Harris's 1994 narrative review synthesizes 35 years of THR history to answer one question: did eliminating cement eliminate osteolysis? Drawing on autopsy mechanics, cellular biology, and comparative clinical series, it examines the causes, mechanisms, and rates of periprosthetic osteolysis around cemented versus cementless components.
In the 1980s, 'cement disease' was accepted dogma — the belief that cement itself caused osteolysis drove a wholesale shift to cementless fixation. Harris dismantled this premise by showing that bulk cement is biologically inert and that osteolysis is driven by submicron polyethylene particles regardless of fixation method.
The clinical consequence was stark: cementless femoral components did not solve osteolysis. They worsened it dramatically, with lysis rates of 22–56% at 4–7 years versus 0–2% with second-generation cemented technique.
When counseling patients on femoral fixation, this paper is why we do not accept short-term follow-up data as reassuring. Lysis rarely appears before 2 years, and 5-year data is the minimum meaningful threshold.
The 'effective joint space' concept introduced here explains why lysis appears at the stem tip or acetabular dome. Particles travel the entire periprosthetic space, not just the area adjacent to the bearing. This framework shapes how we interpret lytic lesions on follow-up radiographs today.
Harris's conclusion. Cemented femur, cementless hemispherical cup (the hybrid construct). Became the dominant primary THR paradigm through the 1990s and 2000s, and directly catalyzed the development of cross-linked polyethylene and alternative bearing surfaces to address the root cause: particle generation.
Harris's 1994 narrative review synthesizes 35 years of THR history to answer one question: did eliminating cement eliminate osteolysis? Drawing on autopsy mechanics, cellular biology, and comparative clinical series, it examines the causes, mechanisms, and rates of periprosthetic osteolysis around cemented versus cementless components.
In the 1980s, 'cement disease' was accepted dogma — the belief that cement itself caused osteolysis drove a wholesale shift to cementless fixation. Harris dismantled this premise by showing that bulk cement is biologically inert and that osteolysis is driven by submicron polyethylene particles regardless of fixation method.
The clinical consequence was stark: cementless femoral components did not solve osteolysis. They worsened it dramatically, with lysis rates of 22–56% at 4–7 years versus 0–2% with second-generation cemented technique.
When counseling patients on femoral fixation, this paper is why we do not accept short-term follow-up data as reassuring. Lysis rarely appears before 2 years, and 5-year data is the minimum meaningful threshold.
The 'effective joint space' concept introduced here explains why lysis appears at the stem tip or acetabular dome. Particles travel the entire periprosthetic space, not just the area adjacent to the bearing. This framework shapes how we interpret lytic lesions on follow-up radiographs today.
Harris's conclusion. Cemented femur, cementless hemispherical cup (the hybrid construct). Became the dominant primary THR paradigm through the 1990s and 2000s, and directly catalyzed the development of cross-linked polyethylene and alternative bearing surfaces to address the root cause: particle generation.