Abstract

This review deals with the available literature on bone resorptive processes around stable and aseptic loosened hip prostheses. The clinical and roentgenological appearances of bone resorptive processes are compared with the histological findings and differences between resorptive process around cemented versus non-cemented hip implants are highlighted. The chemical and mechanical contributions to the bone resorptive process are described. The role of macrophages and the chemical mediators they produce during loosening of implants is described. Also the different pathways by which macrophages reach the lesions is discussed. This review ends with recommendations to diminish problems with particulate debris and thereby to improve long term fixation of implants.