This article is a comprehensive review of the published literature on total hip replacement design. It seeks to provide a nonbiased view of the technology related to total hip implants and bearing surfaces. Implant designs and fixation methods are discussed with summaries of their respective long-term outcome studies. Fixation methods include cemented, cementless and hybrid techniques and are explained and presented with current outcome data and their respective failure modes that have promoted new technological development. The current data point toward cementless acetabular fixation as being superior to cemented fixation. As for stem fixation, there are good data to suggest that either method of fixation is acceptable in the proper setting. Also included in this article is a brief review of bearing surfaces and hip biomechanics.