Total hip replacement (THR) is an established procedure for symptomatic end stage arthritis of the hip to improve function and alleviate pain thereby improving the quality of life of millions of patients. Of the range of possible joint replacements, it is suggested that THR is a landmark surgery. It is one of the most cost effective and predictable operations. Its success in the short term as well as in the long term has led to THR being performed in younger and more active patients. Survival of THR in the young and active patients was suboptimal for many years and management of this group continues to be a challenge. This paper provides an up-to-date review of the relevant history of uncemented hip replacements, key design features, mechanisms of fixation, current status, guidance to use and long-term results of uncemented hips.