The enduring success of the low friction arthroplasty advanced by Sir John Charnley as a solution for hip problems may be appreciated by the fact that in 1999, over 270,000 hip arthroplasties were performed in the United States. Over the last three decades, patient profiles have substantially changed resulting in a greater service life demand on UHMWPE hip components. Material failure, often leading to osteolytic response is increasingly associated with younger, more active patients. In this context, the low friction solution has become a problem limiting in vivo system longevity and initiated a reexamination of alternative bearing surfaces. This presentation summarizes current clinical solutions to long-term bearing articulation involving metal-polyethylene, metal-metal, ceramic-polyethylene and ceramic-ceramic alternatives. Clinical and laboratory evidences are presented which describe the efficacy and concerns of these bearing couples as well as their current availability through the FDA regulatory process.