80 adult patients undergoing total hip arthroplasty (THA) were randomly assigned to one of four bearing surfaces: cobalt-chrome (CoCr) and ultra-high molecular weight polyethylene (UHMWPE), CoCr and oxidized zirconium and cross-linked polyethylene (HXLPE), Oxinium and UHMWPE, and Oxinium and HXLPE. The purpose of this study was to investigate the clinical and radiographic outcomes in these four bearing surfaces at 60 months postoperative. Findings revealed that the use of HXLPE provided a significantly lower linear wear rate than UHMWPE at final follow-up, but there were no differences between the use of CoCr and Oxinium femoral heads. Additionally, there were no significant differences in clinical outcomes between bearing surfaces at any time point.