There are many theories about what causes aseptic loosening, especially in patients who are less than five years out from surgery. With the main culprit likely being instability of the knee, where the knee was not placed in a nice stable manner at the time of surgery. Placing undue pressure just on one side of the knee causing increased force on one side of the prosthesis, which may predispose the patient to loosening over time. The other is the technique of how the cement was interdigitated at the time of surgery. And we now know a lot more about this and different generation of techniques have been adopted in order to decrease the chances of aseptic loosening over time.
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