Almost 40 years have passed since I performed the first total hip replacement in Columbus, Ohio, at the University Hospital, January 1971. During my practice years I performed over 15,000 arthoplasties of the joint, most specifically total hip replacement. During those busy years, I seldom took time to reflect on the surgical miracle that unfolded before me daily. Total hip replacement is now established as the premier surgical treatment for arthritis of the hip. It has continued to produce consistent results, characterized by pain relief and improved function with long term durability.

Modern total hip replacement was developed by Sir John Charnley, an English Orthopedic surgeon, who was actively practicing surgery during the 60's and 70's. On two occasions I visited his center in England and was most impressed. His contribution to orthopedics, specifically total hip replacement, was monumental.

I am amused when I recall a conversation I had with an older colleague, shortly after I commenced my practice, limited to joint replacement. He told me that there were so few patients with arthritis of the hip that I would never be able to do joint replacement exclusively. How wrong he was for soon I was extremely busy riding the wake of a new technology.

Currently there are approximately 300,000 people in the United States annually undergoing hip replacement surgery. The need and demand for the operation worldwide is immense. Moreover joint replacement is typically used in the elderly, as the population ages the demand for the procedure continues to increase. In the United States alone the number of patients eligible for Medicare will increase from nearly 36,000,000, in 2006 to nearly 145, 000,000, in 2015. This will be a dramatic increase in the number of people requiring orthopedic procedures, specifically joint replacement.

Orthopedic surgeons specializing in joint replacement technology are declining in number. This creates a major concern in the face of the increased numbers of the population requiring this operation. The reasons given for the declining physician work force include; discounted surgical fees, government bureaucracy and the litigious climate. These issues stand in face of the enormous task of managing patients undergoing total hip replacement. Although the complications are few, they can be serious. The post operative period requires close monitoring and supervision as the elderly often have compromised health. The performance of the surgical procedure requires physical strength and dexterity and is labor intense.

Total joint replacement is not the final answer. There will be a continued effort to enhance the regeneration of articular cartilage which will limit the indication for surgical intervention. Until that time, I am confident, total joint replacement will remain a valuable alternative.

Successful total joint replacement surgery offers great patient satisfaction; relieving pain, restoring function and personal fulfillment for the surgeon.