Causes of instability of endoprosthesis components after hip and knee arthroplasty: a science review

Authors:

Ismael Abbas, clinical resident, North-Western State Medical University named after I.I. Mechnikov, 41 Kirochnaya Street, 191015 St. Petersburg, Russian Federation, e-mail: ismael-abbas@mail.ru.

Tkachenko Alexandr Nikolaevich, Grand PhD in Medical sciences, Professor, North-Western State Medical University named after I.I. Mechnikov, 41 Kirochnaya Street, 191015 St. Petersburg, Russian Federation; tel.: +7-911-215-19-72; e-mail: altkachenko@mail.ru.

Khaydarov Valery Mikhailovich, PhD in Medical sciences, North-Western State Medical University named after I.I. Mechnikov, 41 Kirochnaya Street, 191015 St. Petersburg, Russian Federation; e-mail: drxaydarov@mail.ru.

Mansurov Djalolidin Shamsidinovich, PhD in Medical sciences, Samarkand State Medical University, 18 A. Temur Street, 140100 Samarkand, Uzbekistan; e-mail: jalolmedic511@gmail.com.

Balgley Alexander Germanovich, MD, North-Western State Medical University named after I.I. Mechnikov, 41 Kirochnaya Street, 191015 St. Petersburg, Russian Federation; e-mail: alexbalgley@yandex.ru.

Totoev Zaurbek Arturovich, MD, St. Petersburg State Budgetary Healthcare Institution “City Polyclinic No. 112”, 25 Akademika Baykova Street, 195427 St. Petersburg, Russian Federation; e-mail: zaurbek.totoev@yandex.

In the heading: Rewiews

Year: 2022 Volume: 4 Journal number: 3 

Pages: 73-81

Article type: scientific and practical

UDC: 616.717.4-001.6-089

DOI: 10.26211/2658-4522-2022-4-3-73-81

Annotation:

Introduction. According to the large number of authors, instability of implant components after hip and knee arthroplasty is the cause of revision endoprosthetics in 20-50 % of cases. The number of patients undergoing surgery for knee or hip joint replacement has a steady growing trend both in Russia and all over the world. The issues related to the study of the endoprosthesis instability causes are vividly discussed in scientific forums and in specialized journals publications.

Aim. The review is devoted to the analysis of the literature data concerning non-infectious and infectious genesis of implant instability.

Materials and methods. Literature data was searched in the open electronic databases of scientific literature PubMed and Library. The search was carried out by keywords and phrases: total hip replacement, total knee replacement, implant instability, periprosthetic infection, re-endoprosthetics. The search depth was 20 years. Inclusion criteria: full-text articles with specific quantitative data. Exclusion criteria: clinical examples and abstracts of reports.

Results. Abrasion of endoprosthesis rubbing surfaces, periprosthetic osteolysis, debris, acute or chronic nonspecific inflammation, pigmentary villonodular synovitis, calcification, necrosis, sequestration and combination of these changes are the main causes of aseptic implant loosening. Endoprosthesis instability can be the result of micro-movement between the prosthesis and the surrounding bone, high joint fluid pressure, errors in arthroplasty planning and implementation, bone tissue loss around the implant in areas that do not have any strain, and other reasons.

Discussion. There is emerging evidence that endoprosthesis instability may be due to subclinical infection associated with low-virulent pathogens or atypical microflora. Probably, the current rates of arthroplasty infection are actually underestimated, since many cases of presumed aseptic instability of the arthroplasty may be caused by unrecognized infection. This circumstance allows to classify such cases as periprosthetic infection.

Conclusion. Detection and identification of microflora in aseptic instability of hip and knee implants, when it was not expected, allow to prescribe patients a rational course of antibacterial drugs while performing revision interventions and, thus, improve their health outcomes. The presented literature review enables to focus on the current status of this issue.

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