**7. List of abbreviations used in the chapter**

352 Recent Advances in Arthroplasty

stem, assuming both the inappropriate bearing surfaces and/or incorrect positioning of the implants contribute to increased wear rate and risk of osteolysis development (Little et al. 2009). Surgical technique can also influence the strength of implant-bone interface. In this connection, any mistake during cementation can increase the risk of premature failure (Barrack, Mulroy et al. 1992). In support, it seems that high-volume surgeons can achieve lower revision rates than low-volume surgeons especially during the early period after the

Charnley believed that THA is appropriate for older people with limited physical expectations (Charnley and Feagin 1973). Later on, younger and more active patients were indicated for prosthetic hip surgery and the expectations of these patients have increased continually. In fact, younger patients who are treated by THA wish to return to recreational and even competitive sports activity. At the same time, patient activity is considered one of the most important factors in the risk of failure especially via increased wear-rate of bearing surfaces (Schmalzried et al. 2000). By this way, *those who experience high-levels of activity are at increased risk for failure due to aseptic loosening and osteolysis*, and vice versa, lower impact activities are less likely to create conditions appropriate to loosening (Kilgus et al. 1991; Lubbeke et al. 2011). Regarding the stability of bone-implant interface, there may be a concern about cracks followed by fracture of the cement mantle in association with highimpact load. Surgeons should advise patients with THA that all high-impact activities could compromise the durability of their implant, especially in terms of accelerated wear and premature aseptic loosening. Another possible concern is risk of fall and direct contact during these sport activities that could lead to catastrophic failure, periprosthetic fracture or dislocation of THA. In addition, patients should know that return to a high-load level is not possible without achieving a very good muscle condition and also appropriate skills in their coordination beforehand as muscles can share the forces traversing an artificial joint and thus could prevent its damage. On the other hand, regular repetitive physical activities positively affect both the bone (in accordance with Wolff´s law) and muscles near the

Aseptic loosening is the leading cause of THA failure in the intermediate and long-term postoperative period. Causally it is associated with rapid wear rate inducing adverse host reaction to wear debris and to repetitive mechanical stresses and strains of the bone-implant interface. Here, we introduced the concept of failure of local tissue homeostasis as underlying the majority of processes leading to aseptic loosening. Given that the implant is stable in the second postoperative year and no gross pathology of bone-implant interface is seen on x-ray, then the fate of implant depends on the ability of host tissues (both, bone and soft tissues) to maintain homeostasis with minimum inflammation despite the occurrence of chronic mechanical and particle load. In this connection, the problem is the inability to maintain the balance at bone-implant interface and resolve inflammation in the periprosthetic tissues that can induce the excessive bone resorption around the implant (osteolysis) leading eventually to aseptic loosening. The increased knowledge of the mechanisms regulating the balance in periprosthetic tissues might open new avenues to

artificial joint (Clifford and Mallon 2005; Wilson and Villar 2011).

prevent aseptic loosening and periprosthetic osteolysis.

surgery (Losina et al. 2004).

**6. Conclusions** *(Gallo)*

**5.5 Life with total hip arthroplasty** 


Aseptic Loosening of Total Hip Arthroplasty as a Result of Local Failure of Tissue Homeostasis 355

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