Orthographic radiography, a revelation at its inception, has been the orthopaedic standard for a century. It has facilitated osteology and empowered arthroplasty like no other parallel technology. While many new imaging modalities – nuclear scans, computerized axial tomography, magnetic resonance imaging, etc. – have advanced the art even further, plain XRays, quite frankly, remain the standard for identifying patient pathology and evaluating surgical intervention. The enlightened scrutiny of properly obtained and successfully reproduced radiographic images still yields far more information in the daily practice of orthopaedics than its more sophisticated and expensive derivatives. A detailed review of readily available diagnostic information is intended to rejuvenate/resuscitate our most valuable ally in the evolving struggle against arthritic disease.

Surgical skills and the principles of efficient behavior are often formed very early in a clinical career. They are rarely consciously analyzed or critically evaluated thereafter. Indeed, it is fair to say that more surgeons have videotaped their golf swing than their surgical technique.

Operative efficiency is a critical ingredient to surgical success. Efficiency creates speed and speed begets volume. Complication rates are directly related to shortened surgical times and highly efficient operative procedures. The concept of creating “muscle memory” through repetitive task, of eliminating costly gaps in surgical flow, and the willingness to analyze and alter even the most successful practices are the essence of personal improvement. While patterns of behavior in surgical experience vary enormously, the principles of expeditious surgeries include such mundane considerations as consistent staff, a simplified surgical system, extensive preoperative preparation, instruments that suit the surgeon more than the patient, and the innate desire to improve the result with every procedure. While rarely discussed, the concepts of appropriate volumes, outcomes oversight, and cost accountability will undoubtedly define the success of joint centers in the 21st t century.