Attempts to resurface the hip joint date back to the 1930s. Throughout the last century many designs failed due to defective materials or fixation (or a combination). The metal-on-metal designs pioneered at the end of the century appeared to herald a new era, until difficulties associated with adverse reactions to metal debris were identified. Ultimately, a much narrower range of indications emerged - large, young males appear to be the ideal recipients. Implant design features and component orientation are crucial to the survivorship of these implants.