Loosening of THR Prostehsis

 Potential areas of lucency around femoral and acetabular components of THR according to Gruen (femur ) and De-Lee and Charnley (cup).



                        Ortho PG notes

Pathological process of aseptic loosening 

        Osteoclastic bone resorption at bone cement interface.

        Polyethylene wear debris at bearing surfaces combined with cement debris formed from movement at          interfaces.

         In vitro, activated macrophages is the key. Macrophage after phagocytosis ,response in two ways.

            a. secretion of TNF-alpha ,IL-1,IL-6,PGE2

            b. activated macrophages differentiate into osteoclasts via distinct pathways (RANKL activated                     and TNF-alpha activated )

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