Widespread use of XLPE has reduced the incidence of both revision surgery and dislocations. This paper aims to create gross estimates of the magnitude of the resulting cost savings.

Data about decreasing rates of revision surgery and dislocations after THA, comparing XLPE versus CPE, were obtained from the literature along with figures for costs. Gross estimates were generated from these figures.

AOA NJRR 17 reports that at 15 years XLPE reduced the “all cause” revision rate of ceramic on polyethylene by 6.8% and at 16 years reduced the rate for metal on polyethylene by 6.5%. Their average 15 year figure was 4.8%, nearly in half. Dislocations were reduced by 24%. Other data substantiate these trends.

Inclusive costs of nonseptic revisions in US dollars, incorporating those relevant costs for the year prior to and the year following surgery, have been shown to average in the neighborhood of $55,000. Dislocations add further to the costs. The estimated savings from XLPE by 15 years on those total hip replacements done in one year in North America equal nearly $1 billion, even without incorporating any increase annually in the number done. While the specific savings in other countries with lower costs are less, similar proportions likely obtain. Despite all the assumptions, the magnitude is striking.

In addition to major benefits to the patients, the surgeons, and the hospitals, XLPE affords a massive advantage economically.

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.