Theories of wear and loosening in hip prostheses: Wear-induced loosening vs loosening-induced wear–a review

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Abstract
The observation of periprosthetic granulomas containing wear debris around apparently well-fixed as well as around loose-fitting prosthetic components has led to the development of the hypothesis of wear-induced loosening. However, the hypothesis of wear-induced loosening can neither explain the rapid early prosthetic migration detected by roentgen stereophotogrammetry nor the epidemiology of clinical failure without supplementary ad hoc-assumptions. By contrast, apart from explaining the rapid early prosthetic migration detected by roentgen stereophotogrammetry, the theory of early loosening can explain the development of wear granulomas as well as to a great extent the epidemiology of clinical failure.

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