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The optimal fixation of the acetabular component in primary total hip arthroplasty remains controversial. Long-term follow-up studies show that significant loosening rates occur with cemented acetabular components and that these problems persist despite attempts to improve cementing technique. Cementless acetabular components that rely on biologic fixation can have lower rates of radiographic loosening at 10 years compared with cemented acetabular components. Although revision rates for both modes of fixation are largely equivalent at 10 years, the superior radiographic performance of cementless acetabular components at 10 years suggests that biologic fixation through bone ingrowth may provide more durable long-term implant survival compared with cemented fixation. Osteolysis is the major obstacle to long-term cementless acetabular component survival. Potential future options that may inhibit osteolysis include decreasing bone resorption that results from debris-stimulated foreign body response through the use of medications; decreasing the number of particles generated by using alternative bearing surfaces; and improving bone ingrowth, particularly through the use of growth factors and improved implant materials and designs.