Total hip replacement was successfully introduced in November 1962 in England by the late Sir John Charnley with the expressed intention of relieving the pain and suffering of those afflicted with severe osteoarthritis of the hip joint. A significant amount of engineering and bio-engineering work went into the production of the final articulating surfaces of metal on high molecular weight polyethylene. This was meant to simulate the low coefficient of friction in normal articular joints. It was not long before this innovation spread throughout the world and today, most joints can be replaced by artificial equivalents. Over the five decades since its introduction, there have been changes in designs of implants with the use now of additional bearing surfaces, for example, metal on metal, ceramic on polyethylene and ceramic on ceramic. Joint replacement has been heralded as one of the greatest orthopaedic innovation of the 20th century. Initially, more hip than knee replacements were done; however, that trend has been reversed in most parts of the world (1).

Numerous studies have reported excellent long-term results in relieving pain and improving the quality of life in patients who otherwise would have had an arthrodesis of their hips for debilitating arthritis (2–4). Worldwide, the demand for total joint replacement has risen as the technology has improved and successful outcomes have been published. There is wide international variation in the number of total hips performed, with figures ranging from 50– 130/100 000 population with the higher figures in the Scandinavian countries (5). In the United States of America (USA), the situation is no different and there is a high demand for joint replacement, especially knees. Approximately 135/100 000 total knees as opposed to 50/100 000 hips were done in 2002 (6). In Jamaica, less than 150 hip replacements are done annually, making for a rate of 5.3/100 000 population. This puts us in the same bracket as Singapore which has a rate of 8/100 000 (5).

Using plain radiographic changes of the hip as the criterion for diagnosing osteoarthritis, it is estimated that approximately 15% of people over 65 years have arthritis of the hip joint (7). The prevalence of osteoarthritis in Jamaica is unknown. Assuming we have a similar prevalence locally, using recent population statistics, the age group 65 years and over accounted for 217 606 individuals or 7.8% of the population (8). This would equate to 32 000 individuals who are suffering from osteoarthritis of the hip alone. There is therefore a need for joint replacement locally.