By 2035, 23% of the population of the United Kingdom will be aged over 65 years according to the UK Office for National Statistics.1 The burden of an ageing population is exacerbated by rising obesity, which is associated with increased risks of developing osteoarthritis. The number of hip and knee replacements performed each year steadily rose from 47 000 in 2004 to 179 000 in 2010, according to data provided by the National Joint Registry, and will probably continue to rise.2 Moreover, the costs of artificial hip and knee implants are escalating, and the increased number of primary hip and knee replacements potentially means more complications, infections, revisions, and peri-prosthetic fracture operations.

How can the NHS deliver an effective, efficient, and cost effective joint replacement service in years to come? The incoming president of the British Orthopaedic Association, Timothy Briggs, has written a report that looks at the question of how to improve the quality of orthopaedic care in the UK. His report, entitled Getting it Right First Time, argues that front line clinical workers are best placed to drive the development of workable pathways of care.3

What are the problems that need …