Since Alan Apley published the first edition of this book the world has changed considerably and so has the practice of orthopaedic surgery. In 1959, hip replacement was rare and had high failure rates, knee replacement and arthroscopy did not exist and fractures were primarily treated in traction. The last edition of this book commented on the projected impact of the HIV/AIDS epidemic. The epidemic has largely been brought under control, with effective treatment resulting in normal life expectancy for sufferers. However, in untreated individuals, the incidence of secondary infection such as tuberculosis is high and the prognosis is still dire. It is interesting and encouraging to note that both the National Joint Registry for England and Wales and the Malawian Joint Registry have shown that hip replacement is an effective treatment for patients who have multimorbidity which includes AIDS with no increased risk of early postoperative mortality compared with patients who do not have AIDS.
Over the lifetime of this book many treatments have been invented, extensively used, found to be ineffective or suboptimal and subsequently have declined dramatically in popularity. Examples of this include arthroscopic debridement for knee osteoarthritis, metal-on-metal hip replacement and excision arthroplasty of the distal ulna. It is important that we continue to challenge the efficacy of existing and novel treatments. In a world of increasing global need orthopaedics has to be proven to be efficacious and cost-effective. Since 1959, the world’s population has more than doubled to over 7 billion people and has aged considerably. Life expectancy at birth is now 80 years in Europe and 74 years in Asia. There are still marked disparities – for instance Japan has a life expectancy at birth of 83 years compared to 57 years in South Africa – but these differences are narrowing. It is projected that by 2050 4% of the world’s population (but 16% of Japan’s population) will be over 80 years of age.