OBJECTIVES:  To determine which prosthetic hip implant combination of bearing surface materials, head sizes, and fixation techniques is most effective in primary total hip replacement (THR). Traditional small head, metal-on-polyethylene cemented implants have a long track record of use, but newer, more expensive implants were developed to improve implant survival. METHODS: We carried out a systematic review of randomised controlled trials comparing different hip implant bearing surfaces, head sizes, and fixation techniques used in THR and resurfacing hip replacement. Our primary outcome was revision surgery. An extensive search and risk of bias assessment were followed by Bayesian network meta-analysis with hazard ratios as the effect measure. We assumed the likelihood of revision surgery to differ between two time periods: shortly after primary surgery (0-2 years) and in the longer run (2-10 years), and we used a random walk model to relate long term to short term outcomes in a single modelling framework. In sensitivity analyses, we analysed both time periods separately. RESULTS: Of the 72 studies in our review, only 15 studies (3177 randomised hips) provided enough information to be included in the analyses. We did not find strong evidence that any of the implants reduces the risk of revision compared to the reference traditional implants. However, small head, metal-on-metal cemented implants (HR 4.44, 1.66 to 16.7 at 0-2 years) and resurfacing hip replacements (HR 12.2, 2.28 to 126 at 0-2 years) showed an increased risk of revision compared to traditional implants. These findings were robust when analyzing time periods separately. CONCLUSIONS:  We found no evidence that newer material combinations reduce the risk of revision when compared to traditional small head, cemented, metal-on-polyethylene implants. Nonetheless, resurfacings and small head, metal-on-metal cemented implants may increase the risk of revision compared with traditional implants.