ArticleFrontiers in surgery2025
Case Report: Prosthetic revision due to aseptic loosening following total knee arthroplasty: a clinical management and pathological mechanism investigation.
Article in Frontiers in surgery, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Total joint arthroplasty is an effective treatment for end-stage joint diseases, with approximately 1.5 million procedures performed globally annually and a 25%-30% annual growth rate in China. However, 10%-15% of patients develop prosthetic loosening or subsidence within 15-20 years postoperatively, predominantly due to aseptic loosening (incidence >10%) caused by wear particle-induced aseptic inflammatory osteolysis. The role of autophagy in this pathogenesis remains incompletely understood. Methods: A 61-year-old female patient developed aseptic loosening 11 months after left total knee arthroplasty. Comprehensive management included preoperative screening (including synovial cell count, differential, and alpha-defensin detection), revision surgery (debridement of necrotic/inflammatory tissue/residual cement and implantation of a new prosthesis with vancomycin-impregnated cement), synovial HE staining, quantitative immunohistochemistry (IHC; Ki67, CD3, CD20, CD68, P62, LC3II, and Beclin1), and postoperative rehabilitation. Results: Postoperatively, pain was relieved: the patient ambulated with crutches at 3 days, achieved 90° knee flexion at 1 week, and full pain-free weight-bearing (110° flexion) at 2 months. Postoperative infection markers (C-reactive protein and erythrocyte sedimentation rate) were temporarily elevated due to surgical trauma and returned to normal during follow-up. Imaging showed a stable prosthesis without infection or recurrent loosening. Synovial HE staining revealed extensive inflammatory infiltration; quantitative IHC showed high expression of inflammatory markers and low expression of autophagy-related markers. Clinical outcomes were favorable with validated patient-reported outcome measures (Knee injury and Osteoarthritis Outcome Score: 85 points; Western Ontario and McMaster Universities Osteoarthritis Index score: 20 points) at 6 months post-revision. Conclusion: The integrated protocol effectively treated aseptic loosening. Wear particle-induced chronic synovitis and altered autophagy-related marker expression may be involved in the pathogenesis, providing preliminary clinical and pathological evidence for further research.
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