What is prosthetic loosening?

Although the survival of the total hip prosthesis is very high, an implant that loosens can always be replaced. The prosthetic patient has pain when walking that limits his perimeter of walking. He even has pain when sitting, getting up from a chair and starting the march. On the other hand, it is very important that the patient with a hip prosthesis always follow the controls that his specialist indicates in a regular way, in order to minimize bone wear in case the prosthesis could be loosened.

Causes of Loosening

The causes of the loosening are multifactorial although classically it is attributed to the reaction that causes in the organism the polyethylene particles that are detached from the polyethylene dome of the acetabular component; This is what is known as periprosthetic osteolysis. The modern polyethylene high cross linked polyethylene domes present less wear and tear, so it is expected that in future years this phenomenon may occur with a decreasing frequency.

However, we have replacement implants for each situation, so it does not make sense to think that a person has a limited number of possibilities to replace a hip prosthesis in the worst case. In addition, the availability of a bone bank allows the anatomical reconstruction of those portions of bone that may be required. Also, in addition to the radiographic-scanner-scintigraphy tests, we performed the helical TAC with three-dimensional representation that allows us to accurately recognize the bone defect and the situation of the prosthesis loosened with great precision.

Our center, with a bone bank linked to the Transplant Services Foundation of the Hospital Clínic of Barcelona, ​​is one of the centers with the most experience in bone transplantation in the world, having performed more than 1500 transplants since 1986


Treatment of prosthetic loosening

The objectives of the replacement of total hip prosthesis are several:

  • Return the joint function in its anatomically most appropriate position.
  • Restore bone loss caused by loosening – osteolysis.
  • The implants used must ensure maximum survival.

For this purpose we use revision implants depending on the degree of wear, both at the acetabulum and at the level of the femur. In the same way allograft or bone transplant is used according to each case and according to a predetermined classification. For example, in the acetabulum we use the modified Icatme classification of Gross with four grades, which is illustrated in the drawing on the right.

The most common cases correspond to grades I and II. We usually use tantalum cups (80% more porous reticulated titanium) and in some cases graft-transplant fragmented-impacted filling according to the Sloof technique. In grades III and IV where there is a lack of a spine, usually the posterior, or a floating hip remains, we use the massive acetabulum transplant from the bone bank. Together with Mount Sinai Hospitals in Toronto and Rush Presbiterian Hospital in Chicago we have the largest experience in this type of transplants in the world.

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