How I choose a bearing surface for my patients

There is insufficient clinical data to demonstrate the overall superiority of any one bearing couple for all total hip cases. It is therefore reasonable to individualize the choice of bearing surface. The fundamental exercise in choosing a bearing surface is maximizing the benefit to risk ratio. There are at least 3 perspectives to consider: the patient's, the surgeon's, and that of the health care delivery system. The following question should be addressed on a patient-by-patient basis: what available bearing is most likely to meet the needs of this patient, with an acceptable risk of revision surgery during his or her lifetime, is accepted in my community, and is there a means to pay for it?