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I'm a little embarrassed to ask this question. But have you ever heard of a hip replacement squeaking during sexual intercourse? I don't notice it at any other time. It's very annoying. What can be done about it?

You are not alone with this problem. In a recent survey of 149 patients with a THR, about one in 10 reported a squeaking hip. In that group, the sound was most noticeable when the patients were bending, walking, using the stairs, and during sexual activity. There are many theories about what can cause this to happen. The best way to find out for sure is to remove the implant and take a look at what's going on. But this isn't always possible. The most common effect is seen as a broad stripe of wear on the femoral head. The wear pattern on implants removed and examined also show signs of impingement (pinching) of the femoral neck. The pinching occurs where the femoral neck meets the rim of the acetabulum (socket). Further testing with an electron microscope showed metal debris along the area of wear. Rim impingement is probably the number one cause of hip squeaking. But there isn't just one cause of impingement. Besides socket malposition, there could be a loss of fluid film lubricating the joint. Some patients have lax (loose) ligaments that can lead to impingement. There's been some suggestion that an incomplete seal around the socket liner could cause squeaking. Some studies have shown that thicker sockets don't squeak but thin ones do. It's possible that the thinner sockets deform when they are put in place. Incomplete positioning of the liner may be the problem there. Whatever the cause, there does not seem to be a way to stop it without removing the implant and revising the hip replacement. This may mean replacing part or all of the components. It's important to match the socket with the right stem. The difference in resonance between the two parts can be enough to cause friction that creates vibration and then squeaking. Adding this variable to a patient with malpositioned components increases the risk of squeaking. Position and placement of the socket is important in preventing these wear patterns.

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