Total hip replacement for canine and feline patients affected by degenerative, traumatic, and vascular injury of the coxofemoral joint has become a highly successful orthopedic procedure. The highly effective BioMedtrix total hip replacement systems use cemented and cementless implants with unique design features to address a variety of bone conditions and surgeon expertise and preferences. There are pros and cons for both systems with common and unique complications that can occur in either system. Surgeon experience and adherence to the principles of technique will strongly influence the complication rate and outcomes.