Implant retrieval studies of the wear and loosening of prosthetic joints: a review

Joint replacement surgery is established as a cost-effective treatment for degenerative joint disorders, but periprosthetic bone loss and aseptic loosening of prostheses is the major surgical complication of this procedure. Early loosening is related to poor initial fixation and design. Late loosening, which is the major problem and the principal cause of failure of this procedure, is related to wear of the prosthetic components. From the retrieval and analysis of failed implants, hypotheses regarding the mechanism of wear-induced loosening and other causes for implant failure may be developed. The criteria and methods, which we have developed for undertaking analysis, and the potentially valuable information available from these analyses, are reviewed.