Total hip arthroplasty (THA) surgery has shown dramatic changes in terms of increased number of procedures and of technical development in recent years. It has been described as "the operation of the 20thcentury" for the excellent results, the high satisfaction of the patients and the improvement of the quality of life.A lot of variations have been introduced over the last few decades in THA especially in terms of indications (both in younger and older patients), techniques and devices (approaches, tissue preservation, biomaterials and industrial finishing), per-operative management (blood loss and pain control) and post-operative protocols (the so called "fast track" surgery). Looking at all these advances the emerging question is: have all of them been justified both in terms of improvement of the results for the patients and of the cost/benefit ratio from an economical point of view?The purpose of this paper is to critically analyse the advantages and the disadvantages of the theoretically proposed "advances in hip arthroplasty" and attempt to understand which are justified of such "advances" nowadays, based on the international and the European perspective with a focus on the author's personal clinical experience. Cite this article:EFORT Open Rev2017;2. DOI: 10.1302/2058-5241.2.170008. Originally published online at www.efortopenreviews.org.