(iv) Bearing surfaces in the young patient: out with the old and in with the new?

SummaryTotal hip arthroplasty has been one of the most successful orthopaedic operations over the last half century, reducing pain and restoring function to millions of patients all over the world. This success has led to younger patients hoping to benefit. There is an increasing range of implant designs and bearing surface choices available for this challenging group of patients.Metal on ultra high molecular weight polyethylene (UHMWPE) remains the gold standard but predictably fails by way of osteolysis secondary to polyethylene wear, particularly in the active patient. This has prompted a resurgence in the development and use of the previously tried but forgotten ceramic and metal articulations, as well as the advent of he new highly-crosslinked polyethylene (PE). It is these bearing surface options that are discussed in this review.