The Aga Khan University (AKU), the first private medical college in Pakistan, was also the first institution in the country to start knee arthroplasty in the late 80s, and currently performs approximately 500 total hip and knee arthroplasties annually. AKU developed a clinical pathway for patients undergoing knee replacement surgery that has been used for the last 20 years. Over time, it has evolved to meet our changing practice and evidence-based protocols. Our work has focused on different aspects of arthroplasty including: complications, outcomes with respect to surgeon volume, blood loss in unilateral and bilateral surgery, and developing Objective Structured Assessment of Technical Skills (OSATS) for the assessment of surgical competence in the operating room. Our Surgical Site Infection program for arthroplasty reported infection rates in accordance with international benchmarks. We have an ongoing prospective cohort study for arthroplasty patients to assess the relationship between Staphylococcus aureus carriage and Surgical Site Infections. We have also published work on hip fractures reporting intraoperative tips and tricks, and a systematic review evaluating the role of surgeon and hospital volume on postoperative morbidity and mortality after hip fractures. Our research has analyzed the effect of delays, type of anesthesia, after-hours surgery, and resident work hour reforms on outcomes of hip fracture surgery. We have also published on surgical techniques for octogenarian patients with hip fractures as well as improvement in quality of life after hip arthroplasty surgery.