An evidence-based guide to hip resurfacing availability in the United States, FDA regulations, metal and ceramic implants, clinical outcomes, and treatment options in Canada.
Last updated: October 2026
For patients living with hip arthritis, choosing the right surgical treatment can involve more than deciding when to undergo surgery. It can also mean deciding which procedure best matches their anatomy, activity level, bone quality, and long-term goals.
Total hip replacement remains a well-established and effective treatment for advanced hip arthritis. However, some patients—particularly younger or more active individuals interested in preserving more of their natural bone—may also wish to explore hip resurfacing surgery.
In the United States, the availability of hip resurfacing has evolved over the past two decades. Concerns surrounding certain metal-on-metal implants, changes in device regulation, and advances in ceramic technology have all contributed to a more complex treatment landscape.
Hip resurfacing is still an option in the United States for appropriately selected patients. However, not every type of resurfacing implant is available under the same regulatory framework, and access to specialized surgeons and implant technologies can differ.
For American patients considering surgery in 2026, understanding these distinctions is essential.
Is Hip Resurfacing Still Available in the United States?
Hip resurfacing remains an FDA-approved surgical option in the United States, but the regulatory status and availability of specific implant technologies differ.
The U.S. Food and Drug Administration (FDA) distinguishes between two procedures that are sometimes confused:
- Metal-on-metal total hip replacement: The femoral head is removed and replaced with an artificial ball attached to a stem.
- Metal-on-metal hip resurfacing: The natural femoral head and neck are preserved and covered with resurfacing components.
According to the FDA's published guidance, there are no FDA-approved metal-on-metal total hip replacement devices currently marketed in the United States. The FDA separately identifies two approved metal-on-metal hip resurfacing devices.
This distinction matters because regulatory restrictions affecting one type of hip implant should not automatically be interpreted as applying to every form of hip resurfacing.
The FDA's premarket approval database also documents regulatory activity involving the Birmingham Hip Resurfacing system, including approval supplements in 2024 and 2025.
However, FDA approval, commercial supply, and actual access to surgery are not identical. Patients should confirm with their orthopedic surgeon which implant systems are currently available and appropriate for their individual circumstances.
Hip resurfacing is also offered by a relatively small number of specialized surgeons compared with conventional total hip replacement. The procedure is technically demanding, and surgeon experience is an important consideration.
For patients interested in newer ceramic resurfacing technology, access within the United States is more restricted because the ceramic device discussed in this article is not FDA-approved for routine use.
What Is Hip Resurfacing Surgery?
Hip resurfacing is a bone-preserving surgical procedure used to treat selected patients with advanced hip joint disease, including osteoarthritis.
In a conventional total hip replacement, the surgeon removes the femoral head and inserts a prosthetic stem into the thighbone.
Hip resurfacing instead preserves the femoral head and neck, reshaping the damaged joint surfaces and covering them with implant components. The damaged socket surface is also replaced with an acetabular component.
The goal is to preserve more of the patient's natural bone while restoring a smoother, more functional joint surface.
Potential Benefits of Hip Resurfacing
- Greater bone preservation: More of the patient's natural femoral anatomy is retained.
- Larger femoral head geometry: This may contribute to joint stability and a reduced risk of dislocation in appropriate circumstances.
- Preservation of future options: Retaining femoral bone may be advantageous if revision surgery becomes necessary.
- Activity-related considerations: Certain active patients may benefit from the procedure's anatomical characteristics.
- Potential for high function: Selected patients may be able to return to demanding physical activities following appropriate rehabilitation and medical clearance.
These potential benefits do not mean that hip resurfacing is automatically superior to total hip replacement.
Hip resurfacing requires careful patient selection and specialized surgical expertise. It also carries specific risks, including femoral neck fracture, implant loosening, and complications related to bearing materials.
For many patients, conventional total hip replacement remains the more appropriate surgical option.
Hip Resurfacing vs. Total Hip Replacement
Hip resurfacing and total hip replacement are both designed to reduce pain and restore hip function. The primary anatomical difference is how much natural femoral bone is preserved.
| Feature | Hip Resurfacing | Total Hip Replacement |
|---|---|---|
| Femoral head | Preserved and capped | Removed |
| Femoral canal | Generally preserved | Stem inserted into the femur |
| Bone preservation | Greater femoral bone preservation | Less femoral bone preservation |
| Joint stability | Large head geometry may provide excellent stability | Excellent stability with modern implants |
| Future revision | May facilitate conversion to total hip replacement in selected cases | Conventional revision options |
| Typical candidates | Carefully selected patients with suitable anatomy and bone quality | Broad range of patients |
| Surgical considerations | Specialized technique and implant-specific risks | Well-established procedure with extensive long-term evidence |
Total hip replacement remains one of the most successful procedures in orthopedic surgery and is appropriate for a broad range of patients.
Hip resurfacing is more specialized. The decision between these procedures should be based on individual anatomy, bone quality, medical history, activity goals, and expected long-term outcomes.
Why Are Patients Interested in Hip Resurfacing?
Many patients considering hip resurfacing are physically active and want to maintain a high level of function after surgery.
Common reasons patients research the procedure include:
- Wanting to preserve more natural bone.
- Seeking an alternative to conventional total hip replacement.
- Hoping to return to sports or other demanding physical activities.
- Concern about joint dislocation.
- Interest in a reconstruction that retains the femoral head and neck.
- Considering the implications of possible future revision surgery.
For appropriately selected patients, hip resurfacing can offer meaningful advantages. However, outcomes depend on anatomy, bone quality, implant choice, surgical technique, and surgeon experience.
Why Did Metal-on-Metal Hip Implants Become Controversial?
Metal-on-metal hip implants received considerable attention because of complications associated with the interaction of metal bearing surfaces.
As metal components articulate during movement, small amounts of metal debris and metal ions may be released.
In some patients, this can contribute to:
- Elevated cobalt or chromium levels.
- Adverse local tissue reactions.
- Inflammation or damage involving tissues surrounding the joint.
- Pain, swelling, or implant-related complications.
- The need for additional monitoring or revision surgery.
The FDA has published guidance for patients and healthcare professionals addressing these concerns.
However, it is important to distinguish between different implant designs.
Metal-on-metal total hip replacements and metal-on-metal hip resurfacing systems are not interchangeable categories. Their clinical performance can differ, and outcomes depend on factors including implant design, component positioning, patient characteristics, and surgeon experience.
The problems associated with some metal-on-metal implants do not establish that every hip resurfacing procedure has the same risk profile.
Nevertheless, metal-related complications remain important considerations for patients evaluating traditional resurfacing.
Traditional Metal Hip Resurfacing: Is It Still a Reasonable Option?
For appropriately selected patients, traditional metal hip resurfacing remains a treatment option worth discussing with an experienced orthopedic surgeon.
Metal hip resurfacing has a longer clinical history than newer ceramic resurfacing technology. Long-term follow-up data provide valuable information about implant survivorship, revision rates, and patient selection.
A 2025 Australian registry-based study examined outcomes extending to 17 years for a contemporary resurfacing system and compared its performance with other resurfacing and conventional hip replacement implants.
The study illustrates why long-term registry evidence remains important when evaluating orthopedic implant performance.
Traditional metal resurfacing is often considered most appropriate for carefully selected individuals, particularly active men with adequate bone quality and suitable femoral head dimensions.
Potential advantages include bone preservation, large femoral head geometry, and a substantial clinical history in well-selected patients.
However, favorable outcomes in selected populations should not be generalized to all patients.
Patients with smaller femoral heads, reduced bone quality, certain medical conditions, or increased risk of metal-related complications may require a different treatment approach.
The decision should always be based on individual clinical assessment.
Why Is Ceramic Hip Resurfacing Attracting Attention?
Ceramic hip resurfacing represents an important development in bone-preserving hip surgery.
Like traditional metal resurfacing, ceramic resurfacing is designed to retain the natural femoral head and neck.
The major difference lies in the bearing surfaces.
Traditional metal resurfacing uses metal-on-metal articulation. Ceramic resurfacing uses ceramic bearing surfaces, avoiding the metal-on-metal contact responsible for metal wear debris and related ion exposure.
This development is particularly relevant because concerns about metal-related complications have historically influenced patient selection and the adoption of hip resurfacing.
Potential Advantages of Ceramic Resurfacing
Ceramic bearing technology may offer:
- Preservation of more natural femoral bone.
- Avoidance of metal-on-metal bearing wear.
- An additional treatment option for appropriately selected patients.
- The potential to address some limitations associated with traditional metal resurfacing.
Importantly, a ceramic bearing does not necessarily mean that every component of an implant is completely metal-free.
Patients interested in avoiding metal exposure should discuss the specific materials and components of the proposed implant with their surgeon.
Ceramic resurfacing also remains a specialized procedure requiring careful surgical planning.
Promising technology should not be confused with proven long-term superiority. Continued clinical monitoring and longer-term studies are essential.
Ceramic vs. Metal Hip Resurfacing: Understanding the Differences
Both ceramic and traditional metal hip resurfacing are designed to preserve femoral bone while restoring hip joint function.
However, the bearing materials, clinical evidence, and regulatory status differ.
| Feature | Ceramic Hip Resurfacing | Metal Hip Resurfacing |
|---|---|---|
| Bearing surfaces | Ceramic-on-ceramic | Metal-on-metal |
| Metal-on-metal wear | Avoided | Present |
| Clinical history | Newer technology | Longer clinical track record |
| Long-term evidence | Still developing | Longer-term follow-up available |
| Patient selection | May provide another option for selected patients | Established selection criteria, particularly for certain active male patients |
| U.S. regulatory status | Device discussed here is not FDA-approved for routine use | Certain systems are FDA-approved |
| Canadian access | Licensed technology available through appropriate providers | Depends on implant and provider |
Neither technology should be considered universally superior.
A comprehensive evaluation should consider age, sex, bone quality, femoral head size, hip anatomy, diagnosis, activity level, medical history, and long-term treatment goals.
What Does the Clinical Evidence Say About Ceramic Hip Resurfacing?
The growing body of published research provides encouraging evidence regarding early and mid-term outcomes.
A 2025 international multicentre study published in The Bone & Joint Journal evaluated ceramic-on-ceramic hip resurfacing in 604 consecutive patients.
The study included 336 men and 268 women, with a mean age of approximately 50 years.
Researchers assessed implant survivorship, revision risk, patient characteristics, and functional outcomes.
The estimated five-year survivorship must be interpreted alongside the study's mean follow-up of approximately 4.04 years and the limited number of hips reaching five years. These figures do not represent a guarantee of individual results.
Key Findings From the Five-Year Study
- The study included 604 patients.
- Mean follow-up was approximately 4.04 years.
- Among the hips with five-year follow-up, estimated implant survivorship was 98.0%.
- The study reported improvements in patient-reported hip function and activity scores.
- No statistically significant relationship between revision risk and sex or femoral head size was identified within the study.
These findings are encouraging, particularly because traditional metal resurfacing has historically involved important patient-selection considerations related to sex and implant size.
However, the results must be interpreted carefully.
Only 128 hips had reached five-year follow-up, and the average follow-up across the study population was shorter.
The study was retrospective, and longer-term follow-up is required to determine whether the observed outcomes are sustained.
Furthermore, results from ceramic and metal resurfacing studies should not be directly compared without accounting for differences in patient populations, implant designs, study methods, and follow-up periods.
The available evidence supports continued clinical interest in ceramic resurfacing, but does not establish that it is the best option for every patient.
Source: The Bone & Joint Journal, 2025, “Influence of head size and sex on the five-year survival of ceramic-on-ceramic hip resurfacing: an international multicentre study.” Read the published study ↗
FDA Approval vs. Health Canada Licensing: What Is the Difference?
For American patients considering ceramic hip resurfacing, understanding the regulatory distinction between the United States and Canada is particularly important.
United States
Medical devices used in the United States are regulated by the FDA.
The FDA has approved certain traditional metal-on-metal hip resurfacing systems.
However, the ceramic hip resurfacing technology discussed in this article is not currently FDA-approved for routine use in the United States.
This does not mean that all hip resurfacing is prohibited in the U.S. Rather, it means that specific implant technologies have different regulatory statuses.
Canada
In August 2026, the ceramic resurfacing device used by Dr. John Antoniou reached an important regulatory milestone in Canada.
The device is identified under Health Canada Medical Device Licence #115850.
Health Canada licensing permits the device to be marketed within the applicable Canadian medical-device framework.
As a result, access to this licensed technology no longer depends on obtaining patient-specific authorization through Health Canada's Special Access Programme.
Health Canada and the FDA are separate regulatory authorities. Licensing in Canada does not constitute FDA approval in the United States.
For American patients, the distinction creates an opportunity to explore a treatment option that may not be available through their local U.S. healthcare providers.
Why Some American Patients Are Exploring Hip Resurfacing in Canada
Traveling internationally for orthopedic surgery is a significant decision.
Patients may consider care outside their home country for several reasons, including access to a specialized surgeon, interest in a particular surgical technique, or availability of implant technologies.
For hip resurfacing, Canada may be relevant to American patients because certain ceramic technologies have a different regulatory status there.
Other considerations may include private surgical scheduling and access to a program offering more than one resurfacing technology.
However, the decision should not be based solely on the availability of a device.
Patients should also consider:
- The surgeon's experience with hip resurfacing.
- Whether the procedure is appropriate for their anatomy and bone quality.
- The available implant options.
- The surgical facility and postoperative care arrangements.
- Travel requirements and recovery planning.
- Follow-up care after returning to the United States.
- Potential complications and how they would be managed.
- The complete cost of surgery, travel, accommodation, and postoperative care.
An appropriate consultation should help patients understand the potential benefits, limitations, and risks before committing to surgery.
Who May Be a Candidate for Hip Resurfacing?
Not every patient with hip arthritis is a suitable candidate for resurfacing.
Eligibility depends on several clinical factors.
Age and Activity Level
Hip resurfacing has often been considered for younger or more active patients, although chronological age alone does not determine eligibility.
Bone Quality
Adequate femoral bone quality is essential because the natural femoral head and neck are retained.
Hip Anatomy
Femoral head size, bone structure, joint deformity, and other anatomical characteristics influence surgical planning.
Medical History
Underlying medical conditions, kidney function, metal sensitivity concerns, prior hip procedures, and other factors may influence implant selection.
Individual Treatment Goals
Patients should discuss expected activity levels, recovery, long-term implant performance, and the possibility of future revision surgery.
Ultimately, the appropriate procedure can only be determined through an individualized orthopedic evaluation.
Who May Not Be a Candidate for Hip Resurfacing?
Hip resurfacing may not be appropriate for patients with certain anatomical or medical characteristics, including:
- Poor bone quality or severe osteoporosis.
- Significant femoral head deformity.
- Advanced bone loss.
- Certain inflammatory or underlying medical conditions.
- Implant-specific material sensitivity concerns.
- Anatomy that does not support safe implant positioning.
- Medical conditions that increase surgical risk.
Some patients who are not suitable candidates for traditional metal resurfacing may still be considered for ceramic resurfacing. Others may be better served by total hip replacement.
These distinctions require an individualized clinical assessment and should not be interpreted as universal eligibility rules.
What Happens During a Hip Resurfacing Consultation?
A hip resurfacing consultation generally includes a detailed assessment of the patient's symptoms, medical history, imaging, anatomy, and treatment goals.
The evaluation may include:
- Review of symptoms and activity limitations.
- Review of X-rays and other relevant imaging.
- Assessment of femoral head size and hip anatomy.
- Evaluation of bone quality.
- Discussion of ceramic and traditional metal resurfacing.
- Consideration of total hip replacement where appropriate.
- Review of potential benefits, risks, and recovery expectations.
- Planning for postoperative care and follow-up.
For American patients traveling to Montréal, the initial consultation process may begin remotely with a review of medical history and diagnostic imaging.
A comprehensive assessment helps determine whether hip resurfacing is appropriate and which surgical option deserves consideration.
Recovery After Hip Resurfacing Surgery
Recovery after hip resurfacing varies depending on the patient's health, bone quality, surgical approach, implant selection, and rehabilitation progress.
Although individual recovery plans differ, patients can generally expect:
- Early mobilization after surgery, as medically appropriate.
- A structured rehabilitation program.
- Gradual return to walking and everyday activities.
- Progressive strengthening and mobility exercises.
- Ongoing follow-up to monitor healing and implant function.
- Activity recommendations based on recovery progress and surgeon guidance.
Many active patients are interested in hip resurfacing because of its potential to support a high level of physical function.
However, return to running, sports, or higher-impact activities should not be rushed. The timing and suitability of these activities must be determined by the treating surgeon.
For patients traveling from the United States, recovery planning should also address the timing of the return journey, mobility during travel, and arrangements for follow-up care at home.
The Benefits of a Comprehensive Hip Resurfacing Program
One of the most important considerations when choosing a surgeon is whether the treatment recommendation is based on a comprehensive assessment of available options.
A program offering multiple surgical approaches can evaluate:
- Traditional metal hip resurfacing.
- Ceramic hip resurfacing.
- Conventional total hip replacement.
For some patients, metal resurfacing may be appropriate because of its longer clinical track record and suitability for their anatomy.
For others, ceramic resurfacing may provide an alternative that avoids metal-on-metal articulation.
For patients with unsuitable bone quality, anatomy, or other risk factors, total hip replacement may offer the more predictable treatment pathway.
The objective is not to choose hip resurfacing at all costs. It is to identify the most appropriate operation for each individual patient.
Hip Resurfacing in Montréal With Dr. John Antoniou
Dr. John Antoniou
Dr. John Antoniou is an orthopedic surgeon in Montréal, Canada, specializing in hip and knee reconstruction.
With experience spanning more than 15,000 hip and knee procedures, his practice evaluates patients for multiple surgical options, including ceramic hip resurfacing, traditional metal hip resurfacing, and conventional total hip replacement.
This range of procedures allows treatment recommendations to be based on the patient's individual characteristics rather than a single implant technology.
Request a ConsultationFor patients traveling from the United States, the consultation process may begin with a review of medical history, previous treatment, and diagnostic imaging.
A comprehensive assessment helps determine whether hip resurfacing is appropriate and which surgical option deserves consideration.
Patients interested in the procedure can explore:
Frequently Asked Questions About Hip Resurfacing in the USA
Is hip resurfacing banned in the United States?
No. The FDA continues to recognize approved metal-on-metal hip resurfacing systems. This should not be confused with the regulatory status of metal-on-metal total hip replacements or newer ceramic resurfacing devices.
Is hip resurfacing still performed in the United States?
Yes. Hip resurfacing continues to be performed by specialized surgeons, although access is more limited than conventional total hip replacement.
Is ceramic hip resurfacing FDA-approved?
The ceramic hip resurfacing technology discussed in this article is not currently FDA-approved for routine use in the United States. It has a different regulatory status in Canada.
Can Americans travel to Canada for ceramic hip resurfacing?
American patients may seek an orthopedic consultation in Canada to determine whether they are eligible for treatment. Surgical candidacy, travel arrangements, and postoperative care must be reviewed individually.
Is metal hip resurfacing safer than ceramic resurfacing?
Neither approach can be described as universally safer. Metal resurfacing has a longer clinical follow-up history but carries metal-related risks. Ceramic resurfacing avoids metal-on-metal articulation, although longer-term clinical evidence remains necessary.
Is hip resurfacing better than total hip replacement?
Not necessarily. Hip resurfacing may offer advantages for selected patients, particularly regarding bone preservation and joint geometry. Total hip replacement remains more appropriate for many others.
Is ceramic hip resurfacing completely metal-free?
Ceramic resurfacing avoids metal-on-metal bearing articulation, but this does not necessarily mean every implant component is metal-free. Patients should confirm the materials used in the specific device.
Can women have hip resurfacing?
Some women may be suitable candidates. Patient selection is particularly important, and eligibility depends on anatomy, bone quality, implant design, and other clinical considerations. Ceramic resurfacing may provide an additional option for selected patients.
Can hip resurfacing be revised later?
Yes. Hip resurfacing preserves more femoral bone, which may provide advantages if conversion to total hip replacement becomes necessary. However, revision complexity depends on the circumstances.
Is hip resurfacing suitable for athletes?
Hip resurfacing may be considered for selected active patients because of its bone-preserving characteristics and joint geometry. Return to sports depends on healing, implant considerations, and individualized surgeon recommendations.
How long does a hip resurfacing implant last?
Implant longevity depends on patient selection, implant design, surgical technique, activity, and other factors. Long-term data are available for traditional metal resurfacing, while ceramic resurfacing currently has a shorter clinical follow-up history.
How much does hip resurfacing surgery cost in Canada?
Private hip resurfacing surgery with Dr. Antoniou starts at $29,700 CAD. Final pricing and package inclusions should be confirmed directly with the clinic.
Can the consultation begin before traveling to Montréal?
The initial assessment may begin remotely through a review of medical history and relevant imaging. The clinic can advise patients about the information required.
How do I know which implant is right for me?
The decision should be based on a detailed evaluation of anatomy, bone quality, activity goals, age, medical history, and individual risk factors. An orthopedic surgeon experienced with multiple surgical approaches can help determine the most appropriate treatment.
Conclusion: Understanding Your Hip Resurfacing Options in 2026
Hip resurfacing continues to occupy a specialized role in modern orthopedic surgery.
In the United States, traditional metal hip resurfacing remains an FDA-approved option for appropriately selected patients, although access to specific implants and experienced surgeons should be confirmed individually.
At the same time, advances in ceramic technology are expanding the range of bone-preserving approaches being investigated and offered in other jurisdictions.
Canada's licensing of ceramic hip resurfacing technology represents a meaningful development for patients exploring treatment outside the United States.
However, the most important decision is not simply whether to choose metal or ceramic. It is whether hip resurfacing is appropriate in the first place.
Careful patient selection, surgical expertise, an understanding of implant-specific risks, and realistic expectations remain essential.
For American patients interested in exploring their options, an individualized orthopedic consultation is the appropriate starting point.
Medical Sources and References
- U.S. Food and Drug Administration. Metal-on-Metal Hip Implants.
- U.S. Food and Drug Administration. Birmingham Hip Resurfacing System — Premarket Approval P040033 and supplements.
- U.S. Food and Drug Administration. Birmingham Hip Resurfacing System, Supplement S038.
- The Bone & Joint Journal. Influence of head size and sex on the five-year survival of ceramic-on-ceramic hip resurfacing: an international multicentre study. 2025. DOI.
- PubMed. Ceramic resurfacing multicentre study, PMID 40588274.
- Wilson CJ, et al. Seventeen-year outcomes for a contemporary total hip resurfacing prosthesis in Australia: an analysis of registry data. Journal of Orthopaedics. 2025. PubMed.
- National Library of Medicine. Full-text Australian registry-based resurfacing study.
- Australian Orthopaedic Association National Joint Replacement Registry. Annual reports.
- Health Canada. Medical Devices Active Licence Listing.
- Health Canada. Medical Devices Active Licence Search.
- Health Canada. About Medical Devices.
- Health Canada. Medical Device Licensing Overview.
- Su EP, Bolognesi MP, et al. Results of the First U.S. FDA-Approved Hip Resurfacing Device at 10-Year Follow-up. The Journal of Arthroplasty. 2021. PubMed.
- Orthopedic Reviews. Hip Resurfacing Arthroplasty: Past, Present and Future.
- Canadian Journal of Surgery. Birmingham Hip Resurfacing for Osteoarthritis: A Canadian Single-Surgeon Series With Minimum 10-Year Follow-up.