One of the major issues confronting the contemporary hip surgeon is the choice of fixation. The correct decision as to the use or abandonment of cement is as yet unclear. The aim of this essay is to view those elements of the scientific process that would allow the surgeon to reach the correct conclusions during the next decade. General considerations are discussed that will help the reader analyze clinical series focused on this problem. Theoretical advantages and disadvantages of both cemented and cementless fixation are also discussed along with supporting data. The major reports of large series of cases pertinent to this issue suggest that results of cemented primary total hip arthroplasty (THA) are excellent in the short run but deteriorate with time. This is in contrast to the results of uncemented primary THAs, which are not only satisfactory in the short run but tend to improve with the passage of time. Uncemented primary THAs are a rational treatment in the young, active male. In revision surgery, cemented techniques are unsatisfactory. Uncemented techniques show promise but as yet remain unproven.