Arthroplasty of the hip and knee remain 2 of the 3 best qualities of life improving surgical procedures performed in the world today. In the past 20 years, there have been remarkable advances in surgical technique, approach, prostheses and also patient expectations. Hip (THR) and Knee (TKR) replacement are now routine procedures, with approximately 100,000 of each performed in the UK annually. Lives are transformed and quality of life improved. Patient pathways, pre, peri and post operatively, have been developed that improve expectations, reduce hospital stay and potentially improve outcomes. Revision surgery is the next great headache for arthroplasty surgeons, as primary procedures are performed in ever younger more active patients, and the older patients have higher expectations and life expectancy. Surgery for wear will become a lesser problem, with improved bearing combinations, peri-prosthetic fractures are increasing exponentially, however infection remains the great unanswered problem. I will present on my own journey as a consultant arthroplasty surgeon over 20 years, incorporating over 2800 THR, 950 TKR and 500 Revision procedures. I will include my own treatment algorithms and how they’ve changed, and showcase some examples

Andrew SW Bruce obtained his medical degree from the University of Sheffield in 1993. He completed his basic surgical training in South Yorkshire, followed by orthopedic training in Durham, Whitehaven, and the South Trent rotation based in Leicester. He then undertook fellowship training in Coventry, where he gained advanced expertise in complex primary hip replacement surgery and all aspects of revision hip surgery. In 2006, he was appointed as a consultant orthopedic and trauma surgeon in Doncaster. He also serves as an honorary defence consultant orthopaedic and trauma surgeon, having dedicated over 30 years to the reserve forces, where he holds the rank of lieutenant colonel. He completed two tours in Afghanistan at Camp Bastion Field Hospital. His primary areas of practice include hip and knee replacement as well as revision hip surgery. He has a particular interest in the diagnosis and treatment of Greater Trochanteric Pain Syndrome (GTPS) and trochanteric bursitis. He is listed on the General Medical Council (GMC) specialist register for trauma and orthopaedic surgery. He is certified by the Royal College of Surgeons of England and is a member of the British Orthopaedic Association (BOA), the British Hip Society (BHS), the British Medical Association (BMA), and the Combined Services Orthopaedic Society (CSOS).