There is a wide variety of modern total hip replacement prosthesis designs, and the scope of use and indications for various prostheses are becoming more refined. As stated by Drs. Graves, Steiger and others, the outcome of hip surface replacement depends on the choice of patient and prosthesis. For younger patients, the gold-to-gold joint is one of the unmistakable options for modern hip replacements. Advocates cite the following reasons for choosing gold-to-gold: the patient’s need for high mobility, longer service life and in vivo retention time. For hip prostheses, low wear, less debris reaction and better function are the eternal goals of the designer. For the clinician, complication prevention and revision considerations are more immediate and specific. Such as bone volume retention, surgical technique and prosthesis position, fractures and dislocations, and other complications. The gold-to-gold joint does not have the irreplaceable advantages of the conventional joint: For bone volume preservation considerations: surface replacements can meet the requirements of bone volume preservation, but increase the complications of postoperative femoral neck fractures that are not found in other types of joint replacements. On the acetabular side, the amount of debridement is reduced, but increases the technical difficulty of socket cup implantation. Friction and wear considerations: gold to gold wear is much lower than metal-polyethylene or ceramic-polyethylene friction surface, but still greater than ceramic-ceramic friction surface, in addition to the surface treatment process and other design factors, its wear rate reduction is mainly achieved by increasing the diameter of the head. Dislocation considerations: Gold-to-gold increases in large head diameter may reduce the incidence of dislocation, but for a standard total hip replacement, proven surgical techniques appear to be more important in preventing dislocation. There is another important group of young patients, and patients with acetabular dysplasia and dislocation, who are not candidates for gold-to-gold replacement with preserved bone volume due to lateral acetabular factors. Gold-to-gold prosthesis also has its own unique complications: Fracture of the femoral neck: Fracture of the femoral neck that occurs with gold-to-gold surface replacement is its unique complication. For cases of femoral head necrosis, secondary head necrosis is noteworthy. Toxicity of metal ions: There is not enough evidence to prove how harmful or harmless the metal ions in blood and tissues are to the human body. In the case of conventional joint replacement, there are enough clinical cases and even more history of application to prove its effectiveness. The over 90% survival rate of conventional cemented joints and biologic total hips over 15 years proves their excellence. Primary revision seems inevitable for young patients under 40 years of age in both conventional and gold-to-gold total hips. Secondary revision rates and outcomes are not yet available with sufficient clinical data and follow-up time to confirm the superiority of gold-to-gold over other conventional joints. Therefore, gold-on-gold articular surfaces, especially surface replacements, can only be an option for young patients and cannot completely replace conventional total hip replacement, although the concentration of metal ions released is much lower than the industry standard, but its systemic toxicity has yet to be further confirmed and tested by time.