I am a Catholic priest with a strange problem. Every time I kneel down and get back up, my hip replacement squeaks. And it’s loud enough to be heard by every one at Mass. What can I do about this?

You are not alone though your situation is certainly unique. The problem of squeaking hips after joint replacement has increased in the last 10 years with the increased use of hard-on-hard bearings.

What do we mean by hard-on-hard bearings? The two main parts of the hip that are replaced include the round head at the top of the femur (thigh bone) and the cup-shaped hip socket.

The materials used for these component parts can be ceramic-on-ceramic, metal-on-metal, or metal-on-polyethylene (plastic). Metal-on-metal and ceramic-on-ceramic are the hard-on-hard bearings. Ceramic-on-polyethylene and metal-on-polyethylene are considered hard-on-soft bearings.

It appears that there are three main factors involved and usually more than one reason for the squeaking. Patient factors such as body size and mass (larger), height (taller), and activity (hip flexion) may be part of the problem.

There’s not much a person can do about their height to change the squeaking. But they can be advised to avoid activities or movements that cause the squeaking. That’s a bit tricky for a priest who must genuflect (bend on one knee down and up) or kneel repeatedly.

Whenever possible, replace kneeling with bowing. When genuflecting is required, try using the other leg as the bending side. And if possible, find the range-of-motion that is squeak-free and stay within that range. This may mean you don’t go down as far when genuflecting.

Sometimes, it’s not the patient at all but rather the way the implant was placed in the hip. The wrong angle, a slight twist of the cup (socket) piece, or a little bit of both has been linked with squeaking.

But the most likely factor is the implant itself and in particular, the materials it is made of. The newer implants made of titanium alloy are more flexible and less stiff. This feature could increase the vibrational force that creates friction and squeaking. Other contributing factors include loss of fluid lubricating the hip, tiny particles of metal or other debris from the implant, or damage to the surface of the implant.

See your surgeon, if you are unable to find ways to avoid the squeaking. A simple revision surgery may be all that’s needed. Replacing the liner or altering soft tissue tension could make all the difference.