{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T23:47:11Z","timestamp":1790984831205,"version":"4.1.0"},"reference-count":18,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,1,12]],"date-time":"2026-01-12T00:00:00Z","timestamp":1768176000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Surg."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Total joint arthroplasty is an effective treatment for end-stage joint diseases, with approximately 1.5 million procedures performed globally annually and a 25%\u201330% annual growth rate in China. However, 10%\u201315% of patients develop prosthetic loosening or subsidence within 15\u201320 years postoperatively, predominantly due to aseptic loosening (incidence &amp;gt;10%) caused by wear particle-induced aseptic inflammatory osteolysis. The role of autophagy in this pathogenesis remains incompletely understood.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Postoperatively, pain was relieved: the patient ambulated with crutches at 3 days, achieved 90\u00b0 knee flexion at 1 week, and full pain-free weight-bearing (110\u00b0 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fsurg.2025.1710878","type":"journal-article","created":{"date-parts":[[2026,1,12]],"date-time":"2026-01-12T08:11:51Z","timestamp":1768205511000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Case Report: Prosthetic revision due to aseptic loosening following total knee arthroplasty: a clinical management and pathological mechanism 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