Cemented total hip arthroplasty is a revolutionary procedure in the care of the patient with arthritis of the hip. Despite this, a certain percentage of cemented total hip arthroplasties fail over time, leading to the development of methods to achieve biologic fixation by bony ingrowth into porous surfaces, and to improve the success of cementing techniques. Recent studies have shown that durable fixation can be achieved with cementing techniques using previous designs with a follow-up of greater than 20 years. The technology of cementless total hip arthroplasty is evolving at an unprecedented rate and it could remedy the few shortcomings seen in earlier cementless designs. The advantages of each type of fixation are becoming clearer, but the issues are far from resolved. A review of the current literature is necessary in order to make an informed decision regarding the type of fixation for each individual patient.