N.N. Priorov Journal of Traumatology and OrthopedicsN.N. Priorov Journal of Traumatology and OrthopedicsВестник травматологии и ортопедии им. Н.Н. Приорова0869-86782658-6738Eco-Vector67809810.17816/vto678098ZEGWLMSCIENTIFIC REVIEWSНаучные обзорыReview ArticleKey pathogenetic components of aseptic loosening of joint prosthesesКлючевые компоненты патогенеза асептической нестабильности эндопротезов суставовhttps://orcid.org/0009-0007-3489-35559994-8149KamenskiyAlexander D.КаменскийАлександр Дмитриевич
Russian Federation
alexkamenskiyvm@yandex.ruhttps://orcid.org/0009-0000-2591-09492524-0855ParakhinYurii V.ПарахинЮрий Вениаминович
Russian Federation

MD, Cand. Sci. (Medicine)

канд. мед. наук

parachinyuri@mail.ruhttps://orcid.org/0000-0003-4201-45775838-4366ParshikovMikhail V.ПаршиковМихаил Викторович
Russian Federation

MD, Dr. Sci. (Medicine), Professor

д-р мед. наук, профессор

parshikovmikhail@gmail.comRussian University of MedicineРоссийский университет медициныClinical Hospital "RZD-Medicine" named after N.A. SemashkoКлиническая больница «РЖД-Медицина» им. Н.А. Семашко12112025310520263324384470304202516072025Copyright ©; 2026, Eco-VectorCopyright ©; 2026, Эко-Вектор2026Eco-VectorЭко-Векторhttps://eco-vector.com/for_authors.php#07https://journals.eco-vector.com/0869-8678/article/view/678098

This review provides a comprehensive analysis of the pathogenetic mechanisms underlying aseptic loosening of joint prostheses and the associated periprosthetic osteolysis. Based on the systematization of current scientific evidence, the key factors contributing to the development of these complications are examined. A central focus is placed on debris-induced inflammation, in which prosthetic wear debris (metals, polyethylene, and bone cement) activates macrophages, leading to the release of pro-inflammatory cytokines (TNF-α, IL-1, IL-6). These mediators disrupt bone remodeling by stimulating osteoclastogenesis via activation of the RANKL/RANK/OPG signaling pathway and by suppressing osteoblast function. Particular attention is paid to the role of mechanical factors, including physiological implant micromotion, which, when exceeding the tolerance threshold (greater than 50–150 μm), impairs osseointegration and promotes the formation of a fibrous synovial-like interfacial membrane, as well as the phenomenon of stress shielding, resulting in bone resorption due to altered load distribution. The influence of pressurized fluid flow (up to 150 mmHg), which enhances bone destruction through direct effects on osteocytes, is also discussed. Specific immune responses to prosthetic components are analyzed in detail: the haptenic properties of metal ions (Co, Cr, Ti) and bone cement can initiate delayed-type hypersensitivity reactions with neoantigen formation and T cell activation. The local and systemic toxic effects of metallic particles are considered, including DNA damage and inhibition of osteoblast and mesenchymal stem cell proliferation. The contribution of bacterial endotoxins adsorbed onto wear particles, which can potentiate inflammation even in the absence of clinically evident infection, is highlighted. It is emphasized that aseptic loosening is a multifactorial process in which the combined action of these mechanisms shifts the balance toward osteolysis. Prospective strategies to reduce the risk of aseptic loosening include investigation of genetic susceptibility, development of biocompatible materials with improved tribological properties, and targeted suppression of inflammatory cascades. A systematic understanding of the underlying pathogenesis constitutes the basis for improving implant longevity and reducing the rate of revision interventions.

Данный литературный обзор посвящён комплексному анализу патогенетических механизмов асептической нестабильности (АН) эндопротезов суставов и связанного с ней перипротезного остеолиза. На основе систематизации современных научных данных рассмотрены ключевые факторы, определяющие развитие этих осложнений. Центральное место занимает анализ дебрис-индуцированного воспаления, при котором частицы износа материалов эндопротеза (металлы, полиэтилен, костный цемент) активируют макрофаги, что приводит к выбросу провоспалительных цитокинов (TNF-α, IL-1, IL-6). Эти медиаторы нарушают баланс костного ремоделирования путём стимуляции остеокластогенеза посредством активации сигнального пути RANKL/RANK/OPG и подавления функции остеобластов. Особое внимание уделено роли механических факторов: физиологической микроподвижности имплантата, которая при превышении порога толерантности (более 50–150 мкм) препятствует остеоинтеграции и способствует формированию фиброзной синовиальноподобной интерфейсной мембраны, а также явлению стресс-шилдинга, приводящего к резорбции кости из-за перераспределения нагрузки. Рассмотрено влияние жидкостных токов под давлением (до 150 мм рт. ст.), которые усиливают деструкцию костной ткани через прямое воздействие на остеоциты. Подробно проанализированы специфические иммунные реакции на компоненты эндопротеза: гаптенные свойства ионов металлов (Co, Cr, Ti) и костного цемента инициируют реакции гиперчувствительности замедленного типа с образованием неоантигенов и Т-клеточной активацией. Обсуждается локальное и системное токсическое действие металлических частиц, повреждающих ДНК, угнетающих пролиферацию остеобластов и мезенхимальных стволовых клеток. Отмечен вклад бактериальных эндотоксинов, сорбирующихся на частицах дебриса, которые потенцируют воспаление даже при отсутствии клинической инфекции. Подчёркивается, что АН является многофакторным процессом, в котором совокупное действие перечисленных механизмов смещает равновесие в сторону остеолиза. Рассмотрены перспективные направления для снижения риска АН, включая изучение генетической предрасположенности, разработку биосовместимых материалов с улучшенными трибологическими свойствами и таргетные стратегии подавления воспалительного каскада. Систематизация патогенеза создаёт основу для повышения долговечности эндопротезов и снижения частоты ревизионных вмешательств.

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