Updated: 9/11/2018

THA Aseptic Loosening

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Introduction
  • Macrophage-induced inflammatory response resulting in bone loss
    • Steps in the process include    
      • 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
Imaging
  • 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
      • Indications  
        • pain due to aseptic loosening
        • pain with evidence of osteolysis 
        • extensive osteolysis that would compromise revision surgery in the future.
 

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