Hip resurfacing: a narrative review of contemporary evidence and clinical outcomes

Introduction

Background

Over the past 20 years, total hip arthroplasty (THA) has become the safest and most successful treatment for end-stage hip osteoarthritis (1-3). Between 2006 and 2014, THA utilisation rates increased by approximately 70% (4), and this trend suggests continued growth from 43% to 70% through 2030 (5,6). The increase in the number of procedures performed worldwide has inevitably led to an increase in revision surgeries, with significant impacts on the healthcare system (7). All of this increasingly emphasises the importance of implant longevity and bone stock preservation strategies (8).

Rationale and knowledge gap

In this context, the average age of patients undergoing THA has changed dramatically, with a substantial reduction. Younger patients create significant challenges (9) for two main reasons: first, they maintain higher activity levels and, second, they have a longer life expectancy with a greater likelihood of undergoing revision hip replacement (RTHA). In these patients, preserving bone stock is a crucial factor in treatment. Hip resurfacing arthroplasty (HRA) has emerged as a viable alternative that preserves bone stock and natural biomechanics (10,11). The procedure is performed by leaving the patient’s femoral head and neck intact (12). Throughout its history, hip resurfacing surgery went through a period of distrust and decline following the revisions of early implants with metal surfaces. Since then, HRA has undergone extensive refinement (13), not only in design but particularly in materials and surgical technique. This narrative review differs from previous analyses in that it provides a more specific consideration of the most recent comparative evidence from the past decade.

Objective

We focus specifically on head-to-head comparisons of HRA and THA from high-quality randomised controlled trials and comparative studies to provide clinicians with evidence-based guidance for surgical decision-making in younger, more active patients with hip osteoarthritis. We present this article in accordance with the Narrative Review reporting checklist (available at https://asj.amegroups.com/article/view/10.21037/asj-25-52/rc).

Methods

Our literature search strategy followed a comprehensive approach designed to capture all relevant contemporary evidence comparing hip resurfacing and THA. From January 2010 to December 2024, we conducted a thorough search of PubMed/MEDLINE, Scopus, and the Cochrane, specifically concentrating on the contemporary era of hip resurfacing in light of notable advancements in design and a better comprehension of failure mechanisms.

The following terms were used in the literature search: “hip resurfacing” or “hip arthroplasty” with “total hip replacement”, “total hip arthroplasty”, or “hip replacement surgery.” More focused outcome terms like “clinical outcomes”, “survival”, “revision rate”, “complications”, and “metal ions” were added to this search to further narrow it down. The selection process involved two independent reviewers screening 487 initially identified articles, with disagreements resolved through consensus discussion with a third reviewer. Studies were included if they represented randomised controlled trials or comparative cohort studies directly comparing HRA to THA, considering that most studies included relatively small sample sizes, often fewer than 50 patients per group, we focused on those with a minimum follow-up of five years and that reported clinical outcome scores or survival data to ensure more reliable and comparable results and to ensure adequate statistical power. We excluded single-arm studies, case reports or small case series, conference abstracts and non-English publications (Table 1).

Data extraction focused on key variables such as study design characteristics, sample size, demographics parameters (age, sex, and body mass index), implant types and bearing surfaces, follow-up, clinical outcome, revision rates and complication profiles.

Evolution of HRA: key milestones

The HRA has its origins in 1926, with the initial proposal by Hey Grove (14); however, its development was characterised by many failures, mainly due to materials technology but also to the still inefficient design. The first experiments involved primitive materials. Smith-Peterson used a glass device (15). In contrast, Sir John Charnley’s use of Teflon resulted in disastrous outcomes due to extensive wear and osteolysis (16,17), bringing the procedure to the brink of obsolescence. Further explorations in the 1960s with metal-on-metal (MoM) bearings (18) and first-generation polyethylene (19), likewise failed to yield durable results. Subsequent versions that included metal components and ultra-high molecular weight polyethene (UHMWPE) nevertheless showed disappointing results (20,21). A significant resurgence in hip resurfacing surgery occurred in the 1990s, driven by advances in materials. Important innovations included the press-fit design invented by Wagner (22), and, most importantly, McMinn’s successful MoM articulation, which had a remarkable 96% survival rate after 10 years (23). The success of this strategy directly influenced the development of the Birmingham Hip Resurfacing (BHR) system.

This device, still implanted, has demonstrated a 10-year survival rate of 92% (24-27), and its initial success fueled the rise in popularity of HRAs (28-30). The popularity of these implants came to a screeching halt following a 2008 report highlighting the incidence of pseudotumors (31). A pivotal moment came in August 2010 with the global recall of the implant, triggered by unacceptable rates of premature failure (32). This event generated a widespread loss of confidence in the orthopaedic community and a sharp reduction in all MoM implants (28-30). The fallout from this period has led to a series of studies of varying sizes aimed at improving the understanding of tribology and failure mechanisms in general (33-35). It has also generated an increasing focus on in-depth analysis of both implant design (36,37) and surgical precision (38-40). Based on these insights, contemporary research is now oriented toward next-generation systems, not only in materials, such as ceramic-on-ceramic and metal-on-polyethene (41-44), but also in the latest robotic surgery technologies and the use of AI for data analysis. It is clear that, although material innovation has always been a cornerstone of HRA progress, achieving better results requires a holistic approach that gives equal priority to surgical technique, engineering, design, and fixation methods, as well as careful patient selection.

Evidence-based patient selection criteria (45)

The current selection criteria for HRA were developed based on the analysis of over 50,000 cases in international registries (46-48). The ideal patient has been defined through several studies, which have demonstrated significantly superior outcomes in specific patients (49,50). Male patients under the age of 55 show better outcomes, with a hazard ratio (HR) for surgical revision of 0.67 compared to older. Femoral head diameter is also an important factor, with heads larger than 55 mm reducing the risk of fracture by 73% compared to smaller sizes. A body mass index (BMI) of less than 30 is another selection criterion, as each one-unit increase in BMI is associated with an approximately 4% higher risk of surgical revision. Patients with high activity demands, typically quantified by UCLA scores exceeding 7, tend to show better outcomes, likely due to the maintenance of muscle mass and bone quality. Primary osteoarthritis with preserved proximal femoral anatomy provides the optimal anatomical substrate for successful resurfacing (51,52). Gender considerations require particular attention and nuanced counselling. While female was historically considered a relative contraindication, contemporary understanding recognizes that women of childbearing age require specific discussion regarding potential metal ion placental transfer, unknown effects on fertility, and availability of alternative bearing options. Postmenopausal women with adequate bone quality and larger femoral heads may still be suitable candidates, provided they receive proper counselling about the slightly elevated revision risks compared to their male counterparts.

Absolute contraindications have been clearly established through registry data and systematic reviews. Avascular necrosis involving more than 30% of the femoral head shows unacceptably high failure rates due to compromised bone quality and collapse risk. Inflammatory arthropathies, including rheumatoid and psoriatic arthritis, exhibit a 3.2 times higher revision risk due to poor bone quality, synovitis, and often smaller anatomical features. T-scores below −2.5 indicate severe osteoporosis, which makes proper fixation impossible and raises the risk of fracture.

Despite being uncommon, metal hypersensitivity is a strict contraindication because it can result in serious negative reactions. Patients with renal insufficiency are not suitable candidates for MoM bearings because it hinders the clearance of metal ions and can result in systemic accumulation.

Complications in contemporary HRA: evidence from recent studies

HRA presents a unique profile of potential complications, different from that of conventional THA, and requires in-depth knowledge for effective management (53). Recent scientific evidence has significantly clarified the risks and effective strategies to mitigate these challenges.

Femoral neck fractures

A major concern after HRA is femoral neck fracture. This complication typically occurs very early in the postoperative period (54-57), while the bone is in the early stages of remodelling (58). Previous literature reviews have highlighted a mean fracture incidence of 1.69% (with a range of 0–9.2%) (59) An important factor that has a significant impact is that this risk is particularly related to the surgeon’s learning curve, with early cases having a higher fracture rate (60). While earlier hypotheses suggested causes such as compromised vascularisation from a posterior approach (61) or iatrogenic notching during femoral reaming (62-64), these theories have been largely refuted by subsequent research (65,66). Today, clearly identified risk factors include varus positioning of the femoral stem, inadequate preoperative bone density, and stress risers from femoral notching. With meticulous technique, many experienced surgeons now consistently perform the procedure via the common posterior approach with minimal to no incidence of subsequent neck fractures (67,68).

Femoral component loosening

The instability of the femoral component after HRA is relatively uncommon, with aseptic loosening rates generally reported to be between 1% and 3% in studies with at least 10 years of follow-up (24-26,69,70). The risk has been substantially diminished through refinements in surgical technique (60,71). Achieving long-term fixation is critically dependent on meticulous preparation of the femoral head, an excellent cementing technique, and the optimisation of the bone-cement-prosthesis interface (72).

Acetabular component loosening

Aseptic loosening of the acetabular component is not a specific complication of HRA. However, the population requiring HRA is young and active, and patients with high activity levels, particularly those who engage in physical activities with a wide range of motion, are at a higher risk of acetabular component loosening (73,74). he reported acetabular loosening rate in the literature is less than 2% at 7–12 years (24-26,69,70,75) and could be significantly reduced or even eliminated with the new highly porous acetabular interfaces (76).

Wear-related issues and adverse local tissue reactions

Periprosthetic adverse local tissue reactions (ALTRs) are not exclusively linked to MoM bearings in HRA; the term “pseudotumor” was first coined to describe a reaction to a polyethylene bearing in a total hip prosthesis (77). Nonetheless, similar reactions were famously described in MoM bearings by Pandit et al. (31). There is a robust association between elevated blood levels of cobalt (Co) and chromium (Cr) ions and the in vivo wear status of MoM implants (78-81). Extensive research has shown that suboptimal positioning of the acetabular component is a primary driver of excessive wear, with “edge loading” identified as the main cause of sharply elevated ion levels (37,82). The central principle for minimizing wear is to achieve stable elasto-hydrodynamic lubrication by ensuring the femoral head is functionally well-covered by the acetabular cup (83). This highlights the critical importance of socket design (84) component positioning (in terms of abduction and anteversion), and implant size (53,54). Indeed, it has been established that variations in the design of resurfacing implants can significantly influence failure rates (36,79,80). Several authors have confirmed a direct relationship between high Co and Cr ion concentrations and the failure of HRA implants (60), often mediated by the development of ALTR (85-88). While a general consensus previously suggested that Co levels above 7–10 parts per billion (ppb) were concerning (89,90), the contemporary intervention threshold has been lowered. Now, cobalt levels exceeding 5 ppb often trigger enhanced surveillance protocols, which may include advanced imaging with metal artifact reduction sequence (MARS) MRI. Despite, documented cases of systemic toxicity from metal debris remain rare and are typically associated only with extremely high blood cobalt concentrations (91,92).

Critical analysis of current evidence

When considering if HRA is a safe and effective alternative THA, a nuanced analysis of the evidence is required. The most recent Systematic Review no statistically significant differences in clinical outcomes and revision rate between HRA and THA (93), and this evidence is also confirmed by a recent systematic review and meta-analysis (94). A careful analysis reveals that the contradictory results in the literature can be explained by considering: patient selection, surgeon experience, and the surgical technique over the time.

The decisive role of patient selection

A consistent pattern emerges where discrepancies in study outcomes are mainly attributable to variations in patient cohorts by looking at their patient demographics, for example, it is possible to understand the contradictory findings between Hersnaes et al. (95) who reported a higher revision rate for HRA (due to fractures and loosening), and Konan et al. (96) or Kostretzis et al. (97) who reported higher revision rates in their THA groups. While the other studies concentrated on younger, more appropriate candidates, the Hersnaes study included older patients, a demographic known to be at higher risk for HRA complications. This makes it clear that variations frequently indicate whether a patient is a good fit for the procedure rather than a serious problem with the procedure itself. When patient selection is stringent, as confirmed by a meta-analysis from Palazzuolo et al. (94) outcomes tend to equalize, confirming HRA’s safety and efficacy in the right population.

An equal result is reported in terms of complications, confirming that HRA is a safe and effective method. A recent meta-analysis by Kumar et al. (98) which included 6 level 1 studies, found similar failure rates between HRA and THA. However, the HRA group experienced a significantly lower rate of complications. The results of the most recent RCTs in terms of clinical outcomes and survivorship are shown in Table 2.

In the majority of comparative studies, statistically significant differences in clinical outcomes between the HRA group and the THA group have not been reported. However, many studies report a better survival rate of HRA compared to THA, with some exceptions. In his retrospective study, Pritchett skilfully combined both quantitative and qualitative analysis; he performed bilateral hip replacement surgery on 332 patients, one side was treated with traditional THA, while the other received a titanium-backed, highly cross-linked acetabular component and a titanium nitride-coated cementless femoral component via HRA. Qualitative data indicated that 86% of patients preferred the HRA side. Additionally, patients reported high hip strength, better balance, and greater overall satisfaction with the HRA. The benefits of HRA, which are likely due to improved maintenance of natural hip movements, have also been highlighted by other researchers (103-108).

The volume-outcome relationship and surgical expertise

The importance of surgical experience and institutional volume cannot be overstated. This factor helps explain the variance between extensive registry data and single-centre studies. In the study conducted by Stoney et al., the survival outcomes of hip resurfacing versus THA were compared using data from the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR). To be included in the HRA group, patients had to be male and under 65 years old, with a femoral head diameter greater than 50 mm. A total of 4,790 patients met these criteria and underwent the BHR procedure. After 17 years, the HRA group showed a significantly higher rate of all-cause revision (6.7%) compared to the THA group (3.4%), with aseptic loosening and fracture being the most common reasons for failure. Major revision surgery, involving both the femoral and acetabular components, was necessary in all cases of failure. The authors attributed the increased failure rate observed in the HRA group to higher levels of physical activity and a negative tissue response caused by the release of metal ions. However, the findings of Halawi et al. (109) contradict these results. Their research showed lower rates of revision surgery, overall complications, all-cause reoperations, and mortality for the 442 BHR group in comparison to the 327 THA group, with a minimum follow-up of 5 years. Critically, all resurfacing procedures in that study were performed by a single, highly experienced surgeon. This aligns with the well-documented principle that outcomes are significantly better when HRA is conducted at high-volume centres by skilled practitioners. This point is imperative to consider when evaluating results (25,26). The results of the most recent comparative studies, in terms of clinical outcomes and survivorship, are presented in Table 3.

Current obstacles and future directions

To maximize the use and results of HRA, future research must fill a number of important knowledge gaps. Modern bearing surfaces lack long-term data beyond 20 years, which raises questions about the ultimate longevity of implants, especially for younger patients. With significant variation in practice regarding the frequency and type of monitoring, optimal surveillance protocols for asymptomatic patients with MoM bearings are still unclear. The majority of healthcare systems lack cost-effectiveness analyses that take revision burden, functional outcomes, and quality-adjusted life years into account, which restricts decision-making at the policy level. Prospective evaluation is necessary to assess the performance characteristics of alternative bearing surfaces in the resurfacing configuration, such as ceramic-on-ceramic and highly cross-linked polyethene. Beyond the current criteria, the precision of patient selection could be improved by the development of machine learning algorithms that take into account multiple patient and surgical factors. Current limitations may be addressed with the help of ongoing developments. With completion anticipated by 2026, two randomized controlled trials exploring ceramic-on-ceramic hip resurfacing are presently accepting participants and could allay worries regarding metal ions. Robotic support for HRA could democratize the process outside of high-volume centers by lowering the learning curve and increasing component positioning accuracy. Personalized surveillance strategies may be made possible by prospective studies looking into biomarkers that predict negative reactions to metal debris.

Development of HRA-specific patient-reported outcome measures may better capture the unique benefits of bone preservation and standard hip mechanics. Future clinical practice is probably going to shift toward more centralization in high-volume centers with proven expertise, mandatory participation in national joint registries to guarantee transparency of results, the use of risk stratification protocols to guide patient selection and the level of surveillance, and customized implant selection based on anatomical features and individual activity profiles.

Study limitations

It is essential to analyse the limitations of this review, as they affect its conclusions. A quantitative meta-analysis could not be conducted due to the considerable variability among the studies in terms of patient populations, implant designs, and surgical techniques. Additionally, the narrative methodology carries a risk of selection bias. There are still large gaps in the evidence as well. Long-term results after 15 years are scarce, especially for more recent non-MoM implants. Direct cross-study comparisons are made more difficult by the absence of standardized definitions for complications. Lastly, the results have limited clinical applicability. The findings may not be applicable to more general orthopaedic procedures because most of the evidence is from specialized, high-volume centers. The speed at which technology is evolving means that findings from earlier studies may not accurately reflect findings from more recent approaches.

Conclusions

This comprehensive review of contemporary evidence supports HRA as a viable alternative to THA in carefully selected patients, when performed by experienced surgeons at specialised centres. The key determinants of success have been clearly identified through the analysis of large registries and RCTs. In contrast to earlier reviews, this analysis emphasizes the crucial role that center volume plays in outcomes and offers evidence-based patient selection algorithms that are based on current registry data. The data shows that HRA preserves bone stock for possible future revisions while producing clinical results and ten-year survival rates that are comparable to those of THA in the right patients. To get the best results, the procedure necessitates meticulous patient selection, skilled surgery, and methodical follow-up. The field awaits several important developments, including long-term data on alternative bearing surfaces that may eliminate metal ion concerns and broader population applicability. Given the available data, we advise male patients under 55 with femoral head diameters greater than 55 mm and high activity demands to think about HRA, so long as the procedure can be carried out at a facility with a high volume of patients and established protocols for patient surveillance and outcome monitoring. HRA’s place in the arthroplasty toolbox is expected to grow as evidence mounts and technology advances, providing bone-preserving alternatives for a wider range of patient demographics.

Acknowledgments

None.

Footnote

Reporting Checklist: The authors have completed the Narrative Review reporting checklist. Available at https://asj.amegroups.com/article/view/10.21037/asj-25-52/rc

Peer Review File: Available at https://asj.amegroups.com/article/view/10.21037/asj-25-52/prf

Funding: None.

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://asj.amegroups.com/article/view/10.21037/asj-25-52/coif). G.F.P. serves as an unpaid editorial board member of AME Surgical Journal from February 2025 to December 2026. The other authors have no conflicts of interest to declare.

Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.

References

1. Hussein IH, Zalikha AK, Tuluca A, et al. Epidemiology of Obese Patients Undergoing Revision Total Knee Arthroplasty: Understanding Demographics, Comorbidities, and Propensity Weighted Analysis of Inpatient Outcomes. J Am Acad Orthop Surg Glob Res Rev 2022;6:e21.00263.
2. Learmonth ID, Young C, Rorabeck C. The operation of the century: total hip replacement. Lancet 2007;370:1508-19. [Crossref] [PubMed]
3. Zampogna B, Papalia GF, Parisi FR, et al. Early return to activity of daily living after total hip arthroplasty: a systematic review and meta-analysis. Hip Int 2023;33:968-76. [Crossref] [PubMed]
4. Patel I, Nham F, Zalikha L, et al. Epidemiology of total hip arthroplasty: demographics, comorbidities and outcomes. Arthroplasty 2023;5:2. [Crossref] [PubMed]
5. Schwartz AM, Farley KX, Guild GN, et al. Projections and Epidemiology of Revision Hip and Knee Arthroplasty in the United States to 2030. J Arthroplasty 2020;35:S79-85. [Crossref] [PubMed]
6. Papalia R, Zampogna B, Torre G, et al. Preoperative and Perioperative Predictors of Length of Hospital Stay after Primary Total Hip Arthroplasty-Our Experience on 743 Cases. J Clin Med 2021;10:5053. [Crossref] [PubMed]
7. George J, Taylor AJ, Schmalzried TP. Examining the “revisability” benefit of hip resurfacing arthroplasty. World J Orthop 2024;15:554-9. [Crossref] [PubMed]
8. Eingartner C. Current trends in total hip arthroplasty. Ortop Traumatol Rehabil 2007;9:8-14.
9. Zampogna B, Papalia GF, Ferrini A, et al. Dual-mobility total hip arthroplasty in patients younger than 55 years old: a systematic review. Arch Orthop Trauma Surg 2023;143:6821-8. [Crossref] [PubMed]
10. Shanaa J, Asad S, Bindra GS, et al. No Difference in Outcomes, Complications, or Revision Rate for Obese vs. Nonobese Patients Following Hip Resurfacing Arthroplasty: A Systematic Review and Meta-Analysis. JBJS Rev 2024;12: [Crossref] [PubMed]
11. Alagha MA, Logishetty K, O’Hanlon C, et al. Three-Dimensional Preoperative Planning Software for Hip Resurfacing Arthroplasty. Bioengineering (Basel) 2023;10:939. [Crossref] [PubMed]
12. Cadossi M, Tedesco G, Sambri A, et al. Hip Resurfacing Implants. Orthopedics 2015;38:504-9. [Crossref] [PubMed]
13. Chai Y, Boudali AM, Jenkins E, et al. Advances in imaging for pre-surgical planning in hip resurfacing arthroplasty. Orthop Traumatol Surg Res 2024;110:103908. [Crossref] [PubMed]
14. Groves EWH. Some contributions to the reconstructive surgery of the hip. Br J Surg 2006;14:486-517.
15. BICKEL WH. BABB FS. Cup arthroplasty of the hip. J Bone Joint Surg Am 1948;30A:647-56.
16. Charnley J. Surgery of the hip-joint: present and future developments. Br Med J 1960;1:821-6. [Crossref] [PubMed]
17. Charnley J. Arthroplasty of the hip. A new operation. Lancet 1961;1:1129-32. [Crossref] [PubMed]
18. Müller ME. Total hip prostheses. Clin Orthop Relat Res 1970;46-68.
19. Gerard Y. Hip arthroplasty by matching cups. Clin Orthop Relat Res 1978;25-35.
20. Trentani C, Vaccarino F. The Paltrinieri-Trentani hip joint resurface arthroplasty. Clin Orthop Relat Res 1978;36-40.
21. Freeman MAR. Conservative total replacement of the hip. J Bone Joint Surg Br 1975;57:114.
22. Wagner M, Wagner H. Preliminary results of uncemented metal on metal stemmed and resurfacing hip replacement arthroplasty. Clin Orthop Relat Res 1996;S78-88. [Crossref] [PubMed]
23. McMinn DJW, editor. Modern Hip Resurfacing. London: Springer London; 2009.
24. Treacy RB, McBryde CW, Shears E, et al. Birmingham hip resurfacing: a minimum follow-up of ten years. J Bone Joint Surg Br 2011;93:27-33. [Crossref] [PubMed]
25. Coulter G, Young DA, Dalziel RE, et al. Birmingham hip resurfacing at a mean of ten years: results from an independent centre. J Bone Joint Surg Br 2012;94:315-21. [Crossref] [PubMed]
26. Holland JP, Langton DJ, Hashmi M. Ten-year clinical, radiological and metal ion analysis of the Birmingham Hip Resurfacing: from a single, non-designer surgeon. J Bone Joint Surg Br 2012;94:471-6. [Crossref] [PubMed]
27. Murray DW, Grammatopoulos G, Pandit H, et al. The ten-year survival of the Birmingham hip resurfacing: an independent series. J Bone Joint Surg Br 2012;94:1180-6. [Crossref] [PubMed]
28. Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR). Australian Orthopaedic Association National Joint Replacement Registry: Annual Report 2014. Australian Orthopaedic Association; 2014.
29. Sahlgrenska University Hospital DoO. The Swedish National Hip Arthroplasty Register: Annual Report 2013. Sahlgrenska University Hospital; 2013.
30. National Joint Registry for England, Wales and Northern Ireland. National Joint Registry (UK): 11th Annual Report 2014. National Joint Registry; 2014.
31. Pandit H, Glyn-Jones S, McLardy-Smith P, et al. Pseudotumours associated with metal-on-metal hip resurfacings. J Bone Joint Surg Br 2008;90:847-51. [Crossref] [PubMed]
32. DePuy ASR Hip Recall - ASR XL Acetabular System and ASR Hip Resurfacing System. Available online: https://www.drugwatch.com/hip-replacement/depuy/recall/
33. Garbuz DS, Tanzer M, Greidanus NV, et al. The John Charnley Award: Metal-on-metal hip resurfacing versus large-diameter head metal-on-metal total hip arthroplasty: a randomized clinical trial. Clin Orthop Relat Res 2010;468:318-25. [Crossref] [PubMed]
34. Cooper HJ, Della Valle CJ, Berger RA, et al. Corrosion at the head-neck taper as a cause for adverse local tissue reactions after total hip arthroplasty. J Bone Joint Surg Am 2012;94:1655-61. [Crossref] [PubMed]
35. Jacobs JJ, Cooper HJ, Urban RM, et al. What do we know about taper corrosion in total hip arthroplasty? J Arthroplasty 2014;29:668-9. [Crossref] [PubMed]
36. Underwood RJ, Zografos A, Sayles RS, et al. Edge loading in metal-on-metal hips: low clearance is a new risk factor. Proc Inst Mech Eng H 2012;226:217-26. [Crossref] [PubMed]
37. Hart AJ, Muirhead-Allwood S, Porter M, et al. Which factors determine the wear rate of large-diameter metal-on-metal hip replacements? Multivariate analysis of two hundred and seventy-six components. J Bone Joint Surg Am 2013;95:678-85. [Crossref] [PubMed]
38. Matthies AK, Henckel J, Cro S, et al. Predicting wear and blood metal ion levels in metal-on-metal hip resurfacing. J Orthop Res 2014;32:167-74. [Crossref] [PubMed]
39. Langton DJ, Sprowson AP, Joyce TJ, et al. Blood metal ion concentrations after hip resurfacing arthroplasty: a comparative study of articular surface replacement and Birmingham Hip Resurfacing arthroplasties. J Bone Joint Surg Br 2009;91:1287-95. [Crossref] [PubMed]
40. Yoon JP, Le Duff MJ, Johnson AJ, et al. Contact patch to rim distance predicts metal ion levels in hip resurfacing. Clin Orthop Relat Res 2013;471:1615-21. [Crossref] [PubMed]
41. de Villiers D, Collins S. Resistance of a novel ceramic acetabular cup to critical impact loads. Proc Inst Mech Eng H 2020;234:1122-8. [Crossref] [PubMed]
42. De Villiers D, Collins S. Wear of large diameter ceramic-on-ceramic hip bearings under standard and microseparation conditions. Biotribology 2020;21:100117.
43. Pitto RP, Sedel L. Periprosthetic Joint Infection in Hip Arthroplasty: Is There an Association Between Infection and Bearing Surface Type? Clin Orthop Relat Res 2016;474:2213-8. [Crossref] [PubMed]
44. Pritchett JW. Polyethylene for hip resurfacing—worth a second look. Ann Joint 2020;5:10.
45. Al-Jabri T, Ridha M, McCulloch RA, et al. Hip Resurfacing Arthroplasty: Past, Present and Future. Orthop Rev (Pavia) 2023;15:77745. [Crossref] [PubMed]
46. Amstutz HC, Le Duff MJ. The 20-year results of the first 400 Conserve Plus hip resurfacing arthroplasties. Bone Joint J 2021;103-B:25-32. [Crossref] [PubMed]
47. Van Der Straeten CInternational Hip Resurfacing Group. Hip resurfacing arthroplasty in young patients: international high-volume centres’ report on the outcome of 11,382 metal-on-metal hip resurfacing arthroplasties in patients ≤50 years at surgery. Hip Int 2022;32:353-62. [Crossref] [PubMed]
48. Dhawan R, Young DA, Van Eemeren A, et al. Birmingham Hip Resurfacing at 20 years. Bone Joint J 2023;105-B:946-52. [Crossref] [PubMed]
49. Matharu GS, McBryde CW, Pynsent WB, et al. The outcome of the Birmingham Hip Resurfacing in patients aged < 50 years up to 14 years post-operatively. Bone Joint J 2013;95-B:1172-7. [Crossref] [PubMed]
50. LeBrun DG, Shen TS, Bovonratwet P, et al. Hip Resurfacing vs Total Hip Arthroplasty in Patients Younger than 35 Years: A Comparison of Revision Rates and Patient-Reported Outcomes. Arthroplast Today 2021;11:229-33. [Crossref] [PubMed]
51. van der Weegen W, Hoekstra H, Brakel K, et al. Limited need for screening of metal-on-metal hip resurfacing patients beyond 10 years of follow-up. Hip Int 2022;32:106-12. [Crossref] [PubMed]
52. Scholes CJ, Ebrahimi M, Farah SB, et al. The outcome and survival of metal-on-metal hip resurfacing in patients aged less than 50 years: a prospective observational cohort study with minimum ten-year follow-up. Bone Joint J 2019;101-B:113-20. [Crossref] [PubMed]
53. Huang Y, Yang Q, Wang Z, et al. Comparisons of in-hospital complications between total hip arthroplasty and hip resurfacing arthroplasty. BMC Musculoskelet Disord 2023;24:375. [Crossref] [PubMed]
54. Shimmin AJ, Back D. Femoral neck fractures following Birmingham hip resurfacing: a national review of 50 cases. J Bone Joint Surg Br 2005;87:463-4. [Crossref] [PubMed]
55. Marker DR, Seyler TM, Jinnah RH, et al. Femoral neck fractures after metal-on-metal total hip resurfacing: a prospective cohort study. J Arthroplasty 2007;22:66-71. [Crossref] [PubMed]
56. Khan M, Kuiper JH, Edwards D, et al. Birmingham hip arthroplasty: five to eight years of prospective multicenter results. J Arthroplasty 2009;24:1044-50. [Crossref] [PubMed]
57. Della Valle CJ, Nunley RM, Raterman SJ, et al. Initial American experience with hip resurfacing following FDA approval. Clin Orthop Relat Res 2009;467:72-8. [Crossref] [PubMed]
58. Campbell P, Beaulé PE, Ebramzadeh E, et al. The John Charnley Award: a study of implant failure in metal-on-metal surface arthroplasties. Clin Orthop Relat Res 2006;35-46. [Crossref] [PubMed]
59. Amstutz HC, Le Duff MJ, Campbell PA, et al. Complications after metal-on-metal hip resurfacing arthroplasty. Orthop Clin North Am 2011;42:207-30. viii. [Crossref] [PubMed]
60. Mont MA, Seyler TM, Ulrich SD, et al. Effect of changing indications and techniques on total hip resurfacing. Clin Orthop Relat Res 2007;63-70. [Crossref] [PubMed]
61. Khan A, Yates P, Lovering A, et al. The effect of surgical approach on blood flow to the femoral head during resurfacing. J Bone Joint Surg Br 2007;89:21-5. [Crossref] [PubMed]
62. Beaulé PE, Campbell PA, Hoke R, et al. Notching of the femoral neck during resurfacing arthroplasty of the hip: a vascular study. J Bone Joint Surg Br 2006;88:35-9. [Crossref] [PubMed]
63. Beaulé PE, Campbell P, Shim P. Femoral head blood flow during hip resurfacing. Clin Orthop Relat Res 2007;148-52. [Crossref] [PubMed]
64. Beaulé PE, Campbell P, Lu Z, et al. Vascularity of the arthritic femoral head and hip resurfacing. J Bone Joint Surg Am 2006;88:85-96. [Crossref] [PubMed]
65. Steffen RT, Foguet PR, Krikler SJ, et al. Femoral neck fractures after hip resurfacing. J Arthroplasty 2009;24:614-9. [Crossref] [PubMed]
66. Ullmark G, Sundgren K, Milbrink J, et al. Osteonecrosis following resurfacing arthroplasty. Acta Orthop 2009;80:670-4. [Crossref] [PubMed]
67. Vendittoli PA, Ganapathi M, Roy AG, et al. A comparison of clinical results of hip resurfacing arthroplasty and 28 mm metal on metal total hip arthroplasty: a randomised trial with 3-6 years follow-up. Hip Int 2010;20:1-13. [Crossref] [PubMed]
68. Mehra A, Berryman F, Matharu GS, et al. Birmingham Hip Resurfacing: A Single Surgeon Series Reported at a Minimum of 10 Years Follow-Up. J Arthroplasty 2015;30:1160-6. [Crossref] [PubMed]
69. Amstutz HC, Le Duff MJ, Johnson AJ. Socket position determines hip resurfacing 10-year survivorship. Clin Orthop Relat Res 2012;470:3127-33. [Crossref] [PubMed]
70. Daniel J, Pradhan C, Ziaee H, et al. Results of Birmingham hip resurfacing at 12 to 15 years: a single-surgeon series. Bone Joint J 2014;96-B:1298-306. [Crossref] [PubMed]
71. Amstutz HC, Le Duff MJ, Campbell PA, et al. The effects of technique changes on aseptic loosening of the femoral component in hip resurfacing. Results of 600 Conserve Plus with a 3 to 9 year follow-up. J Arthroplasty 2007;22:481-9. [Crossref] [PubMed]
72. Amstutz HC, Le Duff MJ. Cementing the metaphyseal stem in metal-on-metal resurfacing: when and why. Clin Orthop Relat Res 2009;467:79-83. [Crossref] [PubMed]
73. Amstutz HC, Le Duff MJ. Aseptic loosening of cobalt chromium monoblock sockets after hip resurfacing. Hip Int 2015;25:466-70. [Crossref] [PubMed]
74. Ramkumar PN, Shaikh HJF, Woo JJ, et al. Hip resurfacing arthroplasty as an alternative to total hip arthroplasty in patients aged under 40 years. Bone Jt Open 2023;4:408-15. [Crossref] [PubMed]
75. Zylberberg AD, Nishiwaki T, Kim PR, et al. Clinical results of the conserve plus metal on metal hip resurfacing: an independent series. J Arthroplasty 2015;30:68-73. [Crossref] [PubMed]
76. Banerjee S, Issa K, Kapadia BH, et al. Highly-porous metal option for primary cementless acetabular fixation. What is the evidence? Hip Int 2013;23:509-21. [Crossref] [PubMed]
77. Svensson O, Mathiesen EB, Reinholt FP, et al. Formation of a fulminant soft-tissue pseudotumor after uncemented hip arthroplasty. A case report. J Bone Joint Surg Am 1988;70:1238-42.
78. Sidaginamale RP, Joyce TJ, Lord JK, et al. Blood metal ion testing is an effectivescreening tool to identify poorly performing metal-on-metal bearingsurfaces. Bone Joint Res 2013;2:84-95. [Crossref] [PubMed]
79. Underwood R, Matthies A, Cann P, et al. A comparison of explanted Articular Surface Replacement and Birmingham Hip Resurfacing components. J Bone Joint Surg Br 2011;93:1169-77. [Crossref] [PubMed]
80. Hart AJ, Buddhdev P, Winship P, et al. Cup inclination angle of greater than 50 degrees increases whole blood concentrations of cobalt and chromium ions after metal-on-metal hip resurfacing. Hip Int 2008;18:212-9. [Crossref] [PubMed]
81. Van Der Straeten C, Grammatopoulos G, Gill HS, et al. The 2012 Otto Aufranc Award: The interpretation of metal ion levels in unilateral and bilateral hip resurfacing. Clin Orthop Relat Res 2013;471:377-85. [Crossref] [PubMed]
82. De Haan R, Pattyn C, Gill HS, et al. Correlation between inclination of the acetabular component and metal ion levels in metal-on-metal hip resurfacing replacement. J Bone Joint Surg Br 2008;90:1291-7. [Crossref] [PubMed]
83. Chan FW, Bobyn JD, Medley JB, et al. The Otto Aufranc Award. Wear and lubrication of metal-on-metal hip implants. Clin Orthop Relat Res 1999;10-24. [Crossref] [PubMed]
84. Graves SE, Rothwell A, Tucker K, et al. A multinational assessment of metal-on-metal bearings in hip replacement. J Bone Joint Surg Am 2011;93:43-7. [Crossref] [PubMed]
85. Bisschop R, Boomsma MF, Van Raay JJ, et al. High prevalence of pseudotumors in patients with a Birmingham Hip Resurfacing prosthesis: a prospective cohort study of one hundred and twenty-nine patients. J Bone Joint Surg Am 2013;95:1554-60. [Crossref] [PubMed]
86. Bosker BH, Ettema HB, Boomsma MF, et al. High incidence of pseudotumour formation after large-diameter metal-on-metal total hip replacement: a prospective cohort study. J Bone Joint Surg Br 2012;94:755-61. [Crossref] [PubMed]
87. Gross TP, Liu F. Incidence of adverse wear reactions in hip resurfacing arthroplasty: a single surgeon series of 2,600 cases. Hip Int 2013;23:250-8. [Crossref] [PubMed]
88. Kwon YM, Ostlere SJ, McLardy-Smith P, et al. "Asymptomatic" pseudotumors after metal-on-metal hip resurfacing arthroplasty: prevalence and metal ion study. J Arthroplasty 2011;26:511-8. [Crossref] [PubMed]
89. Griffin WL, Fehring TK, Kudrna JC, et al. Are metal ion levels a useful trigger for surgical intervention? J Arthroplasty 2012;27:32-6. [Crossref] [PubMed]
90. Malek IA, King A, Sharma H, et al. The sensitivity, specificity and predictive values of raised plasma metal ion levels in the diagnosis of adverse reaction to metal debris in symptomatic patients with a metal-on-metal arthroplasty of the hip. J Bone Joint Surg Br 2012;94:1045-50. [Crossref] [PubMed]
91. Tower SS. Arthroprosthetic cobaltism: neurological and cardiac manifestations in two patients with metal-on-metal arthroplasty: a case report. J Bone Joint Surg Am 2010;92:2847-51. [Crossref] [PubMed]
92. Mao X, Wong AA, Crawford RW. Cobalt toxicity--an emerging clinical problem in patients with metal-on-metal hip prostheses? Med J Aust 2011;194:649-51. [Crossref] [PubMed]
93. Za P, Casciaro C, Papalia GF, et al. Hip resurfacing versus total hip arthroplasty: a systematic review and meta-analysis of randomized clinical trials. Int Orthop 2024;48:2589-601. [Crossref] [PubMed]
94. Palazzuolo M, Bensa A, Bauer S, et al. Resurfacing Hip Arthroplasty Is a Safe and Effective Alternative to Total Hip Arthroplasty in Young Patients: A Systematic Review and Meta-Analysis. J Clin Med 2023;12:2093. [Crossref] [PubMed]
95. Hersnaes PN, Gromov K, Otte KS, et al. Harris Hip Score and SF-36 following metal-on-metal total hip arthroplasty and hip resurfacing - a randomized controlled trial with 5-years follow up including 75 patients. BMC Musculoskelet Disord 2021;22:781. [Crossref] [PubMed]
96. Konan S, Waugh C, Ohly N, et al. Mid-term results of a prospective randomised controlled trial comparing large-head metal-on-metal hip replacement to hip resurfacing using patient-reported outcome measures and objective functional task-based outcomes. Hip Int 2021;31:637-43. [Crossref] [PubMed]
97. Kostretzis L, Lavigne M, Kiss MO, et al. Despite higher revision rate, MoM large-head THA offers better clinical scores than HR: 14-year results from a randomized controlled trial involving 48 patients. BMC Musculoskelet Disord 2021;22:400. [Crossref] [PubMed]
98. Kumar P, Ksheersagar V, Aggarwal S, et al. Complications and mid to long term outcomes for hip resurfacing versus total hip replacement: a systematic review and meta-analysis. Eur J Orthop Surg Traumatol 2023;33:1495-504. [Crossref] [PubMed]
99. Bisseling P, Smolders JM, Hol A, et al. Metal ion levels and functional results following resurfacing hip arthroplasty versus conventional small-diameter metal-on-metal total hip arthroplasty; a 3 to 5year follow-up of a randomized controlled trial. J Arthroplasty 2015;30:61-7. [Crossref] [PubMed]
100. Borgwardt A, Borgwardt L, Zerahn B, et al. A Randomized Seven-Year Study on Performance of the Stemmed Metal M2a-Magnum and Ceramic C2a-Taper, and the Resurfacing ReCap Hip Implants. J Arthroplasty 2018;33:1412-20. [Crossref] [PubMed]
101. Costa ML, Achten J, Foguet P, et al. Comparison of hip function and quality of life of total hip arthroplasty and resurfacing arthroplasty in the treatment of young patients with arthritis of the hip joint at 5 years. BMJ Open 2018;8:e018849. [Crossref] [PubMed]
102. Vendittoli PA, Shahin M, Rivière C, et al. Hip Resurfacing Compared with 28-mm Metal-on-Metal Total Hip Replacement: A Randomized Study with 15 Years of Follow-up. J Bone Joint Surg Am 2020;102:80-90. [Crossref] [PubMed]
103. Aqil A, Drabu R, Bergmann JH, et al. The gait of patients with one resurfacing and one replacement hip: a single blinded controlled study. Int Orthop 2013;37:795-801. [Crossref] [PubMed]
104. Barrack RL, Ruh EL, Berend ME, et al. Do young, active patients perceive advantages after surface replacement compared to cementless total hip arthroplasty? Clin Orthop Relat Res 2013;471:3803-13. [Crossref] [PubMed]
105. Haddad FS, Konan S, Tahmassebi J. A prospective comparative study of cementless total hip arthroplasty and hip resurfacing in patients under the age of 55 years: a ten-year follow-up. Bone Joint J 2015;97-B:617-22. [Crossref] [PubMed]
106. Mont MA, Seyler TM, Ragland PS, et al. Gait analysis of patients with resurfacing hip arthroplasty compared with hip osteoarthritis and standard total hip arthroplasty. J Arthroplasty 2007;22:100-8. [Crossref] [PubMed]
107. Vendittoli PA, Lavigne M, Girard J, et al. A randomised study comparing resection of acetabular bone at resurfacing and total hip replacement. J Bone Joint Surg Br 2006;88:997-1002. [Crossref] [PubMed]
108. Costa ML, Achten J, Parsons NR, et al. Total hip arthroplasty versus resurfacing arthroplasty in the treatment of patients with arthritis of the hip joint: single centre, parallel group, assessor blinded, randomised controlled trial. BMJ 2012;344:e2147. [Crossref] [PubMed]
109. Halawi MJ, Oak SR, Brigati D, et al. Birmingham hip resurfacing versus cementless total hip arthroplasty in patients 55 years or younger: A minimum five-year follow-up. J Clin Orthop Trauma 2018;9:285-8. [Crossref] [PubMed]
110. Ridon PE, Putman S, Migaud H, et al. Long-term comparative study of large-diameter metal-on-metal bearings: Resurfacing versus total arthroplasty with large-diameter Durom™ bearing. Orthop Traumatol Surg Res 2019;105:943-8. [Crossref] [PubMed]
111. Palazzuolo M, Antoniadis A, Delaune L, et al. Comparison of the long-term cause of failure and survivorship of four hundred and twenty seven metal-on-metal hip arthroplasties: resurfacing versus large head total hip arthroplasty. Int Orthop 2021;45:3075-81. [Crossref] [PubMed]
112. Bitar C, Moberg I, Krupic F, et al. 11-Year outcomes in patients with metal-on-metal ASR hip arthroplasty. J Orthop 2022;32:98-103. [Crossref] [PubMed]
113. Domb BG, Bheem R, Monahan PF, et al. Minimum Five-Year Outcomes of Hip Resurfacing: Propensity-Score Matched Against Total Hip Arthroplasty Control Groups. J Arthroplasty 2021;36:2012-5. [Crossref] [PubMed]
114. Stoney J, Graves SE, de Steiger RN, et al. Is the Survivorship of Birmingham Hip Resurfacing Better Than Selected Conventional Hip Arthroplasties in Men Younger Than 65 Years of Age? A Study from the Australian Orthopaedic Association National Joint Replacement Registry. Clin Orthop Relat Res 2020;478:2625-36. [Crossref] [PubMed]
115. Pritchett JW. Hip Replacement or Hip Resurfacing with a Highly Cross-Linked Polyethylene Acetabular Bearing: A Qualitative and Quantitative Preference Study. JB JS Open Access 2020;5:e0004.