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


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

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:

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:

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

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

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


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.

Keywords: , , , ,

Download the full text of the article

List of cited literature:

1. Kaminsky AV, Marchenkova LO, Pozdnyakov AV. Revizionnoe endoprotezirovanie tazobedrennogo sustava: epidemiologiya, prichiny, faktory riska [Revision hip replacement: epidemiology, causes, risk factors]. Vestnik travmatologii i ortopedii im. N.N. Priorova [N.N. Priorov Journal of Traumatology and Orthopedics]. 2015(2):83-9. (In Russian).

2. Prokhorenko VM, Azizov MZ, Shakirov HH. Revizionnoe endoprotezirovanie tazobedrennogo sustava: issledovanie «sluchaj-kontrol’» [Revision hip replacement: a case-control study]. Sovremennie problemi nauki i obrazovaniya [Modern problems of Science and Education]. 2016(6):36-40. (In Russian).

3. Cherian JJ, Jauregui JJ, Banerjee S, Pierce T, et al. What Host Factors Affect Aseptic Loosening After THA and TKA. Clin Orthop Relat Res, 2015;473(8):2700-9. doi: 10.1007/s11999-015-4220-2.

4. Harwin SF, Sodhi N, Ehiorobo J, Khlopas A, et al. Outcomes of Dual Mobility Acetabular Cups in Total Hip Arthroplasty Patients. Surg Technol Int. 2019;4:367-70.

5. Kelmer G, Stone AH, Turcotte J, King PJ. Reasons for Revision: Primary Total Hip Arthroplasty Mechanisms of Failure. J Am Acad Orthop Surg. 2021;29(2):78-87. doi: 10.5435/jaaos-d-19-00860.

6. Kornilov NN, Kulyaba TA, Fil AS, Muravyeva YV. Dannye registra endoprotezirovaniya kolennogo sustava RNIITO im. R.R. Vredena za 2011-2013 gody [Data from the register of knee arthroplasty of the R.R. Vreden RNIITO for 2011-2013]. Travmatologiya i ortopediya Rossii [Traumatology and orthopedics of Russia]. 2015;75(1):136-51. (In Russian).

7. Shubnyakov II, Tikhilov RM, Denisov AO, Akhmedilov MA, Cherny AZh, Totoev ZA, Javadov AA, Karpukhin AS, Muravyeva YuV. Chto izmenilos’ v strukture revizionnogo endoprotezirovaniya tazobedrennogo sustava v poslednie gody? Travmatologiya i ortopediya Rossii [Traumatology and Orthopedics of Russia]. 2019;25(4):9-27. (in Russian).

8. Sadoghi P, Liebensteiner M, Agreiter M, Leithner A, et al. Revision surgery after total joint arthroplasty: a complication-based analysis using worldwide arthroplasty registers. J Arthroplasty. 2013;28(8):1329-32. doi: 10.1016/j.arth.2013.01.012.

9. Bozic KJ, Kamath AF, Ong K, Lau E, et al. Comparative Epidemiology of Revision Arthroplasty: Failed THA Poses Greater Clinical and Economic Burdens Than Failed. Clin Orthop Relat Res. 2015;473(6):2131-8. doi: 10.1007/s11999-014-4078-8.

10. Meding JB, Ritter MA, Davis KE, Farris A, et al. Meeting Increased Demand for THA and Follow-Up: An Actuarial Method to Determine Optimal Follow-Up Schedules. OJO Open Journal of Orthopedics. 2015;5(8):245-52.

11. Ivantsov VA, Lashkovsky VV, Bogdanovich IP, Anosov VS, et al. Klinicheskij monitoring revizionnogo endoprotezirovaniya tazobedrennogo i kolennogo sustavov [Clinical monitoring of revision hip and knee arthroplasty]. Medicinskie novosti [Medical news]. 2020;313(10):23-6. (In Russian).

12. McNabb DC, Kim RH, Springer BD. Instability after total knee arthroplasty. J Knee Surg. 2015;28(2):97-104. doi: 10.1055/s-0034-1396080.

13. Flick TR, Ross BJ, Sherman WF. Instability After Total Hip Arthroplasty and the Role of Advanced and Robotic Technology. Orthop Clin North Am. 2021;52(3):191-200. doi: 10.1016/j.ocl.2021.03.001.

14. Balberkin AV, Dustov HS, Kolondaev AF. Poperechno-svyazannyj sverhvysokomolekulyarnyj polietilen-perspektivnyj material v endoprotezirovanii sustavov [Cross-linked ultra-high molecular weight polyethylene-a promising material in joint replacement]. Vestnik Avicenni [Vestnik Avicenna]. 2012;50(1):161-8. (In Russian).

15. Zagorodny NV. Nekotorye statisticheskie dannye ob endoprotezirovanii tazobedrennogo i kolennogo sustavov v RF za 2014-2015 gody [Some statistical data on hip and knee arthroplasty in the Russian Federation for 2014-2015]. Opinion Leader. 2017(3-2):12-8. (in Russian).

16. Bragina SV. Sovremennye vozmozhnosti rannej laboratornoj diagnostiki periproteznogo osteoliza kak prediktora razvitiya asepticheskoj nestabil’nosti endoprotezatazobedrennogo sustava (obzor literatury) [Modern possibilities of early laboratory diagnosis of periprosthetic osteolysis as a predictor of the development of aseptic instability of hip arthroplasty (literature review)]. Genii ortopedii [Orthopaedic Genius]. 2020; 26(2):261-5. (In Russian).

17. Herry Y, Viste A, Bothorel H, Desmarchelier R, et al. Long-term survivorship of a monoblock long cementless stem in revision total hip arthroplasty. Int Orthop. 2019;43(10):2279-84. doi: 10.1007/s00264-018-4186-2.

18. Elke R, Rieker CB. Estimating the osteolysis-free life of a total hip prosthesis depending on the linear wear rate and head size. Proc Inst Mech Eng H. 2018;232(8):753-8. doi: 10.1177/0954411918784982.

19. Moon NH, Shin WC, Do MU, Kang SW, et al. Wear and osteolysis outcomes for highly cross-linked polyethylene in primary total hip arthroplasty compared with conventional polyethylene: a 15- to 18-year singlecentre follow-up study. Hip Int. 2021;31(4):526-32. doi: 10.1177/1120700019896970.

20. Korshnyak VY. Rykov AG, Volovik VE. Prichiny rasshatyvaniya komponentov endoproteza tazobedrennogo sustava v zavisimosti ot sposoba ih fiksacii [Causes of loosening of hip joint endoprosthesis components depending on the method of their fixation]. Healthcare of the Far East. 2015(2):98-102. (In Russian).

21. Aspenberg P, van der Vis H. Fluid pressure may cause periprosthetic osteolysis: particles are not the only thing. Acta Orthop Scand. 1998;69(1):1-4. doi:10.3109/17453679809002344.

22. Liverani E, Rogati G, Pagani S, Brogini S, et al. Mechanical interaction between additive-manufactured metal lattice structures and bone in compression: implications for stress shielding of orthopaedic implants. J Mech Behav Biomed Mater. 2021;121: 04608. doi: 10.1016/j.jmbbm.2021.104608.

23. Maksimov AL, Gorbach EN, Kaminsky AV. Analiz prichin asepticheskoj nestabil’nosti endoproteza tazobedrennogo sustava kompanii «Altimed» [Analysis of the causes of aseptic instability of the hip replacement of the company “Altimed”]. Sovremennie problemi nauki i obrazovaniya [Modern problems of Science and Education]. 2012(5):52-52. (In Russian).

24. Cherian JJ, Jauregui JJ, Banerjee S, Pierce T, et al. What Host Factors Affect Aseptic Loosening After THA and TKA? Clin Orthop Relat Res. 2015;473(8):2700-9.

25. Learmonth ID, Young C, Rorabeck C. The operation of the century: total hip replacement. Lancet. 2007;370(9597):1508-19. doi: 10.1016/S0140-6736(07)60457-7.

26. Madsen RV, Nam D, Schilcher J, Dvorzhinskiy A, et al. Mechanical instability induces osteoclast differentiation independent of the presence of a fibrous tissue interface and osteocyte apoptosis in a rat model for aseptic loosening. Acta Orthop. 2020;91(1):115-120. doi: 10.1080/17453674.2019.1695351.

27. Shen TS, Gu A, Bovonratwet P, Ondeck NT, et al. Etiology and Complications of Early Aseptic Revision Total Hip Arthroplasty Within 90 Days. J Arthroplasty. 2021;36(5):1734-39. doi: 10.1016/j.arth.2020.11.011.

28. Parvizi J, Fassihi SC, Enayatollahi MA. Diagnosis of Periprosthetic Joint Infection Following Hip and Knee Arthroplasty. Orthop Clin North Am. 2016;47(3):505-15. doi: 10.1016/j.arth.2014.03.009.

29. Ting NT, Della Valle CJ. Diagnosis of Periprosthetic Joint Infection-An Algorithm-Based Approach. J Arthroplasty. 2017;32(7). 2047-50. doi: 10.1016/j.arth.2017.02.070.

30. Parvizi J, Tan TL, Goswami K, Higuera C, et al. The 2018 Definition of Periprosthetic Hip and Knee Infection: An Evidence-Based and Validated Criteria. J Arthroplasty. 2018;33(5):1309-14. doi: 10.1016/j.arth.2018.02.078.

31. Renz N, Yermak K, Perka C, Trampuz A. Alpha Defensin Lateral Flow Test for Diagnosis of Periprosthetic Joint Infection: Not a Screening but a Confirmatory Test. J Bone Joint Surg Am. 2018;100(9):742-50. doi: 10.2106/JBJS.17.01005.

32. Evangelopoulos DS, Ahmad SS, Krismer AM, Albers CE, et al. Periprosthetic Infection: Major Cause of Early Failure of Primary and Revision Total Knee Arthroplasty. J Knee  Surg. 2019;32(10):941-6. doi: 10.1055/s-0038-1672203.

33. Berbari EF, Marculescu C, Sia I, Lahr BD, et al. Culturenegative prosthetic joint infection. Clin Infect Dis. 2007;45(9):113-9. doi: 10.1086/522184.

34. Parvizi J, Gehrke T. Definition of periprosthetic joint infection. J Arthroplasty. 2014;29:1331. doi: 10.1016/j.arth.2014.03.009.

35. Loppini M, Pisano A, Di Maio M, La Camera F, et al. Outcomes of patients with unexpected diagnosis of infection at total hip or total knee arthroplasty revisions. Int Orthop. 2021;45(11):2791-96. doi: 10.1007/s00264-021-05137-8.

36. Vinkler T, Trampush A, Renc N, Perka K, et al. Klassifikaciya i algoritm diagnostiki i lecheniya periproteznoj infekcii tazobedrennogo sustava [Classification and algorithm of diagnosis and treatment of hip periprosthetic infection]. Travmatologiya i ortopediya Rossii [Traumatology and orthopedics of Russia]. 2016(1):33-45. (In Russian).

37. Sebastian S, Malhotra R, Sreenivas V, Kapil A et al. Sonication of orthopaedic implants: A valuable technique for diagnosis of prosthetic joint infections. J Microbiol Methods. 2018;146:51-4. doi: 10.1016/j.mimet.2018.01.015.

38. Renard G, Laffosse JM, Tibbo M, Lucena T et al. Periprosthetic joint infection in aseptic total hip arthroplasty revision. Int Orthop. 2020;44(4):735-741. doi: 10.1007/s00264-019-04366-2.

39. Hipfl C, Mooij W. Perka C, Hardt S et al. Unexpected low-grade infections in revision hip arthroplasty for aseptic loosening : a single-institution experience of 274 hips. Bone Joint J. 2021;103-B (6):1070-7. doi: 10.1302/0301-620x.103b6.bjj-2020-2002.r1.

40. Nikolaev NS, Pchelova NN, Preobrazhenskaya EV, Nazarova VV et al. «Neozhidannye» infekcii pri asepticheskih reviziyah [“Unexpected” infections during aseptic revisions]. Travmatologiya i ortopediya Rossii [Traumatology and orthopedics of Russia]. 2021;27(3):56-70. (In Russian).

41. Purudappa PP, Sharma OP, Priyavadana S, Sambandam S et al. Unexpected positive intraoperative cultures (UPIC) in revision Hip and knee arthroplasty — A review of the literature. J Orthop. 2019;17:1-8. doi: 10.1016/j.jor.2019.06.028.

42. Rothenberg AC, Wilson AE, Hayes JP, O’Malley MJ et al. Sonication of Arthroplasty Implants Improves Accuracy of Periprosthetic Joint Infection Cultures. Clin Orthop Relat Res. 2017;475(7):1836. doi: 10.1007/s11999-017-5315-8.

43. GoswamiK,ParviziJ.Culture-negativeperiprostheticjoint infection: is there a diagnostic role for next-generation sequencing? Expert Rev Mol Diagn. 2020;20(3):269-72. doi: 10.1080/14737159.2020.1707080.

44. Wang FD, Wang YP, Chen CF, Chen HP. The incidence rate, trend and microbiological aetiology of prosthetic joint infection after total knee arthroplasty: A 13 years’ experience from a tertiary medical center in Taiwan. J Microbiol Immunol Infect. 2018;51(6).717-22. doi: 10.1016/j.jmii.2018.08.011.

www.xhamaster actress priyamani sex videos chuda chudi bangla chuda chudi keral sex sex in tamil youtube sex between young couple desi sex scenes sunnyleone hot sex baglabf
sex movies com hind sexi video desi sexey video tamil sex video songs mms x sexihotgirl suny leone porn chennai girl escorts xvideos office tamil xxxx videos fittrip snyper 6ft in cm
ben 10 sex video videos of boys and girls indian college girl porn videos xnxnxxx desi chudai vedio hot girl sexy sexgaral nexxx bf videos chodne ka