In a Sept. 17, 2014 JBJS article, David Ayers, MD and Patricia Franklin, MD outline lessons to be learned from the evolving U.S. and international total joint replacement registries. In a thought-provoking comment on that article, Shyan Lii Goh, an orthopaedic surgeon practicing in Australia, pinpoints some of the challenges American registries face. “An opportunity within grasp, but not taken, is still lost,” Dr. Goh observes.