Both noncemented fixation and improved cemented fixation of total hip replacements emerged to counteract the clinical and radiographic failures of early cemented procedures. A randomized clinical trial comparing a second-generation cemented with a second-generation noncemented total hip replacement demonstrated that in the medium term both implants allow excellent, disease-specific, global and functional capacity outcome measures. No significant differences existed between the cemented and noncemented implants in terms of these parameters or revision rate. Cost-to-utility analyses of both types of replacements revealed that total hip replacement is one of the most cost-effective medical interventions. Noncemented total hip replacements seem as efficacious as cemented devices in patients younger than 70 years.