Hip Resurfacing:
Looking Back on Nearly 20 Years and What Lies Ahead

What Makes Hip Resurfacing Different?

Most people are familiar with total hip replacement, but hip resurfacing takes a different approach.

In a traditional hip replacement, the damaged ball of the hip joint is removed and replaced with an artificial ball attached to a stem that extends into the thighbone.

Hip resurfacing allows us to preserve more of the patient’s natural bone. Rather than removing the entire femoral head, we reshape it and place a metal cap over it. The damaged socket is replaced as well.

One of the main advantages is that we can preserve the femoral head and neck while maintaining a joint that is closer in size to the patient’s natural anatomy. This can be particularly appealing for younger, active patients.

However, resurfacing isn’t the right choice for everyone. Bone quality, anatomy, age, and activity level all play an important role in determining whether a patient is a good candidate.

How Hip Resurfacing Has Evolved

Hip resurfacing isn’t a new concept. In fact, surgeons were performing earlier versions of the procedure in the 1970s and 1980s.

Unfortunately, those early implants had their share of problems, including excessive wear, loosening, and bone loss. As a result, the procedure became much less common.

Things began to change in the 1990s as implant designs and materials improved. The Birmingham Hip Resurfacing system was introduced in 1997 and received FDA approval in the United States in 2006.

I began using the BHR system the following year. At the time, it offered another option for certain patients who needed hip surgery but wanted to preserve more of their natural bone.

What We’ve Learned Over the Years

As more surgeons gained experience with metal-on-metal hip resurfacing, we developed a better understanding of which patients benefited most from the procedure.

Research has shown particularly good results in younger men with larger femoral heads. One prospective U.S. study found that 96% of BHR implants in men under 65 had not required revision surgery at the 10-year mark.

Those are encouraging results, and they reflect why resurfacing remained a valuable option in carefully selected patients. However, they don’t mean resurfacing is necessarily better than modern total hip replacement for everyone.

We also learned more about the challenges associated with metal-on-metal implants.

Over time, the metal surfaces can release small amounts of cobalt and chromium. In some patients, this can cause reactions in the surrounding tissue and even damage to the bone. There is also a risk of fracture involving the preserved femoral neck.

These are important considerations, and they reinforce something I’ve always believed is essential in orthopedic surgery: choosing the right procedure for the individual patient.

Why the Birmingham Hip Resurfacing System Was Discontinued

The changes to the BHR system didn’t happen all at once.

In 2015, Smith+Nephew removed the smaller implant sizes, measuring 46 millimeters or less, from the market. The company also changed its recommendations to contraindicate use in women because of higher revision rates.

Larger implant sizes continued to be available for appropriately selected male patients.

In spring 2026, the BHR system was phased out of the U.S. market entirely.

For me, this marked the end of nearly two decades of working with an implant that had been an important part of my practice.

If your hip is functioning well, there is no reason to assume something is wrong simply because the implant has been discontinued. Regular follow-up remains important, though. The FDA generally recommends that patients with metal-on-metal hip implants see their orthopedic surgeon every one to two years, or sooner if they develop symptoms or concerns.

What’s Next for Hip Resurfacing?

Although the BHR is no longer available in the United States, I don’t believe this is the end of hip resurfacing.

There are some interesting developments underway, particularly with newer materials that eliminate the metal-on-metal bearing surface.

One system I’m following is Polymotion Hip Resurfacing. Instead of using two metal surfaces, it combines a metal femoral cap with a polyethylene bearing. The goal is to preserve the benefits of resurfacing while avoiding some of the concerns associated with metal-on-metal implants.

Polymotion is currently being evaluated through a U.S. investigational study, which reached full enrollment in April 2026. It has not yet received FDA approval for routine use.

Ceramic-on-ceramic hip resurfacing is another area I’m watching closely.

Systems such as ReCerf and H1 have made progress internationally. ReCerf has received approval in Canada, along with FDA Breakthrough Device Designation in the United States. While that designation is a promising step in the regulatory process, it does not mean the implant is FDA-approved for use here.

At this point, I have not started using a replacement resurfacing system in my practice. I’ve had a good experience with BHR, and I’m certainly interested in seeing how these newer designs perform.

As with any new technology, I want to see strong clinical evidence and feel confident that it offers meaningful benefits for my patients before incorporating it into my practice.

Looking Ahead

After nearly 20 years of performing hip resurfacing, I’ve seen how valuable this procedure can be for the right patient.

While I’m disappointed to see the Birmingham system leave the U.S. market, I’m encouraged by the continued research and development in this area.

For patients considering hip surgery, my approach remains the same. We look at your symptoms, your anatomy, your lifestyle, and what you hope to get back to doing.

Whether that leads us to a traditional total hip replacement or potentially a newer resurfacing option in the future, the goal is to find the treatment that gives you the best opportunity for long-term success.