Early loosening of hip replacements:causes, course and diagnosis

Abstract Early loosening of joint implants is largely determinatedby a combination of five factors (patient, material, implantdesign, fixation and operative technique). To preserve bonestock, avoid complex reconstructive surgery, obtain goodfunctional results and relief of pain the indication forrevision should be made at an early stage on the basis of thediagnostic trio history, clinical findings, radiography andnot delayed unnecessarily. Regular clinical examination andcontrol radiographs following discharge from hospital enablesurgeons to recognize early signs of complications. A usefulalgorithm is radiographs in two planes taken after one, two, andfive years and in cases without visible morphological changesand pain also after ten years (cumulative risk of failure<5%). If there is an evidence of one or two radiographiccriteria for loosening (sintering, migration, radiolucency,osteolysis) the risk that the implant will fail is increased by5 to 10 times.