A hip resurfacing has two parts: a cap over the reshaped femoral head and a cup set into the socket. "Metal-on-metal" describes what those two surfaces are made of — both are cobalt-chromium, articulating metal against metal. It was the original bearing of the modern operation, developed in Birmingham in the 1990s, and for the right patient it remains one of the most durable joint surfaces in orthopaedics.
The reason it works so well is geometry. A resurfacing keeps the patient's own large femoral head, so the bearing is wide — close to the size of the native hip. A large, well-made, well-positioned metal bearing wears extremely slowly and is very stable. The difficulties that surrounded metal-on-metal were never about the well-selected case; they were about small bearings, small heads, poor cup position and inexperienced hands, which is the thread that runs through the rest of this page.
Between roughly 2008 and 2018, metal-on-metal hip surgery went through real turbulence. Several devices — most prominently the DePuy ASR — were withdrawn after independent data showed unacceptable revision rates, and the regulator issued repeated alerts that widened the group of patients needing formal monitoring. Analysis of National Joint Registry data identified the recurring culprits clearly: small bearing diameter, smaller native head size, sub-optimal cup positioning and lower-volume surgeons.
The cause was the bearing in the wrong setting, not the operation itself. Where metal surfaces wore or corroded, cobalt and chromium ions were released into the joint and bloodstream, and in some patients that provoked an adverse reaction. That complication — metallosis, or adverse reaction to metal debris — is covered in full on the metallosis page, including symptoms, surveillance and revision. The point for this page is simpler: the failures clustered in identifiable risk factors, and modern practice is built around avoiding every one of them.
Used selectively, metal-on-metal is not a compromise — for the patient it fits, it is the choice with the longest and strongest evidence base of any resurfacing bearing. The single metal-on-metal implant offered in this practice is the Adept, which holds an ODEP 15A rating in men with 48 to 58 mm heads, meaning a documented fifteen-year record in exactly the patients in whom it is used.
The principle The question today is not "metal-on-metal or nothing" but "which bearing fits this particular patient." Where the profile matches, metal-on-metal is the evidence-led choice; where it does not, ceramic is. Both are decided on imaging, examination and a frank conversation — see am I a candidate?
The biggest change in resurfacing has been the arrival of ceramic-on-ceramic bearings. Modern medical-grade ceramic releases no cobalt or chromium, needs no metal-ion surveillance, and has reopened the operation to women and smaller-framed patients who were poorly served by metal. Two ceramic implants are now in routine use — the ReCerf and the H1 — alongside the metal-on-metal Adept.
This does not make metal-on-metal obsolete. Its advantage is time: decades of registry follow-up that the ceramic bearings, being newer, have not yet had the years to accumulate. For an active man with a larger head, that certainty of long-term outcome is a genuine clinical benefit. The full side-by-side of all three implants is set out on the implants overview, and the women's perspective on the bearing change is covered on the hip resurfacing for women page.
Which bearing is right for you is not a decision to make from a web page. It is settled at consultation, on your imaging and your goals.
Book a ConsultationWhen the bearing is matched to the right patient and the surgery is performed at a high-volume centre, modern metal-on-metal resurfacing is safe and durable. The problems of the past clustered in small bearings, small heads, poor cup positioning and low surgical volume — a risk envelope that careful selection and an experienced surgeon stay well outside. This is one reason surgeon volume matters so much for this particular operation.
Choosing metal-on-metal does mean accepting lifelong surveillance: periodic checks of whole-blood cobalt and chromium, with imaging if anything changes. That pathway exists to catch the rare problem early, while it is simple to address, and it is part of choosing the bearing knowingly. What surveillance involves, and what the body's response to metal debris actually is, are set out in full on the metallosis page.
Yes, for a defined group of patients. After the device withdrawals of the 2010s many people assume it has stopped, but a well-chosen metal-on-metal resurfacing in the right patient, performed at a high-volume centre, has an excellent long-term record. The implant used in this practice, the Adept, holds an ODEP 15A rating in men with 48 to 58 mm heads — a documented fifteen-year track record. What changed is selection: it is now offered only where the data is unambiguously strong.
Typically active men with larger native femoral heads (around 48 to 58 mm), good bone quality, and a willingness to attend lifelong surveillance. This is the profile in which long-term registry data for metal-on-metal resurfacing is strongest. It is not suitable for women of child-bearing potential, smaller-framed patients with small native heads, or patients with significant kidney impairment or metal allergy — for whom ceramic resurfacing is the answer.
When the bearing is matched to the right patient and the surgery is performed at a high-volume centre, modern metal-on-metal resurfacing is safe and durable. The problems of the late 2000s and early 2010s were concentrated in small bearing diameters, smaller native heads, sub-optimal cup positioning and lower-volume surgeons. Used today in the patient profile its data supports, it sits well outside that risk envelope, with lifelong metal-ion surveillance part of choosing it knowingly.
Neither is universally better; they suit different patients. Metal-on-metal has the longest documented track record and is the evidence-led choice for active men with larger heads. Ceramic-on-ceramic releases no cobalt or chromium, requires no metal-ion surveillance, and has reopened resurfacing to women and smaller-framed patients who were poorly served by metal bearings. The right answer depends on your anatomy, sex, bone quality and preferences, and is settled at consultation.
Metal-on-metal or ceramic is a decision made on your anatomy, not a headline. Mr Hussain will review your imaging and tell you plainly which bearing suits your hip, and why.
Book a Consultation