How does aseptic loosening occur and how can we prevent it?

摘要

Aseptic loosening is the loosening of a prosthesis from bone in the absence of infection or trauma. It is the most common cause for failure and revision surgery after primary total joint arthroplasty. The number of joint replacement procedures is increasing and with this, the revision burden is predicted to increase. It is therefore imperative to understand the causes of aseptic loosening, in order to reduce its occurrence. In this article the main causes of aseptic loosening are discussed, highlighting the integral part that wear particles play and the host's biological response to these particulates, resulting in osteol-ysis of the peri-prosthetic bone leading to aseptic loosening of the implants. Factors which result in an increase in the production of these wear particles are focused on, as it is crucial to be able to show how to prevent their production. The role of therapeutic treatments will also be discussed to show how they can be used to dampen down the host's response to these wear particles. The ultimate goal of these strategies is to ultimately reduce the catastrophic outcome of aseptic loosening and help reduce the revision burden. This will not only have both huge financial and significant service implications, it will also more importantly, significantly improve long-term patient outcomes and overall satisfaction and well-being.