Is Popping Normal After Hip Replacement?

Popping after a hip replacement is common and, in most cases, harmless. Studies of patients with total hip replacements consistently find that a substantial fraction report some kind of noise from the joint, with popping being one of the most frequently described sounds. In one study of ceramic-on-ceramic hips, about 15% of patients specifically reported popping, while the overall noise rate across all types reached roughly a third of all joints. The sound can be startling, but understanding where it comes from and when it actually signals a problem can save you a lot of unnecessary worry.

How Common Are Noisy Hip Replacements?

The short answer is that noisy hips are far more common than most patients expect going into surgery. In a study of 174 ceramic-on-ceramic total hip replacements, nearly 32% of patients reported some form of noise, including popping, clicking, and grinding. Popping alone accounted for about 15% of all hips in that group.¹ A separate case-controlled study found that about 38% of ceramic-on-ceramic hip replacements produced noise, compared with roughly 13% of hips that used a ceramic head on a polyethylene liner.² Among younger patients across a broader mix of implant types, the overall rate was lower, around 9%, but still meaningful.³

The numbers vary depending on the type of bearing material used, the patient population studied, and even how the question is asked, since many people live with occasional clicks and pops without ever mentioning them to their surgeon. The consistent takeaway across the literature is that hearing something from your replaced hip does not, by itself, mean something has gone wrong.

Why Replacement Hips Pop

The mechanisms behind joint noise after hip replacement differ from the cracking you might hear in a natural joint. In a healthy joint, that satisfying pop when you stretch often comes from a gas bubble suddenly forming in the fluid-filled space as the joint surfaces separate slightly. MRI studies have captured this in real time, showing that the crack corresponds to the moment the bubble appears, not when it collapses.⁴ An artificial hip, however, has metal, ceramic, or plastic components where cartilage and bone used to be, so the noise sources are different.

One well-documented cause is something called micro-separation, a slight medial-lateral looseness in the replacement joint that allows the femoral head (the ball component) to shift just enough to contact the rim of the acetabular cup (the socket component). That contact generates a pop or click.⁵ This is especially likely in the early months after surgery, when the surrounding muscles and soft tissues haven’t yet tightened up around the new components. Clinical experience confirms that in many cases, the noises caused by this post-operative laxity resolve on their own within a few weeks as healing progresses.⁶

In ceramic-on-ceramic bearings specifically, a rolling-and-sliding mechanism between the ball and socket surfaces can produce vibration. The friction characteristics change depending on how lubricated the surfaces are and on the precise geometry of the components, sometimes generating audible sounds during hip flexion.⁷

Soft Tissue Sources of Popping

Not every pop originates from the implant surfaces themselves. Tendons and muscles around the hip can also produce noticeable sounds after surgery. The iliopsoas tendon, a thick band that crosses the front of the hip, is a frequent culprit. After a hip replacement, this tendon can rub or catch on the edge of the acetabular cup, causing a snapping or popping sensation. The problem tends to arise when the cup extends slightly beyond the front rim of the native pelvis, or when the cup is oversized relative to the patient’s anatomy.⁸ In a series of failed larger-diameter metal-on-metal hips, anterior iliopsoas impingement was the primary cause of symptoms, and all patients improved after revision.⁹

Iliopsoas-related popping is distinct from implant-surface noise in a key way: it usually comes with groin pain that gets worse with activities like climbing stairs, getting out of a car, or bringing the knee toward the chest. If you feel a pop deep in the front of the hip accompanied by a sharp ache, that combination points more toward a tendon issue than a benign bearing sound.

How Your Bearing Material Changes the Odds

The material pairing inside your replacement hip is the single biggest factor in how likely you are to hear noise. Hard-on-hard combinations like ceramic on ceramic and metal on metal generate significantly more sound than hard-on-soft pairings, where a ceramic or metal ball sits inside a polyethylene (plastic) liner. In a study of young patients, those with hard-on-hard bearings were about five to six times more likely to report grinding, popping, or clicking compared to those with a polyethylene liner.³

Ceramic-on-ceramic hips deserve special mention because they have developed a reputation for squeaking, a distinct high-pitched sound that is different from the lower-frequency popping most patients describe. Squeaking remains relatively uncommon and, for most patients, does not require treatment in the absence of pain or other mechanical symptoms.¹⁰ The causes of squeaking have been debated for years. Researchers have proposed that it involves a transition between rolling and sliding contact at the bearing surface, with friction playing a central role, but the phenomenon is still not fully explained.¹¹

The timing of noise also differs by bearing type. Patients with ceramic-on-ceramic hips were significantly more likely to first notice sounds after the first year, suggesting that some noise emerges as the joint “breaks in” or as tissue conditions change around a well-fixed implant. Certain movements seem to trigger it more than others: bending over was a particularly common noise-provoking position for ceramic-on-ceramic hip owners.²

Metal-on-polyethylene hips are the quietest option in most studies, which makes intuitive sense: a soft liner absorbs vibration in a way that two hard surfaces cannot. If avoiding noise is a high priority for you, this is worth discussing with your surgeon before the procedure, though bearing choice involves trade-offs in wear resistance and longevity that go well beyond sound.

When Popping Should Get Your Attention

The vast majority of pops and clicks from a replaced hip are cosmetic annoyances rather than medical emergencies. But there are a few scenarios where the sound warrants prompt evaluation.

Painful popping: A pop that comes with a sharp pain in the groin, thigh, or buttock each time it occurs may indicate tendon irritation, impingement between the implant and surrounding bone, or component loosening. Pain is the clearest signal that something beyond benign soft-tissue snap is happening.
New grinding: A deep grinding sensation, as opposed to a brief pop, can mean the bearing surfaces are wearing abnormally. Higher wear rates are associated with osteolysis, a process where tiny debris particles cause the bone around the implant to gradually break down.¹²
Relentless squeaking in ceramic hips: Occasional squeaking in a ceramic-on-ceramic hip is usually benign. However, persistent and painful squeaking without any preceding trauma can be an early sign of a ceramic liner fracture, which requires surgical attention.¹⁰
Instability symptoms: If the pop is accompanied by a feeling that the hip “gives way” or shifts out of position, that could indicate subluxation (partial dislocation). Component positioning, particularly the angles of the cup and stem, plays a role in how stable the replacement feels. Reduced combined anteversion and lower femoral offset are among the factors that increase dislocation risk.¹³

A reasonable rule of thumb: a painless pop that doesn’t limit your activity and isn’t getting progressively louder or more frequent is almost always benign. Mention it at your next scheduled follow-up. A painful pop, a new grinding, or a feeling of mechanical instability is worth calling your surgeon’s office sooner.

Who Is More Likely to Have a Noisy Hip

Beyond bearing material, a few patient-level factors seem to influence noise rates. Women were roughly 1.8 times more likely to report noise than men in one study of young hip replacement recipients.³ The reasons are not definitively established, but differences in pelvic anatomy, muscle mass around the hip, and patterns of soft-tissue laxity are all plausible contributors. Thinner layers of muscle and fat around the joint may also make internally generated sounds easier to hear from the outside, amplifying the perception of noise even if the mechanical cause is no different.

Body habitus and activity level can play a role as well. Patients who are physically active put their replacements through a wider range of motion and higher loads, creating more opportunities for transient micro-separation or tendon snapping. This doesn’t mean you should avoid activity. Post-operative exercise and strength training are among the best things you can do for long-term joint function. But active patients should expect that their hip might talk to them occasionally, especially during deep squats, lunges, or rapid changes of direction.

How Noise Affects Quality of Life

Even when popping is medically benign, it can bother people. Research looking at patient-reported outcomes found that patients with noisy hip replacements scored statistically worse on measures of pain, function, and overall quality of life compared to patients with silent metal-on-polyethylene hips.¹⁴ The exception was activity level: patients with noisy ceramic-on-ceramic or metal-on-metal hips reported similar activity scores to those with silent hips, suggesting the noise didn’t hold them back from doing things but did affect how satisfied they felt.

The psychological dimension of joint noise is underappreciated. For some people, every pop triggers a flash of anxiety about whether the implant is failing. That anxiety itself can change movement patterns, discourage exercise, and diminish the benefit of the surgery. If you find yourself avoiding activities because of sounds that your surgeon has confirmed are benign, it may be worth addressing the worry directly rather than waiting for the noise to disappear.

What Can Be Done About Persistent Noise

For noise that develops in the early post-operative weeks and comes from soft-tissue laxity or healing tissues, the most effective treatment is time and rehabilitation. As the muscles surrounding the hip strengthen and the joint capsule tightens, many pops and clicks simply fade away.⁶ Structured physical therapy that focuses on the hip abductors and external rotators can accelerate this process by improving the muscular envelope around the joint.

When noise persists and is traced to a specific tendon issue like iliopsoas irritation, treatment usually starts with conservative measures such as targeted stretching, activity modification, and sometimes a guided injection to calm down the inflamed tendon. If those measures don’t bring relief, surgical release of the tendon (a psoas tenotomy) is a well-established next step.⁸ Tendon-related problems around hip replacements are treatable, and management generally begins with non-surgical approaches before considering operative options.¹⁵

For noise that originates from the bearing surfaces themselves, the options are more limited. There is no lubricant you can inject or adjustment a therapist can make that changes how two hard surfaces interact inside the joint. In the small number of cases where bearing noise is severe enough to significantly affect quality of life, or where it signals a mechanical problem like a ceramic liner fracture, revision surgery to replace the bearing may be warranted. In the case series involving oversized metal femoral balls causing iliopsoas impingement, revision resolved the symptoms in every patient.⁹ But revision for noise alone, without pain or mechanical symptoms, is rare and generally not recommended.

Talking to Your Surgeon About It

If popping is bothering you, the most useful thing you can do before your appointment is pay attention to the details. Surgeons find it much easier to diagnose the source of noise when you can describe when it happens (sitting to standing? walking? bending over?), how often, whether it has changed over time, and whether it comes with any pain or sensation of the hip shifting. A pop that occurs only with deep flexion and started three months after surgery tells a very different story than a new grinding that appeared two years in.

Imaging can help narrow things down. Standard X-rays show component position and can reveal obvious problems like loosening or fracture. If a ceramic liner fracture is suspected, a CT scan provides more detail. For soft-tissue causes, an MRI or ultrasound can identify tendon inflammation or fluid collections around the joint. In many cases, though, the physical exam and your description of the symptoms are enough for an experienced surgeon to identify whether the noise is benign or worth investigating further.

One thing worth keeping in mind: surgeons hear about noisy hips constantly. The research confirms that a large minority of hip replacement patients experience some form of joint sound. Your surgeon is unlikely to be alarmed by a painless pop, but they also won’t dismiss a sound that comes with pain or functional limitation. The conversation is worth having either way, if only to put your mind at ease.

1
PubMed. Factors Influencing Noise Following Primary Ceramic-on-Ceramic Total Hip Arthroplasty
2
PubMed Central. Ceramic noise from total hip replacements a case-controlled study
3
PubMed Central. Hard-on-Hard Bearings Are Associated With Increased Noise Generation in Young Patients Undergoing Hip Arthroplasty
4
PubMed Central. Real-time visualization of joint cavitation
5
PubMed. Three-dimensional modeling of in vitro hip kinematics under micro-separation regime for ceramic on ceramic total hip prosthesis: an analysis of vibration and noise
6
EFORT Open Reviews. Bearing surfaces in primary total hip arthroplasty
7
Wear. A proposed mechanism for squeaking of ceramic-on-ceramic hips
8
Arthroscopy: The Journal of Arthroscopic & Related Surgery. For Post-Hip Arthroplasty Iliopsoas Tendonitis, Psoas Tenotomy Is the Preferred First-Line Treatment, Even in Cases of Cup Overhang
9
PubMed. Failure of larger-diameter metal-on-metal total hip arthroplasty resulting from anterior iliopsoas impingement
10
Journal of Bone and Joint Surgery. Ceramic Liner Fractures Presenting as Squeaking After Primary Total Hip Arthroplasty
11
PubMed. The squeaking hip: a phenomenon of ceramic-on-ceramic total hip arthroplasty
12
PubMed. A literature review of the association between wear rate and osteolysis in total hip arthroplasty
13
PubMed Central. Factors affecting impingement and dislocation after total hip arthroplasty – Computer simulation analysis
14
PubMed Central. Do different types of bearings and noise from total hip arthroplalyse influence hip-related pain, function, and quality of life postoperatively?
15
Elsevier / PubMed Central. Tendon Disorders After Total Hip Arthroplasty: Evaluation and Management