Background: Potential advantages suggested but not confirmed for surface replacement arthroplasty (SRA) over THA include lower frequency of limp, less thigh pain, less limb length discrepancy, and higher activity. Questions/purposes: We therefore determined whether patients having SRA had a limp, thigh pain, or limb length discrepancy less frequently or had activity levels higher than patients having THA. Methods: In a multicenter study, we surveyed 806 patients aged 18 to 60 years with a premorbid UCLA activity score of 6 or more who underwent hip arthroplasty for noninflammatory arthritis at one of five orthopaedic centers. Patients had either a cementless THA with an advanced bearing surface (n = 682) or an SRA (n = 124). The patients were demographically comparable. Specific telephone survey instruments were designed to assess limp, thigh pain, perception of limb length, and activity levels. Minimum followup was 1 year (mean, 2.3 years; range, 1.1-3.9 years). Results: When controlled for age, sex, and premorbid activity level, patients with SRA had a higher incidence of complete absence of any limp, lower incidence of thigh pain, lower incidence of perception of limb length discrepancy, greater ability to walk continuously for more than 60 minutes, higher percentage of patients who ran after surgery, greater distance run, and higher percentage of patients who returned to their most favored recreational activity. Conclusions: When interviewed by an independent third party, patients with SRA reported higher levels of function with fewer symptoms and less perception of limb length discrepancy compared to a similar cohort of young, active patients with THA. Level of Evidence: Level III, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.