**Part 3**

**Loosening** 

272 Recent Advances in Arthroplasty

[40] Sugisaki, M. Ikai, A. & Tanabe, H. (1995), Dangerous angles and depths for middle ear

[41] Swift, J. Q. Roszkowski, M. T. Alton, T. & Hargreaves, K. M. (1998), Effect of intra-

[42] Tanaka, E. Detamore, M. S. & Mercuri, L. G. (2008), Degenerative disorders of the

[43] Thut, P. D. Hermanstyne, T. O. Flake, N. M. & Gold, M. S. (2007), An operant

[45] West, M. J. & Slomanka, L. (2001), 2-D versus 3-D cell counting--a debate. What is an

[46] Westesson, P. L. Eriksson, L. & Liedberg, J. (1986), The risk of damage to facial nerve,

[47] Yoshida, K. Takatsuka, S. Hatada, E. Nakamura, H. Tanaka, A. Ueki, K. Nakagawa, K.

[48] Zuniga, J. R. Ibanez, C. & Kozacko, M. (2007), The analgesic efficacy and safety of intra-

in vitro/in vivo evaluation: *Int.J Pharm.*, Vol. 195, pp. 179-188.

optical disector?: *Trends Neurosci.*, Vol. 24, pp. 374-380.

arthroplasty: *J Oral Maxillofac Surg*, Vol. 65, pp. 1477-1485.

examination of the temporomandibular joint.

*Radiol.Endod.*, Vol. 102, pp. 22-27.

joint.

1295.

pp. 296-307.

and middle cranial fossa injury during arthroscopy of the temporomandibular

articular versus systemic anti-inflammatory drugs in a rabbit model of temporomandibular joint inflammation: *J Oral Maxillofac Surg*, Vol. 56, pp. 1288-

temporomandibular joint: etiology, diagnosis, and treatment: *J Dent Res*, Vol. 87,

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sodium incorporated PLGA (50:50) microspheres: formulation considerations and

superficial temporal vessels, disk, and articular surfaces during arthroscopic

Okada, Y. Yamamoto, E. & Fukuda, R. (2006), Expression of matrix metalloproteinases and aggrecanase in the synovial fluids of patients with symptomatic temporomandibular disorders: *Oral Surg.Oral Med Oral Pathol.Oral* 

articular morphine and mepivicaine following temporomandibular joint

**14** 

**Risk Factors for Aseptic Loosening** 

Scott J. MacInnes, Andrew Gordon and J. Mark Wilkinson *Academic Unit of Bone Metabolism and Department of Orthopaedics,* 

Total hip arthroplasty (THA) is one of the most successful orthopaedic procedures and has relieved pain and improved hip function in millions of patients worldwide. Despite the success of modern prosthetic designs and bearing surfaces, around 10% of THA prostheses still fail within 10 years1. Improvements in surgical technique and prosthesis design have decreased the incidence of deep sepsis, dislocation and fracture, however aseptic loosening, the clinical end point of osteolysis, remains the most frequent complication and in the UK accounts for 63% of all revision surgery (Table 1)2. Prosthesis loosening results in pain and disability, requiring revision surgery. Revision THA is associated with a 3 to 8-fold greater in-hospital mortality, poorer functional outcome, longer hospital stay, and higher cost than

The problem of osteolysis has been recognized in Judet's acrylic hemiarthroplasty introduced in the 1940s. Prosthesis loosening complicating THA in the 1950's and 1960's was poorly understood and attributed to unconfirmed sepsis6 and prosthesis motion7. In the 1980's loosening was thought to be the result of "cement disease"8, arising due to a foreign body reaction to methyl methacrylate. When the development of cementless prostheses

**National Joint Registry hip Annual Report Data 2009** 

Primary procedures 65,229 90% Revision procedures 7,203 10%

Aseptic Loosening 3,524 49% Osteolysis 999 14% Pain 2,035 29% Infection 1,020 14% Dislocation/ subluxation 1,141 16% Periprosthetic fracture 618 9% Table 1. Summary of hip surgery data from 7th Annual Report National Joint Registry for

Total procedures 72,432

**1. Introduction** 

primary surgery1,3-5.

**Indication for revision** 

England and Wales2

**Following Total Hip Arthroplasty** 

*University of Sheffield, Sheffield,* 

**Number %** 

*United Kingdom* 
