Yes. With a ceramic implant, a woman is assessed for hip resurfacing on the same basis as anyone else: the quality of her bone, the size of her hip, and what level of activity she wants to get back to. That has only been true for a few years, and it is worth understanding why.
For most of the 2000s and 2010s, surgeons stopped offering resurfacing to women, and they had good reason. The implants of that era were metal-on-metal, and the national records showed they failed more often in women than in men: for a 55-year-old woman, roughly one in twelve needed a second operation within five years. NICE issued guidance to that effect, and by 2015 the maker of the best-known implant had withdrawn its smaller sizes and advised against using it in women at all.
The problem was not women; it was the combination of a small hip and a metal bearing. Women's hip joints are, on average, smaller than men's, and a smaller metal-on-metal bearing wears faster and sheds more cobalt and chromium into the bloodstream. For a woman who might still have children, that was a risk nobody wanted to take. So for a decade the advice was simple: not this operation, not with this implant.
A ceramic bearing removes each of those concerns in turn. It releases no cobalt or chromium, so there is nothing to build up in your blood and nothing to monitor. It wears more slowly than any other joint surface in use, which matters most if you are in your forties and expect the implant to work for decades. And it is made in sizes small enough to fit the hips that ruled so many women out before.
The cumulative effect is that women, smaller-framed men, and patients of child-bearing potential can now be considered for hip resurfacing on the same terms as anyone else: on the strength of their anatomy, bone quality and activity goals. The bearing chemistry no longer rules them out. The approvals and hospital adoption behind this shift are charted in our article on ceramic hip resurfacing in Birmingham.
The change is easiest to see in a real plan. The films below belong to a woman in her late forties with end-stage osteoarthritis of the right hip, the result of a hip that had been catching and wearing for years. She was young, active and wanted to keep as much of her own hip as possible. Her anatomy was the only thing standing in the way.
At 44 mm, her head was simply too small for metal-on-metal resurfacing. The Adept system, the only metal-on-metal resurfacing still available, is not made below a 48 mm head. This was not an implant the practice chose against; it was one that does not come small enough to fit her. A decade ago that single measurement would have closed the door on resurfacing altogether.
Her only remaining route to a pain-free hip would then have been a total hip replacement. A replacement is a reliable operation, but in a woman of this age it carries trade-offs that resurfacing does not: a lasting risk of dislocation, formal limits on higher-impact activity, and a greater likelihood of major revision surgery in later life as the first implant wears. We compare the two operations in full on hip resurfacing versus total hip replacement, and the specific risk of dislocation after a hip replacement is covered separately.
Ceramic-on-ceramic resurfacing made a different answer possible. BIOLOX delta ceramic implants are manufactured down to a 40 mm head, so a 44 mm hip sits comfortably within range. She was treated with a ReCerf ceramic resurfacing, shown in place above. Her own femoral head was preserved, and the replacement she would otherwise have needed, with everything that follows it, was avoided.
Much the same as any active patient with a worn hip would. Mr Hussain looks at your standing X-rays, measures the size of your femoral head, checks the strength of your bone and asks what level of activity you want to get back to. From that, the implant choice is usually clear before you leave the room.
The questions women most often arrive with, and the answers:
The conversation is, in the end, the same conversation as for any well-selected resurfacing candidate. The historic complications that once made it a different conversation no longer apply.
This is no longer theoretical. The Royal Orthopaedic Hospital has reported its first female ceramic hip resurfacing patient, operated on by Mr Shakir Hussain; how she weighed the decision and what recovery has really been like are told in her patient story.
The three implants in the field carry meaningfully different positions for women. The brief view below sits alongside the full implant overview for context.
Adept is a metal-on-metal implant and is not offered to women in this practice. The cobalt and chromium exposure concerns that drove the historic restriction on metal-on-metal resurfacing in women remain valid for Adept.
Adept detail →ReCerf is the ceramic-on-ceramic resurfacing offered to women at this practice, suitable across the range of native head sizes. The published five-year outcomes cohort includes a substantial proportion of female patients with low revision rates. For women choosing ceramic resurfacing here, ReCerf is the implant used.
ReCerf detail →H1 is the British ceramic-on-ceramic resurfacing developed at Imperial College London and made by Embody, also suitable for women across the range of native head sizes. It is a newer ceramic option in the field, with ReCerf the more established choice.
H1 detail →Both ReCerf and H1 are ceramic-on-ceramic options suitable across the size range; at this practice the ceramic resurfacing offered to women is ReCerf, and the decision is settled on imaging in clinic, where the right answer usually becomes clear in the consultation.
One of the strongest reasons women were steered away from hip resurfacing in the metal-on-metal era was concern about cobalt and chromium exposure during pregnancy. Maternal ion levels with a metal-on-metal hip can cross the placenta, and the long-term implications for the developing fetus were never fully characterised. For any woman with the option of avoiding that exposure entirely, avoiding metal-on-metal was the right call.
With a ceramic implant that concern disappears. Nothing from the bearing enters your bloodstream, so there is nothing to reach a baby. Once you have recovered from surgery there is no implant-related reason to delay a pregnancy, a normal delivery is fine, and your midwife and obstetrician will look after you exactly as they would anyone else.
Patients planning pregnancy after resurfacing often ask about timing of the surgery itself relative to pregnancy. The conservative position is to allow full recovery and return to a stable activity baseline, typically six to twelve months from surgery, before pursuing pregnancy. There is no fixed rule; the timing is settled with the surgeon and the wider clinical team.
The fees are the same for women as for any patient. Self-pay packages at Royal Orthopaedic Hospital private care are fixed and all-inclusive: £13,450 for a ceramic ReCerf resurfacing and £12,250 for an Adept metal-on-metal resurfacing. For most women the relevant figure is the ceramic one, since ceramic-on-ceramic is the bearing that reopened the operation for women. One figure covers the surgeon's and anaesthetist's fees, the implant, theatre time, the hospital stay, in-patient physiotherapy and routine follow-up. The £250 initial consultation is charged separately.
Insured patients are covered by most comprehensive UK private medical policies where the operation is clinically indicated, and Mr Hussain is recognised by the major insurers. The full breakdown is on the fees and insurance page.
Yes. Ceramic implants have reopened the operation for women. The ceramic bearing releases no cobalt or chromium, so the concerns that ruled women out in the metal-on-metal years do not apply. You are assessed on your bone, the size of your hip and what level of activity you want to get back to, exactly as any other patient is. ReCerf is the ceramic resurfacing used here; H1 is the other ceramic option.
Because the implants of the 2000s and early 2010s were metal-on-metal, and they failed more often in women. Smaller hips meant smaller metal bearings, which wore faster and released more cobalt and chromium, a particular worry for women who might have children. The national registry and NICE both said so, and resurfacing became an operation for active men with large hips. None of that applies to a ceramic implant.
Yes, on the points that mattered most. A ceramic bearing releases no cobalt or chromium, which was the single biggest problem for women before, and it is made in sizes that fit smaller hips. The published five-year results for ReCerf include a large proportion of women, with low revision rates.
Yes. The worry about metal ions in pregnancy only ever applied to metal-on-metal bearings; a ceramic implant releases none. Pregnancy after resurfacing is well documented and a normal delivery is fine. Timing is usually the only thing to plan, and that is discussed in clinic.
Often, yes. If you are under 40 and active, keeping your own bone matters more than at any other age, because whatever is done now has to last decades and leave room for the future. A ceramic resurfacing keeps the bone, wears slowly and lets you get back to running and sport. A look at your X-rays and a frank conversation are the right starting point.
Here, ReCerf. Both are ceramic-on-ceramic implants with the same bearing material and both suit women across the size range; they differ mainly in where they come from, H1 from Imperial College London and ReCerf from MatOrtho, built on the long-established Adept shape. The final choice is made on your X-rays in clinic.
A private consultation with imaging review is the most useful next step. We will tell you, plainly, whether hip resurfacing is the right operation for you, which of the two ceramic implants suits your anatomy, and what realistic recovery looks like.
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