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This review article addresses aseptic loosening, the leading cause of hip arthroplasty failure requiring revision. The authors reviewed literature on the pathogenesis, causes, and risk factors of aseptic loosening, focusing on mechanical and biological mechanisms, the role of wear particles, patient factors, and modern diagnostic approaches. They conclude that a comprehensive diagnostic approach, considering mechanical, biological, and patient-related factors, is needed for early detection of prosthetic instability.
Early detection of aseptic loosening, using modern diagnostic approaches, may allow for optimized monitoring and revision treatment strategies.
Introduction. Aseptic loosening remains the leading cause of hip joint replacement failure and the primary indication for revision arthroplasty. Despite advances in implantation technologies, the problem of long-term component stability remains of high clinical and socioeconomic significance. Objective. To systematize current data on the pathogenesis, causes, and risk factors of aseptic loosening of hip joint replacements and to analyze the possibilities for early diagnosis of this complication. Materials and Methods. An analytical review of domestic and international publications on the mechanical and biological mechanisms of aseptic loosening, the role of wear particles, individual patient factors, and modern diagnostic approaches, including imaging methods, biomarkers, and innovative instrumental technologies, was conducted. Results. Aseptic loosening is a multifactorial process involving component micromovement, impaired osseointegration, and the development of periprosthetic osteolysis, which is often asymptomatic in the early stages. Traditional diagnostic methods have limited sensitivity, while modern approaches, such as acoustic arthrometry and assessment of bone metabolism and inflammation biomarkers, demonstrate promise for the early detection of instability. Conclusion. A comprehensive approach to diagnosing aseptic loosening, taking into account mechanical, biological, and patient-related factors, enables the detection of prosthetic instability at the preclinical stage and optimizes monitoring and revision treatment strategies.
