As the world's population ages and the developed world seeks to determine how to best care for its aging population, the determination of the value of total hip replacements is becoming more critical and pressing. This paper reviews the recent literature describing the indications, comparative cost effectiveness, and comparative effectiveness in reducing pain, prolonging survival, and improving function and quality of life of THA in the treatment of osteoarthritis patients over age 65. This paper also compares the public health approach of the United States and United Kingdom in the treatment of osteoarthritis in their elderly population to shed light on different approaches to the same problem.