The significance of implants and biotechnology surrounding them are frequently underestimated by the lay observer. For example, it is currently estimated that between 8 and 10% of Americans have a permanent implant of some kind. It is further estimated that one in four Americans over sixty years of age has an implant, and that nearly eight million total joints are currently in use in the USA. While it was difficult to find similar statistics outside of America, most would probably agree that similar percentages exist in the entire Western world.

Many of the advances in biomaterials, biomechanics and surgical instrumentation technology have occurred during the past fifty years. This presentation concentrates on the steps forward and backward during the last half of the twentieth century leading to the successful and gratifying experience most patients have with their total hip and total knee replacements today.

While many orthopaedic implants are used in procedures other than the replacement of arthritic joints, this presentation is principally oriented toward total joint replacement, which represents nearly half of the revenue generated by the orthopaedic industry today. It will also be heavily oriented toward the US experience due to the fact that the author's primary experience is within the American orthopaedic industry.

During the early decades of the twentieth century only a few meaningful steps in treating orthopaedic problems with implants were significant. However, the rate of the introduction of new technology increased substantially over time, especially during the last decade or two.