Total hip arthroplasty (THA) is among the most clinically efficacious and the most cost-effective orthopaedic operations in the past 5 decades. Most would credit Sir John Charnley as the pioneer in the development and in the introduction of contemporary THA materials, designs, and surgical techniques in the early 1960’s. Many innovations have been developed and introduced into clinical application since that time. Unfortunately, many failures have also been realized over the past 50 yr. This review focuses on the innovations and complications in THA in the past 2 decades.