CAUSES, DIAGNOSIS AND THERAPY OF ASEPTIC HIP PROSTHESES LOOSENING - ACURRENT CONCEPT REVIEW

Purpose: Aseptic loosening of prostheses implants is the most common c omplication of hip replacement surgery and represents an increasing pr oblem because of still rising numbers of primary arthroplasties. This study reviews the current scientific status of causes, diagnosis and t herapeutical concepts on this theme in literature. Method: We analyzed 6.386 cases on aseptic hip revision arthroplasties published in the i nternational literature and seperated the results for cup and femoral components. On this basis we deduced some recommendations for the oper ative procedure in aseptic hip revision surgery. Results: The mean fol low-up time of all studies was 6,8 years in the case of cemented and 4 ,0 years in the case of uncemented hip revision arthroplasty. As an av erage rate of rerevision, 15,1% was calculated for cemented cup revisi ons, 4,3% for uncemented cup revisions. Rates of aseptic loosening wer e 23,1% for cemented procedure, 8,8% for uncemented cup implants. Femo ral revision implants showed an average aseptic loosening rate of 21,2 % for cemented procedures and a average rate of rerevisions of 12,7%; uncemented procedures showed aseptic loosening in 4,4% of the cases an d rerevision in 5,5%. For old, relatively immobile patients with reduc ed physical constitution, cemented reimplantation has still to be rega rded as the method of choice. In young patients uncemented revision ar throplasty is to prefer both on the acetabular and the femoral side to achieve superior results with good long-term prognosis. Regarding the bony defects induced by loosening, bone grafting is recommended for c emented and uncemented reimplantation technique. Conclusion: In the ca se of aseptic hip revision arthroplasty, the therapeutical procedure h as to be adapted especially to the age and general constitution of the patient as well as to the bony defects induced by prosthetic loosenin g. For the future, controlled studies should respect the initial condi tion of primary as well as revision arthroplasty in reporting the resu lts.