Clicking noise

[tricky]

I am 3 months post op and progress seems to be normal.  I can walk, bike and have returned to the tennis court, albeit not at full speed yet.  I have noticed during my morning stretches, however, that when I do single leg lifts, I get a clicking noise in the area of the implant. It is not painful, but it doesn't occur on the non-operated side.  I don't hear anything when I am walking or am upright or riding the bicycle.  Does anybody have similar problems or theories on why this is happening?

[littleb]

Do you actually hear the click? I am a little over 3 weeks post op and I can feel it move sometimes, kind of like the sensation of cracking your knuckles but mild and silent. I am assuming that it's ligaments and capsule moving around. I know I've read here that dehydration can cause less fluid movement in the joint. Maybe give your doctor a call just to be sure.

[Pat Walter]

Many people have cluncking or clicking.  I had it for months and even at 4 years post op, I can sit and move a certain way and feel the clunk.  The muscles around the new hip resurfacing are not strong and not holding the two components tightly together - so you can hear and more often, feel the clucking as they come together.  This is very normal and many people have it.  Nothing to worry about.  Give yourself time to heal.  It takes 6 months for most healing and 1 year for most people to fully heal.  It is a long process, but you are able to be pretty active by 6 months.  Take it easy and enjoy the new hip.

Pat

[Dayton96]

Pat:

The clicking indicates metal on metal rubbing I take it?  After a period of time, does that mean the clicking slowly disappears as the metal wears down to a comfortable fit?  How many patients actually reach a point where they forget they even have an implant?

Mac

[John C]

Pat:

The clicking indicates metal on metal rubbing I take it?  After a period of time, does that mean the clicking slowly disappears as the metal wears down to a comfortable fit?  How many patients actually reach a point where they forget they even have an implant?

Mac

I don't think that it is intended for the metal to wear enough to change the fit; in the cases where it does, I think there would be serious problems with metal debris. I think that it is more a matter of the muscles and ligaments tightening up to keep the two metal parts in constant contact, along with good lubrication from getting warmed up.
I would be curious to hear a large statistical answer to your question. I know that for me, I am aware of my hip every day, as well as at night after about 3 AM. It does not hold me back, in that I am limp free, and either ski, or play tennis and windsurf every day, but I could not say that I have ever had a whole day when I was not made aware of my hip a few times during the day; not necessarily painful, just little twinges or sensations that tell you that it is not the perfect hip of a 16 year old. I would call it a success, but it has the characteristics of most old injuries that have healed. After all, it was sliced open and dislocated. I think that it would be unusual to have a car accident or a war wound that was this traumatic, and not to expect to be aware of it afterwards.
A miraculous surgery, but nonetheless a major surgery.

John

[Dayton96]

John:

If the "muscles and ligaments" are "tightening up to keep the two metal parts in constant contact," why wouldn't that result in metal debris?

Also, what did you mean when you said "along with good lubrication from getting warmed up?"

Mac

[sroberts]

You'll have increased metal ions during the first year but not metal debris. If there is debris, it's an indication of poor placement and potential for future revision. The lubrication is synovial fluid that comes back after the neck capsule heals up.



spencer

[John C]

Hi Mac,
I think that Spencer really did a better job of clarifying my thoughts than I could have, but since you asked me, I will see if I can answer without confusing what Spencer said so well.
When we say that the two parts are held "in constant contact" by healed muscles and ligaments, this is with the understanding that there is a very thin film of synovial fluid between them. This is as opposed to the two parts actually separating enough so that there is a space, that allows a clunking feeling when they come back in contact. This film layer is what allows the parts to move while still "in constant contact" without creating excessive wear. It is just like in any engine with MOM parts: You generally want the parts to be in constant contact, with a film of oil providing lubrication. For example, one of the roles of piston rings is to maintain constant contact with the cylinder walls, so that the piston is not just banging around in there. If some parts do not stay in contact, you can start hearing some banging in the engine as they lose and regain contact.
Spencer did a great job of explaining my unscientific use of the terms "metal ions", vs "metal debris". Metal ions are microscopic and something that all MOM joints will produce, hopefully at low levels. Metal debris is something that I think of as being on a larger scale, and can be seen in the surrounding tissue. Cases that show large amounts of metal debris often involve prosthesis that show visible wear patterns that have visibly altered the shape of the prosthesis from excessive wear, usually attributed to poor implant positioning, or in some cases attributed to poor fluid film lubrication due to implant positioning or design.
My comment about warming up is an image that I have that is probably even less scientific, but here it is. When a car sits for awhile, the oil drains off of the moving parts, leaving them with little or no lubrication when you first start the engine. Prior to the development of modern oil additives, it was often believed that the most wear in a well maintained engine happened in the first few moments when the engine was started up, before the oil circulated through all of the moving parts. I have this same image of my hip. After sleeping all night, I have the image that the fluid film layer is not as thorough as it is after the joint has been moved through a few cycles that would circulate the synovial fluid around the full perimeter the the joint surface. I have seen this spoken of in some studies discussing wear in MOM joints, but I do not know for sure if the image is correct. These studies proposed the hypothesis that MOM joints could be subject to this same issue of "start up" wear being greater than "warmed up" wear when movement cycles had circulated synovial fluid throughout the joint interface.
I am neither a medical person, nor a car mechanic, but hopefully I have clarified my own image of what is going on.

John

[aemcdon]

I have had both hips done, left one 3 yrs in december and right one 2yrs in dec of this year. I had the clicking noise in the left one for a little over 2 years and do have clicking noises in my right one. My left one does not click at all anymore and feels great, the right one I do believe is still healing, we all heal at different rates, depending on what activities we are involved in. The right one gets a twinge every now and then, but I also had this going on in the left one until it was completely healed. I know it will pass.