The effect of the roughness and topography of ultrahigh molecular weight polyethylene (UHMWPE) bearing surfaces on the microscopic contact mechanics with a metallic counterface was investigated in the present study. Both simple sinusoidal roughness forms, with a wide range of amplitudes and wavelengths, and real surface topographies, measured before and after wear testing in a simple pin-on-plate machine, were considered in the theoretical analysis. The finite difference method was used to solve the microscopic contact between the rough UHMWPE bearing surface and a smooth hard counterface. The fast Fourier transform (FFT) was used to cope with the large number of mesh points required to represent the surface topography of the UHMWPE bearing surface. It was found that only isolated asperity contacts occurred under physiological loading, and the real contact area was only a small fraction of the nominal contact area. Consequently, the average contact pressure experienced at the articulating surfaces was significantly higher than the nominal contact pressure. Furthermore, it was shown that the majority of asperities on the worn UHMWPE pin were deformed in the elastic region, and consideration of the plastic deformation only resulted in a negligible increase in the predicted asperity contact area. Microscopic asperity contact and deformation mechanisms may play an important role in the understanding of the wear mechanisms of UHMWPE bearing surfaces.