Evaluation of: Pennington M, Grieve R, Sekhon JS, Gregg P, Black N, van der Meulen JH. Cemented, cementless, and hybrid prostheses for total hip replacement: cost effectiveness analysis.BMJ346, f1026 (2013). Total hip arthroplasty is an extremely successful operation by almost any measure. As the population in the developed world ages, it is also becoming a very popular operation, with nearly 500,000 replacements predicted in the USA by 2030. As more hip replacements need to be performed, the cost will become more of an issue. The debate between the effectiveness of implant types, cemented or cementless, has been ongoing for years. Although largely decided in the USA, in favor of cementless implants, the discussion in the UK continues. There are many studies arguing in favor of implants using cement and for those not using cement. Ultimately, the best implant is the one that is most comfortable in the hands of the surgeon implanting it. Financial factors must be considered, however, and the more information available, the better to help surgeons decide what is best for their patients.