Nicklaus -- who won't be at Augusta this month for the first time in 41 years -- decided in January, after months of consideration, that the pain of hobbling around on his arthritic left hip should end, and on January 27 he became one of the more than 300,000 Americans who will have hip-replacement surgery this year.

In recent years the pain and discomfort of an arthritic hip had become unmanageable for Nicklaus. Like many, he pursued alternative remedies until he was forced to bow out of the 1998 British Open. Throughout the fall Nicklaus, who experienced little pain when simply walking or simply swinging but frustration and discomfort whenever he did both, assessed his lifestyle and accepted some short-term idleness to achieve a long-term goal -- ending his career by playing every major championship in 2000.

The bad news is that Nicklaus' ailment, the degeneration of the hip joint, is common among the 50-plus population on the U.S. The good news is that hip-replacement surgery has proven to be remarkably successful and safe. In the last 20 years the cost of the operation has risen to an average of $20,000-plus per hip (including hospital costs), but the procedure has also become less invasive and the healing time has decreased significantly. Most patients, even avid golfers, are now leading "normal" lives in just three to six months.

With 36 million Americans suffering from some form of the more than 100 varieties of arthritis, the popularity of hip surgery will continue to grow. Approximately 16 million people alone suffer from osteoarthritis, the most common form, which specifically affects joints. Hip surgery has become so commonplace that it has already spawned a cottage industry, including one satisfied patient's Web site (onbeinghip.com) that shamelessly offers a 50-page booklet sharing his experiences of surgery, all for just $19.95.

The human hip is a ball-and-socket joint designed to support your body's weight, aid in balance and allow you to walk and turn. The hip bone allows the ball-shaped end of the large bone in your leg, the femur, to move softly and rotate as required.

Because of their construction and the multiple duties they perform, hips are subject to excessive wear and tear. Over time the joint can degenerate and become inflamed or arthritic until the range of motion in the leg decreases. With osteoarthritis, as this condition is known, the soft lining or cartilage that surrounds the bone decomposes to the point that the femur grinds directly on rough bone in the socket, causing great pain -- as was the case for Nicklaus.

Another condition that can lead to hip replacement is avascular necrosis, when the round-shaped head of the femur loses its blood supply and actually dies. This condition is often associated with alcoholism, substance abuse, fractures and dislocation of the hip. Rheumatoid arthritis, a chronic inflammatory disease, can also affect the hip until surgery is a formality.

In each case, hip-replacement surgery can allow dramatic pain relief, can restore full function to the hip joint and return patients to an active lifestyle. According to the American Academy of Orthopaedic Surgeons, around 60 percent of hip replacements are performed on women, and the average ages are 69.6 for women and 63.1 for men. Sixty-eight percent of surgeries are performed on those aged 65 and over.

Nicklaus, of course, isn't the first professional athlete to undergo hip surgery. Former professional football and baseball player, Bo Jackson underwent hip replacement surgery in 1991, after a dislocated hip suffered during a tackle revealed avascular necrosis. Jackson returned to baseball briefly, but his hip couldn't withstand the pounding. As one surgeon suggests, "This surgery is great, but it isn't good enough to allow people to slide into second base."

Senior PGA Tour veterans George Archer and Bobby Nichols have had the surgery in the past few years, and both have successfully returned to the tour. In fact Archer won the First of America Classic last year, only two years after his procedure. Nicklaus, who was queasy about going under the knife, spent months asking them and others questions about their experiences.

Nicklaus deliberated so long that Nichols was concerned that the Golden Bear would delay his decision so long that he'd cause serious injury. "When you alter the way you do things, when you compensate for an injury" Nichols says, "your body starts to break down in other areas. If Jack had kept going, he may have had serious back problems."

Ironically, Dr. Charles Engh, a surgeon at the Inova Joint Replacement Center in Springfield, Virginia, believes that because Nicklaus delayed his surgery, his recovery may actually be faster than the average patient. The aggressive fitness regimen Nicklaus adopted in a vain attempt to fend off the hip problems likely provided him with the strength to sail through recovery.

Nicklaus spent years trying to find alternative ways to control the pain in his hip. In 1997 he experimented regulary with alternative medicine including treatments from an unlicensed provider who sent an electric current through Nicklaus' body while his feet stood in water. In later months, Nicklaus adhered to a stretching regimen prescribed by his longtime physical therapist, Pete Egoscue.

Like Nicklaus, Nichols procrastinated for about eight months before having both his hips replaced over a span of six months in 1996. He spent most of that year off the golf course. "I should have had it done much sooner," Nichols now says. "No matter what you do before surgery, the pain is going to come back. You just can't get comfortable when your hip is hurting. It's isolated and specific pain, and there's a lot of difference between pain and soreness. If you can't have a normal life, I would suggest getting it done."

Archer spent two years talking to surgeons before he had his surgery. "I knew it was time for surgery when I started finishing my swing with one hand," says Archer. "I ended up with a one-handed follow-through." Archer took three months off before he played again.

The obvious question for avid golfers is how will surgery affect your game? Well, unless you're a legitimate senior tour candidate, you've got to weigh the benefits of overall health and a pain-free existence against the importance of your golf handicap.

By today's standards the surgery is relatively simple and safe. The procedure takes between one and three hours and patients are typically in the hospital for at least five days.

Patients can have both hips done at the same time, though it's a fairly rare procedure. Dr. Adrian Graff-Radford, from the Desert Orthopaedic Center in Rancho Mirage, California, operated on Archer and tennis legend Rod Laver. He believes that a one-at-a-time approach generally allows for an easier recovery, simply because one strong hip to stand on will allow your other hip the best opportunity to heal. Graff-Radford says he performs only two or three double-hip operations per year, based on the strength of the patient and his or her bone structure.

How is the surgery done? First, an incision is made on the side of the thigh for the surgeon to access the hip area. The length of the incision is decreasing as technology improves, but it's usually around 10 to 12 inches.

The circular head of the femur bone is sawed off and replaced by an artificial piece later in the procedure. All of the deformed cartilage is then removed from the acetabulum, the cavity area in the hip bone, allowing the space for a replacement part to be inserted. This first piece (or prothesis) comes in two varieties, and your choice will depend on the strength of your bones.

The original model, designed 40 years ago, is simply glued in place using an epoxy cement. The other, invented 20 years ago, has a fine mesh of holes on its outer surface that allows bone to grow into the mesh. Patients with poor bone quality and active lifestyles are more likely candidates for the cemented variety, particularly as the recovery time for the uncemented prothesis is considerably longer. There is, however, no definitive research at this stage to suggest that one model is consistently better than the other.

The other side of this piece, where the replacement femoral head is attached, is predominantly a slick plastic cup that acts as a bearing, though developments in technology suggest that other materials may characterize the future.

The femur is then shaped to attach the artificial femoral head, also a metallic piece that's often a shaft with a metal or ceramic ball on top. Once the two new pieces are connected, the surgery is completed by sealing the incision.

Healing time varies. There is typically swelling of hip for three to six months, and patients often use crutches or walkers. It's a simple matter of resting, giving your leg some time to settle and for the wound to seal itself. For the first three weeks you'll walk on crutches, and try to sleep on your back in order to reduce the risk of the joint dislocation during the night. Seventy-two-year-old Bart Zucosky, from Clark, New Jersey, followed his surgery with six weeks of physical therapy three times per week, and found this most beneficial to his recovery.

Dr. Engh usually allows his patients who play golf to chip and putt within two or three months, but usually won't allow anyone to take a full swing until three to six months into recovery.

Active patients can become frustrated with the rest period following surgery, and many have trouble finding the patience to cope with the rest time. Chuck Dolan, a New Jersey-based attorney and high-handicapper replaced both his hips in 1990, allowing 10 months between surgeries. Dolan's hip problems peaked when he broke down in pain during his daily run. Four months later he was on the operating table.

The 61-year-old Dolan's approach to recovery was manic. He was back to work in three weeks on each occasion. "I got sick of sitting around the house," he says. He was playing golf within three months and hasn't looked back. "It has just been a wonderful experience," Dolan says. "I've played pain-free golf all over the world ever since then." His follow-up X-rays have confirmed that the replacement joints are still in good form.

Archer, who contends with more frequent and demanding physical activity than the average amateur, is pleased with the results of his surgery. He admits to a noticeable loss of power in his game but says, "I have good days and bad days, but the pain is gone."

Graff-Radford says Archer struggled with his swing after surgery because of the weight he placed on his right side during his backswing. Until his right leg strengthened, Archer's swing plane was affected by the fact that he was trying to accommodate for his lack of strength.

Most of the problems with the surgery have been eliminated. In the early years of the procedure the prostheses were prone to wear out. Older models loosened and dislocated, particularly when installed in highly active patients. This often required repeat surgery after 10 to 15 years. Furthermore, recovery periods were much longer because of the substantial incision and wound inflicted on the the thigh. Today, blood clots can still cause the leg to swell, and infection of the joint is possible, although such complications are increasingly rare.

The industry is also now expanding steadily to shoulders, elbows, fingers and toes -- surgeries previously considered too dangerous or lacking in technology. And as the reliability of parts has improved, hip surgery has become more feasible for younger patients.

One of the most dramatic advances has been the improvement of the replacement parts, which is all but eliminating the need for repeat surgery. The inner plastic surface of the commonly-used acetabulum attachment is now being challenged by longer-lasting materials. Through greatly refined manufacturing procedures, both ceramic and metal prostheses are much more reliable. Metal bearings, for example, fashionable in the 1970s, offered mixed long-term results because of the inconsistency of the materials. The newer materials, however, have been widely used in Europe for the past 10 years and currently are being used by selected hospitals and surgeons in the U.S. as part of an FDA study prior to federal approval.

Not everyone is waiting for the government's green light. Nicklaus, for example, had ceramic prostheses installed by Dr. Benjamin Bierbaum at New England Baptist Hospital, in Boston, one of the 10 hospitals participating in the study.

"Plastic has proven to be fine for older, less active patients," says Ned Lipes, president of Osteonics Corporation, a New Jersey-based orthopedic parts manufacturer that is creating ceramic parts, "but ceramic parts will sustain more pressure and last longer. The issue at this stage is the price of this material, which may currently cost a patient around 20 percent more for surgery."

Dr. Harlan Amstutz, medical director at the Joint Replacement Center at Orthopaedic Hospital in Los Angeles, has helped pioneer the comeback of all-metal parts, and is constantly testing surface-replacement parts (using the technique illustrated by the X-ray on page 62).

"Aside from the wear of the plastic," says Amstutz, "there is sometimes an inflammatory and toxic reaction of the body to plastic, but we don't really know what causes the reaction. If you're considering surgery, you should investigate all the options for materials. This is a very exciting time for design in this industry."

The future of hip surgery will likely include even less invasive techniques, robotic and video camera-guided procedures and require incisions of perhaps four inches or less. Parts with composite materials are likely to develop. Graff-Radford believes that further studies in the areas of bone growth and body biomechanics may determine the direction of the industy's future.

Meanwhile, George Archer, who continues to win on the senior tour courtesy of a titanium hip, reflects on the health of the aging population, and suggests that anyone who delays a needed hip-replacement surgery may be sacrificing some prime years. "Nicklaus played his best golf at 30," he says, "but now many people are playing their best at 60 or 65."

George Peper: Hip, hip hooray!