Total hip replacement can provide pain relief and restore function in patients suffering from hip arthritis, including in those under the age of 50. However, shortened implant longevity in this age group has been a concern because the clinical results after revision surgery are inferior to those after primary hip arthroplasty. Technical choices (approach, implants, type of fixation and bearing couple) must be made to maximise longevity based on published data and thoroughly discussed with the patient. Finally, long term results (clinical outcome and implant longevity) associated with this surgery are such that it appears unnecessary to postpone the surgery once the indication is established.