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Hip preservation · Clinically reviewed

Hip resurfacing, bone-conserving surgery for the right patient.

A specialist-commissioned alternative to total hip replacement for younger, active adults - with careful patient selection and lifelong MHRA-guided follow-up.

A radiographer guides a patient onto the bed of an advanced 3 Tesla MRI scanner in a London imaging suite

Why trust this guide

  • 01

    Clinically reviewed

    Written by our editorial team and reviewed by a UK-registered orthopaedic clinician before publication.

  • 02

    Sourced from guidance

    Checked against NICE, MHRA and British Orthopaedic Association sources you can see at the end.

  • 03

    Current for 2026

    Reflects modern UK guidance on metal-on-metal surveillance, MHRA follow-up and specialist-commissioned hip preservation.

Key facts

Hip resurfacing at a glance.

The essentials, in plain English - what the operation is, who it is for, and what follow-up looks like in the UK today.

  • What it is

    A bone-conserving alternative to total hip replacement - the femoral head is capped rather than removed, and a matching metal cup is fitted into the socket.

  • Best-known implant

    The Birmingham Hip Resurfacing (BHR) system by Smith & Nephew is the most established design used in the UK.

  • Ideal candidate

    A younger, active man with good bone quality and primary osteoarthritis or femoroacetabular impingement - not a routine option for most patients.

  • Bearing surface

    Large-diameter metal-on-metal - offers stability and a wider range of motion but requires long-term metal-ion surveillance.

  • Where it is done

    Specialist-commissioned hip preservation centres with high-volume surgeons, MDT input and access to Mako-assisted planning where indicated.

  • Follow-up

    Lifelong MHRA-guided review - clinical assessment, cobalt and chromium blood levels and cross-sectional imaging when needed.

Why this guide matters

A niche operation, done properly.

Hip resurfacing is not a routine option - but for a well-selected patient in the right hands, it remains a durable, bone-conserving solution. Three points shape the rest of this page.

  • Patient selection is everything

    Age, sex, bone quality, head size and activity level all matter. In the wrong patient, resurfacing fails earlier and for reasons a stemmed replacement would have avoided.

  • Specialist-commissioned centres

    This should only be done by high-volume hip preservation surgeons with MDT support, robust consent processes and access to Mako-assisted planning where indicated.

  • Metal-on-metal means surveillance

    MHRA guidance requires lifelong follow-up with clinical review, cobalt and chromium levels and cross-sectional imaging when concerns arise.

How the decision is made

From first review to a considered plan.

The steps a UK hip preservation team will follow when deciding whether resurfacing is the right operation for you.

  1. 01

    Assessing

    Specialist hip preservation review

    A consultant hip surgeon confirms the diagnosis and whether the joint can realistically be preserved rather than replaced.

  2. 02

    Assessing

    Patient selection assessment

    Age, activity level, bone quality, sex, femoral head size and kidney function are all weighed carefully - selection is critical.

  3. 03

    Assessing

    Imaging and templating

    Standing pelvic radiographs plus MRI or CT to assess head size, bone stock, dysplasia and any impingement lesions.

  4. 04

    Confirming

    Baseline metal ion levels

    Cobalt and chromium blood levels are recorded before surgery to give a true baseline for later surveillance.

  5. 05

    Confirming

    MDT discussion

    Complex or borderline cases are reviewed by the hip preservation MDT to decide between resurfacing, replacement, arthroscopy or osteotomy.

  6. 06

    Preparing

    Informed consent

    A detailed conversation about metal-on-metal risks, ALVAL, pseudotumour, revision risk and lifelong follow-up before any decision is made.

  7. 07

    Preparing

    Pre-operative optimisation

    Weight, smoking, diabetic control and physiotherapy are addressed so the joint has the best possible chance of a durable result.

Typical timeline: first specialist consultation to a settled decision over several weeks.

Symptoms

What brings people to a hip surgeon.

Most patients considering resurfacing have osteoarthritis or femoroacetabular impingement affecting a still-young, active hip. Here is what that usually feels like.

  • Groin and hip pain

    Deep, activity-related groin pain is the most common presenting symptom of the underlying arthritis or impingement.

  • Stiffness and reduced rotation

    Loss of internal rotation and difficulty putting on socks or shoes - a classic early sign of hip osteoarthritis.

  • Mechanical symptoms

    Catching, clicking or a sense of the hip locking - often reflects a labral tear or impingement lesion.

  • Functional limitation

    Difficulty with sport, running, prolonged standing or long walks - a key driver of surgical decision-making.

  • Referred thigh or knee pain

    Hip pathology often refers pain to the anterior thigh or knee - misdiagnosis as a knee problem is common.

  • Night pain

    Pain waking you at night or when lying on the affected side signals more advanced disease.

  • Young, active adult

    Resurfacing is considered when a total hip replacement feels premature - typically men under 65 with high functional demand.

  • Red flag - suspected pseudotumour

    New pain, swelling or a mass around a metal-on-metal hip needs urgent specialist review and cross-sectional imaging.

Treatment

How resurfacing sits alongside other hip options.

Resurfacing is one option in a wider hip preservation toolkit - alongside total hip replacement, arthroscopy, osteotomy and structured rehabilitation.

  • Birmingham Hip Resurfacing (BHR)

    The best-evidenced UK resurfacing option - a cobalt-chrome femoral cap and matching acetabular cup, cemented and press-fit respectively.

  • Total hip replacement

    The standard alternative - removes the femoral head and neck and uses a stem. Discussed in detail at /treatments/hip-replacement-surgery/.

  • Hip arthroscopy

    For impingement or labral pathology without significant arthritis - covered at /treatments/hip-arthroscopy/.

  • Periacetabular osteotomy

    A joint-preserving option for symptomatic hip dysplasia in younger patients - covered at /treatments/periacetabular-osteotomy/.

  • Mako-assisted planning

    Robotic-arm assisted planning may be used adjunctively for component positioning in selected specialist units.

  • Structured physiotherapy

    A staged rehabilitation programme is essential - restoring range, strength and gait pattern over three to six months.

  • Weight optimisation

    A lower BMI reduces bearing wear, ion release and implant loading - the single biggest modifiable factor for longevity.

  • Ongoing MHRA-guided surveillance

    Annual review with clinical assessment and metal-ion testing - with MRI or ultrasound if a soft-tissue reaction is suspected.

What this guide is based on

The sources behind every claim on this page.

UK national guidance and specialist society standards, current at the time of last review.

Key references

Guidelines and standards we relied on.

A quiet reminder

This guide is for information, not medical advice.

Your hip surgeon knows your imaging, ion levels and full history and can tell you which parts apply to you. If in doubt, get seen.

  • MHRA. Medical Device Alert - all metal-on-metal hip replacements: updated advice on patient monitoring.

  • NICE. Total hip replacement and resurfacing arthroplasty for end-stage arthritis of the hip (TA304).

  • British Orthopaedic Association (BOA). Hip preservation and metal-on-metal follow-up guidance.

  • British Hip Society. Consensus statements on hip resurfacing and revision.

  • National Joint Registry (NJR). Annual report - resurfacing outcomes and revision rates.

Red flags

When a resurfaced hip needs urgent review.

Most resurfaced hips settle down and behave beautifully. These are the situations where you should not wait for your next annual appointment.

  • New or worsening groin pain

    Pain returning months or years after a resurfacing needs urgent orthopaedic review to rule out an adverse local tissue reaction.

  • Palpable mass or swelling

    A soft-tissue mass around the hip may reflect a pseudotumour - this needs specialist imaging without delay.

  • Rising cobalt or chromium levels

    MHRA thresholds trigger cross-sectional imaging and closer follow-up - do not miss the annual blood check.

  • Loss of function or limp

    A new limp, giving way or difficulty weight-bearing suggests loosening, fracture or ALVAL.

  • Systemic symptoms

    Fatigue, cognitive change or thyroid dysfunction has been reported at very high ion levels - flag any new systemic complaint.

  • Suspected periprosthetic infection

    Fever, night sweats, wound discharge or sudden severe pain - a surgical emergency requiring urgent assessment.

  • Femoral neck fracture

    Sudden severe pain with inability to weight-bear early after surgery may signal a femoral neck fracture around the resurfacing.

  • Renal impairment

    Reduced kidney function slows metal-ion clearance and is a relative contraindication to any metal-on-metal bearing.

  • Pregnancy planning

    Women planning pregnancy with a metal-on-metal hip should have their ion levels reviewed and discussed in advance.

Living with it

A resurfaced hip, looked after for life.

Four habits that make the biggest difference to how a resurfaced hip performs, and how quickly any problems are spotted.

A quiet reminder

Follow-up is part of the operation.

A resurfacing is not something you do once and forget - lifelong surveillance is what makes early problems fixable.

  1. 01 Activity

    Return to sport is realistic

    A well-selected, well-performed resurfacing supports impact activity better than a stemmed replacement - but build up gradually with your physio.

  2. 02 Surveillance

    Show up for every follow-up

    Annual review, metal-ion levels and imaging when indicated - lifelong. This is how problems are picked up early and painlessly.

  3. 03 Bone health

    Protect the bone you kept

    Vitamin D, calcium, resistance training and, where appropriate, bone-density review keep the preserved femoral head strong.

  4. 04 Escalate

    Report new pain quickly

    New groin pain, swelling or a limp is not something to sit on - contact your surgical team the same week.

Frequently asked

Everything we get asked about hip resurfacing.

Quick answers on candidacy, the Birmingham Hip Resurfacing, risks and lifelong follow-up.

  • What is hip resurfacing?

    It is a bone-conserving hip operation. Instead of removing the femoral head and neck, the surgeon caps the femoral head with a metal shell and fits a matching metal cup into the socket. Most of your own bone is preserved.

  • How is hip resurfacing different from a total hip replacement?

    A total hip replacement removes the femoral head and inserts a stem down the femur. Resurfacing keeps the femoral head and neck intact and covers the joint surfaces with metal. Resurfacing preserves bone and often supports higher-impact activity, but it uses a metal-on-metal bearing and needs lifelong surveillance.

  • Who is the ideal candidate for a Birmingham Hip Resurfacing?

    Typically a younger, active man with good bone quality and primary osteoarthritis, femoroacetabular impingement or comparable disease, and a femoral head large enough to support the implant. Women, patients with osteoporosis, severe dysplasia, small femoral heads, metal sensitivity or significant renal impairment are usually better served by a total hip replacement.

  • What are the main advantages?

    Bone preservation, more physiological loading of the femur, a large-diameter head with a low dislocation risk, an easier future revision to a stemmed replacement if needed, and a better track record of return to sport in the right patient.

  • What are the main risks?

    The bearing is metal-on-metal, which releases cobalt and chromium ions. In a small proportion of patients this can trigger an adverse local tissue reaction, sometimes called ALVAL or a pseudotumour. Femoral neck fracture, component loosening and infection are other recognised risks.

  • What follow-up will I need?

    You will be followed for life. MHRA guidance recommends annual clinical review with cobalt and chromium blood tests, and MRI or ultrasound imaging if there is any concern about a soft-tissue reaction. Reporting new pain, swelling or a limp promptly is the single most important thing you can do.

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