Treatment of the young patient with degenerative disease of the hip has historically been a difficult problem for the orthopaedist. Total hip arthroplasty in the young patient has generally produced inferior results as compared to older patients. Surface replacement arthroplasty (SRA) was initially developed over 50 years ago to treat degenerative disease of the hip. It has regained enthusiasm over the last 10 to 15 years as an alternative to total hip arthroplasty for the treatment of degenerative disease of the hip in younger patients. The modern metal-on-metal bearing provides improved wear characteristics over its metal-on-polyethylene predecessor. Multiple studies have demonstrated mid-term results of metal-on-metal SRA, which are comparable to total hip arthroplasty. The long-term survival data of SRA remains to be seen, as does the long-term effect of elevated serum ion levels.