would have refused consent.

Squeaking has not been a problem here despite the prevalence being higher than most in the literature. The authors recommend that squeaking should be discussed preoperatively. A checklist for Orthopaedic Trainees is being drafted to enable trainees to counsel patients appropriately, allowing patients a better opportunity to give informed consent.