[Is aseptic loosening of joint prostheses aseptic?]

The observed changes in the periarticular space may be caused by both mechanical action and biological reactions. Periprosthetic infections are the most common cause of loosening and destructive changes in the joints, however, the diagnosis of an aseptic reaction is not always fully obvious. Micromovements between the implant and the surrounding bone can cause remodeling of the bone trabeculae and migration of fibroblasts into the voids between the implant surface and the bone. In addition, repetitive stresses can induce fibroblast proliferation. On the other hand, the residues arising from the wear of implanted materials in the joints may play an important role in the process of loosening of prostheses - both aseptic and septic. Direct interactions between the released molecule and the macrophage surface are sufficient to activate osteoclastogenic signaling pathways. You cannot ignore allergic reactions to metals used in prostheses in patients undergoing arthroplasty. Demonstration of hypersensitivity to the components of dentures in some cases requires the use of appropriate material in order not to cause an inflammatory allergic reaction. Emerging treatment strategies using mesenchymal stem cells (MSCs) are aimed at improving the initial implant integration and preventing periprosthetic osteolysis. It should be emphasized, however, that the diagnosis of aseptic loosening in many clinical situations raises doubts, because it is at the root of everyone.