Osteoporosis and aseptic loosening of endoprosthesis components after joint replacement

Introduction. The urgency of the problem of aseptic loosening (AL) of the components of the endoprosthesis after total joint replacement (TJR) in the early and late postoperative period is due to the difficulties of diagnosis, the lack of a unified treatment regimen for patients with low bone mineral density awaiting planned TJR. With the increase in the number of primary arthroplasty of the joint, the number of revision interventions associated with AL also increases. In the last decade, there has been an increase in interest in this topic in the literature, which is manifested by a large number of publications presented by a series of observations or clinical cases. However, there is no universal algorithm for the diagnosis and treatment of this group of patients limited by the low level of evidence of existing studies, the speed of the emergence of new data.The aim of the study was to determine the relationship between the presence of reduced bone quality and aseptic loosening of the components of the endoprosthesis in the postoperative period of total joint replacement.Materials and methods. The search for publications was carried out in the databases eLibrary, PubMed with a search depth of 21 years (from 2000 to 2021) by keywords: Aseptic loosening, osteoporosis, total joint arthroplasty. Demographic data of patients, features of surgical interventions and treatment results were analyzed. 6 articles published from 2000 to 2021 were selected for literature analysis.Conclusion. Currently, there is no single algorithm for the diagnosis and treatment of patients with low BMD who are shown TJR. This determines the need to improve the diagnostic and therapeutic concepts of this pathology. According to the clinical recommendations for the treatment of osteoporosis, nitrogen-containing bisphosphonates are the first-line drugs to improve the quality of bone tissue. The problem of the dosage regimen of drugs of this group reduces the compliance of patients with osteoporosis therapy, which ifies the entire treatment process. Diagnosis of patients with osteoporosis awaiting planned total knee replacement and further correction of bone mineral density in the pre- and postoperative period will reduce the risk of intraoperative complications in the form of tibial and femoral fractures, as well as aseptic instability of the components of the endoprosthesis in the early and late postoperative period, which will significantly increase the "survival" of the components of the endoprosthesis