Installing a total hip endoprosthesis is one of the most successful orthopedic procedures today. For patients with hip pain due to a variety of conditions, total hip arthroplasty can relieve pain, restore physical function, and improve quality of life. It is indicated for patients who have failed conservative or previous surgical treatment of a damaged hip joint and who continue to have persistent, debilitating pain and a significant reduction in daily life activities. Patients with significant deformity and limited mobility may also be candidates if the resulting disability is significant, even in the absence of pain. The decision to undergo surgery is made with an understanding of the possible benefits and risks. A thorough understanding of the procedure and the expected outcome is an important part of the decision-making process. Modern technology and instrumentation along with standardized surgical methods and rehabilitation protocols make total hip arthroplasty a highly predictable, cost-effective reconstructive procedure for severely disabled patients. Until the advent of a reproducible biologic solution for hip osteoarthritis, total hip arthroplasty promises to remain an excellent treatment for patients suffering from end-stage hip arthritis.