Metal-on-metal
Adept
The proven option for active men with larger native heads. Manufactured by MatOrtho, with ODEP 15A rating in male patients with 48 to 58 mm heads.
Adept detail →
Hip resurfacing is a bone-preserving form of hip replacement. Instead of removing the arthritic femoral head and inserting a long stem down the thigh-bone, the surgeon reshapes the worn surface of the femoral head and caps it with a smooth shell. A matching cup is set into the socket. The native femoral head, neck, and the canal of the upper femur all stay where they are.
That matters for three reasons you will notice. The new joint is almost the same size as your own hip was, so it feels like your hip and is much less likely to dislocate. Your weight still passes through your own bone in the way it always did, so the muscles around the hip keep working normally and your sense of where the leg is stays intact. And because the top of your thigh-bone is untouched, if the resurfacing ever wears out, many years from now, it can be converted to a standard hip replacement as if it were a first operation.
Both restore a worn hip, but they take very different approaches. A short comparison sits below. For a full side-by-side guide covering bone preservation, longevity, activity, anatomy and revision, see the dedicated Resurfacing vs Replacement page.
Neither is universally better. The right operation depends on bone quality, anatomy, age, sex, activity goals and the bearing options that are sensible for the individual.
Am I a Candidate?Active adults with hip arthritis and good bone, who want to keep running, cycling, working physically or playing sport. Age and sex matter less than they used to; what decides it is the quality of your bone and the size and shape of your hip on X-ray.
The classic resurfacing patient is an active adult with hip osteoarthritis, good bone quality and a life the hip needs to keep up with: running, cycling, skiing, manual work, a sport played seriously. In the metal-on-metal era that group was narrowed further, to men with larger native femoral heads. The arrival of ceramic bearings has widened it again, and women and smaller-framed patients who were once steered away from the operation are now routinely considered.
What decides suitability is not age or sex on their own but what the imaging and examination show: the quality of the bone in the femoral head and neck, the shape and condition of the joint, and whether the goals you have for the hip are ones a resurfacing serves better than a total hip replacement. Some hips are simply better served by a replacement, and a straight answer will say so.
The full account of how suitability is assessed, including the factors that count for and against, is on the am I a candidate? page.
You lie on your side and the hip is reached through an incision at the back of the joint, through muscle that heals well. The ball of the hip is lifted out of the socket so that Mr Hussain can work on both halves of the joint in turn.
The worn surface of the ball is shaved back to healthy bone and shaped to take the cap, rather like preparing a tooth for a crown. The socket is prepared to match and a new cup, with a surface your bone grows into, is pressed firmly into place. The cap is then fixed onto the prepared ball: cemented for the metal implant, pressed on for the ceramic ones. The hip is put back together and the layers closed. Nothing has been removed except the worn surface.
The operation typically takes around 90 to 120 minutes. Anaesthesia is most often general, often supplemented by a regional block, with tranexamic acid used to limit blood loss. Many patients spend one to three nights in hospital, and some specialist centres now run enhanced-recovery pathways for selected day-case patients.
For a deeper step-by-step walk-through, including imaging, anaesthetic and rehabilitation detail, see the dedicated Procedure page; for what happens before the operation, from pre-operative assessment to getting surgery-fit, see preparing for hip resurfacing.
You walk on the day of surgery, go home after one to three nights, are off crutches at around four to six weeks and back at a desk in six to twelve. Running and impact sport come back between four and six months, cleared individually. Most patients say the first fortnight is the hard part and the rest is steadily easier.
The week-by-week detail, including driving, flying, work and sport, is in our recovery guide.
Surgeons have been trying to cap rather than replace the hip since the 1920s. The early attempts failed because the materials could not take the load. The modern operation was invented in Birmingham in the 1990s, nearly lost its reputation to a bad metal bearing in the 2010s, and has been reborn with ceramic in the 2020s. The full story is told in our history of hip resurfacing.
The decade after 2010 was the hardest in modern hip surgery. One widely used metal-on-metal resurfacing was withdrawn worldwide after it failed in up to half of patients within ten years, and the UK regulator put every patient with a metal-on-metal hip under surveillance. The problem was the bearing, not the idea: small metal bearings and badly positioned cups shed cobalt and chromium, and the tissues reacted. Most surgeons stopped resurfacing. A small group of high-volume specialists carried on, with excellent results in well-chosen patients, which is why choosing a hip resurfacing surgeon who still does the operation regularly matters so much.
Yes, and it is growing again, because of ceramic. For years the obstacle was that ceramic could not be made thin enough to work as a resurfacing cap without cracking. Modern medical ceramic, a toughened alumina called BIOLOX delta, can. ceramic-on-ceramic resurfacing wears more slowly than any other joint surface in use and releases no cobalt or chromium, so the problem that dogged the metal years simply does not arise.
Two ceramic resurfacing systems are now in clinical use, both with a strong British connection. The ReCerf, made by MatOrtho and developed from the proven Adept geometry, was first implanted in 2018 and received its CE mark in 2024. Multicentre two-year and five-year results published in 2024 and 2025 have been encouraging. The H1, developed at Imperial College London with Professor Justin Cobb and made by Embody, was first implanted in 2017 and was awarded a CE mark under the new EU Medical Device Regulation in 2025. A monoblock, anatomically contoured ceramic implant, it suits patients across the range of native head sizes and, like ReCerf, has reopened the conversation for many, including women previously advised against the operation in the metal-on-metal era.
The original metal-on-metal Adept implant is still in use in a defined group of patients: typically active younger men with larger native heads, where decades of registry data confirm excellent durability. The combination of three implants now available means the conversation has shifted from "is this patient suitable for resurfacing" to "which resurfacing bearing is the right fit for this patient's anatomy and life".
The proven option for active men with larger native heads. Manufactured by MatOrtho, with ODEP 15A rating in male patients with 48 to 58 mm heads.
Adept detail →The all-ceramic successor to Adept. Made by MatOrtho, CE marked in 2024, with multicentre two- and five-year outcomes data now published.
ReCerf detail →The British ceramic resurfacing from Imperial College London and Embody. CE marked under EU MDR in 2025.
H1 detail →All hip surgery carries the general risks of any major operation, including infection, blood clots, nerve injury, and the small anaesthetic risks that come with any procedure. Resurfacing has its own distinct profile in addition to these, and any proper conversation about the operation covers the following. How common each one is, and what reduces it, is set out in full in our guide to the risks and complications of hip resurfacing.
Worried about a particular risk? The complications guide covers each one in detail, including how often it happens and what is done to prevent it.
Self-pay hip resurfacing with Mr Hussain in Birmingham costs £12,250 for an Adept metal-on-metal resurfacing and £13,450 for a ceramic ReCerf resurfacing, as fixed-price, all-inclusive packages at Royal Orthopaedic Hospital private care. One figure covers the surgeon's and anaesthetist's fees, the implant, theatre time, your hospital stay, in-patient physiotherapy and routine post-operative follow-up. The £250 initial consultation is charged separately, and your itemised quotation is confirmed in writing after your consultation.
If you are insured you do not need the package. Hip resurfacing is covered by most comprehensive UK policies where it is clinically needed, and Mr Hussain is recognised by Bupa, AXA Health, Vitality, Aviva, WPA and Cigna. Your insurer will ask for preauthorisation before surgery; the practice handles that paperwork with you. The full breakdown of self-pay and insured routes is on the fees page and in the insurance guide.
A written quotation takes one consultation. Bring your X-rays if you have them; if not, imaging is arranged on the day.
Book a ConsultationIn well-selected patients the metal-on-metal resurfacings have some of the best long-term records in joint registries: the Adept holds an ODEP 15A rating in men with 48 to 58 mm femoral heads, meaning strong documented survival beyond fifteen years. The ceramic implants are newer and do not yet have decades of follow-up, though medical-grade ceramic has been used in total hip replacement for decades and wears extremely slowly. Every resurfacing in this practice is followed up over the long term.
Most patients take their first steps on the day of surgery, are walking unaided by four to six weeks, and are cleared for a graduated return to impact sport at four to six months. The full week-by-week timeline, from the day of surgery to the return of sport, is on the recovery page.
For well-selected patients, yes; a return to running is one of the main reasons active patients choose resurfacing over total hip replacement. The large bearing and preserved bone make impact activity a realistic goal rather than an exception. The phase-by-phase return is mapped in the guide to running after hip resurfacing.
There is no fixed age cut-off. What matters is bone quality, anatomy and activity, assessed on imaging and examination, rather than the date on your birth certificate. Resurfacing is most often chosen by patients in their forties, fifties and sixties who intend to stay active, but suitability is decided case by case on the same candidacy criteria at any age.
Neither is universally better. Resurfacing preserves bone, uses a large stable bearing and suits high activity; a total hip replacement fits almost any anatomy and bone quality and remains the dependable default of modern hip surgery. The right answer depends on your bone, anatomy, age and goals; the full side-by-side comparison is on the resurfacing vs replacement page.
With Mr Hussain in Birmingham, self-pay packages cost £12,250 for an Adept metal-on-metal resurfacing and £13,450 for a ceramic (ReCerf) resurfacing: fixed-price and all-inclusive, covering the surgeon's and anaesthetist's fees, implant, theatre time, hospital stay, in-patient physiotherapy and routine follow-up. The £250 initial consultation is charged separately, and most comprehensive UK private medical policies cover the operation where clinically indicated.
Yes. It is done less often than in the 2000s, because most surgeons stopped after the metal-on-metal problems, but it continues in specialist centres and is growing again now that ceramic implants are available. Mr Hussain performs it regularly at the Royal Orthopaedic Hospital and privately in Birmingham.
About 90 to 120 minutes for one hip. You are usually in hospital for one to three nights and walking on the day of surgery. Both hips in one operation takes two to three hours.
The most useful next step is a private consultation with imaging review. We will tell you, plainly, whether hip resurfacing is the right operation for you, which bearing would suit you, and what realistic recovery looks like.
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