Total hip replacement is one of the most successful procedures in surgery. In Germany there is a great variety of cemented and uncemented implants with different principles of fixation. We reviewed the different principles, with particular reference to long-term clinical outcome, and discuss the most popular systems available in Germany. Despite many new developments which have been made in the field of cementless hip replacement, cemented total hip arthroplasty will remain the "gold standard" until prospective long-term data (> 15 years) of cementless systems become available.