Metal on metal hip replacement is in news again.It was launched few year ago with fanfare & was advocated by group of surgeons for consideration in younger patients.Bone preservation was the main aim. Complications associated with metal on metal are now in news especially,"ALVAL"(asymtomatic lymphocytic vasculities associated lesions.This is unique to metal on metal hip replacements.It is time to ponder whether one should recommend it for their patients.