Pathogenetic Mechanisms of Aseptic Loosening of Hip Endoprosthesis Components after Total Arthroplasty

INTRODUCTION: In the structure of complications after total hip arthroplasty, aseptic instability is one of the main reasons for revision interventions, which requires continued study of the causes, methods of early diagnosis and biological approaches to the treatment of osteolysis and aseptic loosening. AIM: To consider modern pathogenetic aspects of aseptic loosening of hip endoprosthesis components after total arthroplasty. MATERIALS AND METHODS: The search for literature sources was conducted in open databases of scientific literature PubMed and eLibrary. The search depth for the main keywords (aseptic implant loosening, endoprosthetics, pathogenesis) was 20 years. The criterion for inclusion of sources in the analytic study was the presence of a full or structured text of the article (indicating specific quantitative data). The exclusion criteria were works that have not been published (dissertation studies and author’s abstracts), clinical cases, abstracts of reports, as well as educational and methodological materials. RESULTS: In the review, the analysis of the literature data is presented on the state of issues of studying molecular-genetic aspects of the mechanisms of bone resorption, periprosthetic osteolysis, impaired osteointegration after total endoprosthetics, including those that lead to the development of aseptic loosening of hip endoprosthesis components. The mechanisms of the most important, in our opinion, pathogenetic factors that may lead to aseptic loosening, are considered. CONCLUSION: The osteolysis formation processes leading to loosening of endoprosthesis components, are multifaceted both in terms of the triggering mechanisms and of the development of immune response. Osteolysis is the result of disruption of local tissue homeostatic mechanisms both at the level of sensors, regulators and of effectors. The study and precise identification of deregulated signaling pathways, mediators and cell differentiation programs contributing to periprosthetic osteolysis, will help in the development of diagnostic, selective and targeted therapeutic strategies.