How to Prevent Aseptic Loosening in Cementless Arthroplasty: A Review

Dragos Apostu,Horea Benea,Dan Cosma,Ondine Lucaciu,Alexandru Mester,Doina Piciu,Daniel Oltean-Dan,Catalin Popa

doi:10.3390/app12031571

Abstract

Aseptic loosening is the main late postoperative complication of cementless total hip arthroplasties (THAs), leading to pain and functional impairment. This article aims to update the orthopedic surgeon on the various methods by which the aseptic loosening rate can be reduced. We performed a systematic review by searching the PubMed database for hip aseptic loosening. We included meta-analysis, randomized controlled trials, reviews, and systematic reviews in the last 10 years, which provided information on techniques that can prevent aseptic loosening in total hip arthroplasty. From a total of 3205 articles identified, 69 articles (2%) met the inclusion criteria, leading to a total of 36 recommendations. A lot of research has been conducted in terms of septic loosening in the last decade. Currently, we have various techniques by which we can reduce the rate of aseptic loosening. Nevertheless, further randomized clinical trials are needed to expand the recommendations for aseptic loosening prevention.

Highlights

Total hip arthroplasty (THA) is one of the most frequently performed orthopedic procedures worldwide, being used to treat hip osteoarthritis and hip fractures
When we compared the current data with a previous work of our team regarding the prevention of aseptic loosening, we found out that researchers and clinicians have added new recommendations in the last years, while the previous remained generally unchanged
Aseptic loosening is a complication that generates a lot of interest in the research community due to its importance

Summary

Introduction

Total hip arthroplasty (THA) is one of the most frequently performed orthopedic procedures worldwide, being used to treat hip osteoarthritis and hip fractures. The overall results of THAs are very good in the majority of cases, resulting in pain decrease, as well as improvement of mobility and hip function. There are two main types of THAs according to bone-implant fixation: cemented and cementless. There are still debates regarding the indications of the two methods of fixation. Cemented THAs are chosen when poor bone quality is present, while cementless THAs are indicated in the case of good bone quality. Cementless fixation is gaining more indications in the last decade, becoming the most used method of fixation in the case of primary THAs

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