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The current paradigm points to an inflammatory response to wear particles as its main trigger. Recently, there have been increasing numbers of positive bacterial isolates reported among patients with clinically absent infection. This paper reviews existing evidence on possible involvement of bacteria and microbial\u2010associated molecular patterns in the pathology of so\u2010called \u201caseptic loosening.\u201d \u00a9 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. 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