Ultra-high molecular weight polyethylene (UHMWPE) materials have played a significant role in the field of reconstructive surgery, particularly as acetabular liners/sockets for total hip joint replacement (THR), and tibial inserts for total knee joint replacement (TKR). This review aims to provide a perspective on key elements regarding the processing-structure-property relationship of UHMWPE and derivatives. Much emphasis will be provided to discuss the clinically relevant properties of UHMWPE blend/composite formulation, Vitamin-E reinforced or highly crosslinked variants. In addition, we provide clinical insights into the role of wear debris in inflammation and osteolysis. The relatively unexplored domain of UHMWPE additive manufacturing. Finally, the relatively unexplored domain of UHMWPE additive manufacturing and the opportunities associated with the next generation of UHMWPE implants are highlighted.