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Updated: Aug 28 2022

THA Aseptic Loosening

  • summary
    • THA Aseptic Loosening is a macrophage-induced inflammatory response that results in bone loss and implant loosening in the absence of an infection.
    • Diagnosis can be made with plain radiographs of the hip.
    • Treatment is generally revision arthroplasty with exchange of all loose components. 
  • Etiology
    • Steps in the process
      • prosthesis micromotion
      • particulate debris formation
      • macrophage activated osteolysis
    • See wear and osteolysis basic science for full description
  • Presentation
    • Symptoms
      • pain
        • location
          • groin pain
          • thigh pain
          • knee pain
        • aggrevating factors
          • often activity related
    • Physical exam
      • may have minimal pain with ROM
      • increased pain with weight bearing
    • Radiographs
      • recommended views
        • AP
        • lateral
      • findings (xrays are not sensitive for osteolysis and typically underestimate extent of involvement)
        • lucency > 2 mm at cement-bone or metal-bone interface
        • component motion with stress views
        • femoral component
          • subsidence > 1 cm
          • fracture of cement mantle
          • change in peg-neck angle
            • can also represent femoral head necrosis/collapse, femoral neck fracture
          • decreased distance from tip of peg to lateral femoral cortex
            • can also represent femoral head necrosis/collapse
          • narrowing of femoral neck after 3 years or > 10%
            • can also represent impingement
        • acetabular component
          • migration or change in position/inclination
          • wearing of polyethylene liner
            • leads to asymmetric superior location of femoral head within acetabular cup
  • Studies
    • Serum labs
      • ESR will be normal
      • CRP will be normal
  • Treatment
    • Nonoperative
      • observation
        • indications
          • stable implant with minimal symptoms
    • Operative
      • revision THA
          • pain due to aseptic loosening
          • pain with evidence of osteolysis
          • extensive osteolysis that would compromise revision surgery in the future.
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