Aseptic loosening and osteolysis are the most frequent late complications of total hip arthroplasty (THA) leading to revision of the prosthesis. This review aims to demonstrate how histopathological studies contribute to our understanding of the mechanisms of aseptic loosening/osteolysis development. Only studies analysing periprosthetic tissues retrieved from failed implants in humans were included. Data from 101 studies (5532 patients with failure of THA implants) published in English or German between 1974 and 2013 were included. "Control" samples were reported in 45 of the 101 studies. The most frequently examined tissues were the bone-implant interface membrane and pseudosynovial tissues. Histopathological studies contribute importantly to determination of key cell populations underlying the biological mechanisms of aseptic loosening and osteolysis. The studies demonstrated the key molecules of the host response at the protein level (chemokines, cytokines, nitric oxide metabolites, metalloproteinases). However, these studies also have important limitations. Tissues harvested at revision surgery reflect specifically end-stage failure and may not adequately reveal the evolution of pathophysiological events that lead to prosthetic loosening and osteolysis. One possible solution is to examine tissues harvested from stable total hip arthroplasties that have been revised at various time periods due to dislocation or periprosthetic fracture in multicenter studies.

Department of Dermatology and Allergology Copenhagen University Hospital Gentofte Denmark

Department of Orthopaedic Surgery Stanford University School of Medicine Stanford CA USA

Department of Orthopaedics Faculty of Medicine and Dentistry University Hospital Palacky University Olomouc Czech Republic

Department of Pathology University Hospital Ostrava Czech Republic

Institute of Clinical Medicine Department of Medicine FIN 00029 HUS Finland; ORTON Orthopaedic Hospital of the Invalid Foundation Helsinki Finland; COXA Hospital for Joint Replacement Tampere Finland

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