Background: Major concerns in hip arthroplasty concern the fate of bearing surfaces. Highly cross-linked polyethylene materials (HXLPE) currently demonstrate successful in vitro results with new technical procedures of cross-linking the polyethylene material, whereas processing the polyethylene below its melting temperature to produce so-called "annealed HXLPE" would allow retention of important mechanical properties. Methods: Data released by the National Joint Registry of England and Wales addressing in 45,877 hips the same Trident uncemented cup, allowed us to compare the performance of a consecutive cohort of patients implanted with the newest generation of annealed HXLPE acetabular bearings (X3: 21,470) vs 2 consecutive nonselected cohorts, one with conventional polyethylene (N2vac: 8225) and one with ceramic-onceramic (CoC) hip bearings (AL: 16,182). The main end point in survivorship has been first defined as revision for any cause, then for any cause which could be related to a failure of the bearing couple. Results: At 6-year follow-up, all Trident cups demonstrated encouraging global survival cumulative rates all between 95% and 99%. A first study demonstrated better survivorship with X3-HXLPE liners vs conventional ultrahigh molecular weight polyethylene. On the second parallel study, the cumulative survival rates were better for X3 liners as compared to CoC bearings. Moreover, when ranking the yearly cumulative percent revision rates, again the best results were obtained with X3 liners with small alumina heads (cumulative percent revision rate at 0.298). Conclusion: Within the frame of this Trident study, the use of this X3 highly cross-linked annealed polyethylene could be considered as a reliable alternate solution to CoC bearings. (C) 2016 Elsevier Inc. All rights reserved.