Min BW, et al. - Among patients younger than 50 years with osteonecrosis of the femoral head (ONFH), researchers assessed long-term outcomes for cementless total hip arthroplasty (THA) using metal-on-highly cross-linked polyethylene (HXLPE) bearing couplings. In patients younger than 50 years who had ONFH, they retrospectively assessed the clinical and radiographic results of a consecutive series of 85 THAs (in 67 patients) conducted with HXLPE liners (Durasul). Data reported that the mean Harris hip score was 49.3 points (range, 26–68 points) before surgery, which improved to 93.6 points (range, 87–98 points) after surgery. While the long-term effects of HXLPE particles remain unknown, the study's implant survivorship rate and wear rate are encouraging and support the continued use of metal-on-HXLPE bearing couplings in these high-risk patients as they do not generate any of the hard-on-hard coupling issues.