Analysis of the incidence of total hip and knee replacement over the next 20 years, as baby boomers reach retirement age, anticipates a six fold increase in the number of knee replacements done by 2030 and a doubling of the number of hip replacements. In 2016 there will be over 572,000 hip replacements and 3.5 million knee replacements performed. In 2005, 7% of the American Academy of Orthopaedic Surgeons identified themselves surgical specialists for adult hip and knee replacement. The number of adult joint reconstruction surgeons is decreasing while the number of patients requiring joint replacements is significantly increasing. This added to the fact that from 1991 to 2007 there has been a 40% decrease in reimbursement for hip replacement while during that same period there has been a 49% cost of living increase, is creating a challenging environment for joint replacement surgeons to continue to undertake the increasing volume of patients as we go forward over the next 20 years.