Abstract
Now that periprosthetic osteolysis is under control, analyzing how it was overcome has substantial value. What can we learn about how to attack the next enigma? There were six important generic drivers leading to that success:
Surmounting the failure to recognize its full nature. Why was it that the lapse between the first case and the publication of the article called “cement disease” was three decades? In part, because the concept of “cement disease” was simultaneously ingenious, essential, incomplete and misleading.
Understanding “biology beyond the histology.” Histology assured us that this destruction process was not malignant but well beyond that was discovery of the novel and exquisite understanding of the molecular biology.
The importance of multiple parallel approaches. The detailed molecular biology suggested that a pharmacologic prophylaxis should exist, but none was ever found. Of the three possible alternate bearings, the most likely (metal-on-metal) failed badly and the least likely (metal-on-polyethylene) succeeded.
The critical role of “beyond luck.” It is essential to understand more fully that serendipity nearly always follows Pasteur's motto that “chance favors only the prepared mind.”
The irreplaceable role of persistence. This is almost a homily.
The unavoidable requirement of risk-taking. Forty years of metal-on-metal THA without pseudotumors provided no protection against its current ravages.
