Every hip replacement makes a few design choices. For most of them, research finds small or no differences between well-established options. Your surgeon's experience with a system, your bone quality, your anatomy and your activity level all shape the choice.1
Fixation: cemented or cementless
Cementless (press-fit)CementedHybrid
Cementless implants have a rough or porous surface that bone grows onto over the following weeks. Cemented implants are fixed with bone cement and are stable immediately. A hybrid uses a cementless cup with a cemented stem. Cementless fixation is most common in the US for planned hip replacement.1
What the evidence shows
- For older adults with a broken hip, cemented stems lead to fewer fractures around the implant and slightly better quality of life25,26
Points of caution
- Uncemented stems carry a higher risk of fracture around the implant in older, weaker bone25
- Cement carries a small risk of a reaction during surgery that affects blood pressure and oxygen (bone cement implantation syndrome)26
Clinical detail- Cochrane (cemented vs uncemented HA): periprosthetic fracture RR 0.20 intraoperative and 0.29 postoperative with cement; pulmonary embolism RR 3.56.26
Bearing: what the ball and liner are made of
Metal or ceramic on polyethyleneCeramic on ceramicMetal on metal (rarely used)
The bearing is where the ball moves inside the liner. Most modern hips use a metal or ceramic ball on a highly cross-linked polyethylene liner. Ceramic-on-ceramic is another option, sometimes chosen for younger patients.1
What the evidence shows
- Modern cross-linked polyethylene has greatly reduced wear, which used to be a leading cause of failure1
Points of caution
- Metal-on-metal hips can release metal particles that cause tissue reactions; FDA has published safety information, and they are rarely used today50
- Ceramic components can rarely squeak or fracture1
Dual mobility
Standard (fixed) bearingDual mobility
A dual mobility hip has a small ball that snaps into a larger plastic ball, which moves inside the cup. The extra movement makes the hip harder to dislocate. It may be used for people at higher risk of dislocation.20
What the evidence shows
- A 2026 meta-analysis of 4,424 hips found much lower dislocation with dual mobility in complex primary hip replacements20
Points of caution
- Most data are short- to mid-term; long-term survival is not yet established20
Clinical detail- Dislocation OR 0.21 (95% CI 0.12 to 0.37) vs fixed bearing; complex primary subgroup 2/267 vs 14/233.20
Planning, navigation and robotics
ConventionalNavigation or ARRobotic arm
Technology can help the surgeon place the cup at the planned angle and check leg length. See robotics and navigation.
What the evidence shows
- Robotic systems reduce cup placement outliers21
Points of caution
- Long-term benefit for revision or function is not established; cost evidence is limited and partly industry-authored23