Often we are consulted by patients who have noted decreasing athletic skill, due to a painful joint. They used to be avid tennis players, runners, and/or other sports; you can fill in the blanks. They come to discuss the possibility of joint replacement to get them back to their previous level of competition without pain. This often poses a dilemma for the surgeon performing joint replacement because in general and traditionally, joint replacement has been thought of as a procedure to alleviate the pain and the loss of function in the individual who has severe arthritis and can no longer carry out activities of daily living. As our techniques have improved and implant materials become more durable, the indications have been pushed a bit to where patients expect and at times doctors commit to surgical intervention in the face of potentially unrealistic expectations. Joint replacement is an extremely reliable procedure and can deliver pain relief in up to 90% of patients and in a well conditioned individual, the ability to return to various athletic endeavors is very real. The concern remains long-term durability. If you expose total hip and knee replacement to repetitive high impact activity, even the newest bearing surfaces will ultimately breakdown under these loads. There has to be a balance between activity and longevity and it is the job of the surgeon to discuss these in detail with the patients. We as surgeons know the reality of bearing surfaces and function and it is our job to make sure that we educate the patient as to where their expectations fit in line with the reality of these bearing surfaces. It is our hope as surgeons that patients return to an active lifestyle to promote health, maintain their weight, and improve their strength. Excessive high impact activity can certainly shorten the life expectancy of a joint replacement and make a revision procedure necessary sooner than the patient and surgeon would like. The balance between activity and longevity should be discussed with your surgeon so that you as the patient have a good understanding of what to expect and realize the potential price you may pay by excess activity.