Ceramic Hip Resurfacing
An Innovative, Metal-Free Alternative for Active Patients
Ceramic Hip Resurfacing
Traditional hip resurfacing uses cobalt-chrome metal-on-metal implants and has been an established surgical option for more than two decades, particularly for younger, active patients with good bone quality.
In appropriately selected patients, metal hip resurfacing has demonstrated strong durability, joint stability and functional outcomes.
Private hip resurfacing currently starts at $29,700 CAD, with the final treatment plan and cost confirmed after individual assessment.
Traditional metal resurfacing has historically produced its most predictable results in patients with characteristics such as:
- Strong bone density
- Larger joint sizes
- Healthy femoral head anatomy
- High activity levels
For this reason, it has most commonly been recommended for younger male patients with favourable anatomy and a low risk of metal-related complications.
Ceramic hip resurfacing represents a newer evolution in resurfacing technology.
It is designed to retain the bone-preserving principles of traditional hip resurfacing while replacing the metal-on-metal bearing with ceramic-on-ceramic articulation.
The ceramic hip resurfacing system used by Dr. John Antoniou is now licensed for use in Canada, and published research has reported encouraging outcomes through five years of follow-up.
Dr. Antoniou provides ceramic hip resurfacing in Montreal for carefully selected patients from Quebec, elsewhere in Canada, the United States and internationally.
At a Glance
What Is Ceramic Hip Resurfacing?
Ceramic hip resurfacing is a bone-preserving surgical procedure used to treat advanced hip arthritis in appropriately selected patients.
Unlike conventional total hip replacement, which removes the femoral head and neck and places a stem inside the femur, hip resurfacing preserves the femoral head and femoral neck.
The damaged surface of the femoral head is reshaped and capped, while the damaged socket is resurfaced with a matching component.
The main difference between traditional metal hip resurfacing and ceramic hip resurfacing is the bearing surface.
Traditional resurfacing uses cobalt-chrome metal-on-metal articulation.
Ceramic hip resurfacing uses advanced ceramic bearing surfaces, avoiding the cobalt and chromium ion exposure associated specifically with metal-on-metal articulation.
By preserving the femoral head and maintaining a large bearing diameter, hip resurfacing is designed to preserve more natural bone and joint geometry.
For appropriately selected patients, these characteristics may contribute to:
- Bone preservation
- Joint stability
- Range of motion
- Natural-feeling hip biomechanics
- Return to a high level of physical activity
Ceramic resurfacing is not automatically preferable to metal resurfacing or total hip replacement. The appropriate treatment depends on the patient's anatomy, bone quality, diagnosis, activity level and long-term goals.
Ceramic Hip Resurfacing Is Now Licensed in Canada
Ceramic hip resurfacing reached an important regulatory milestone in Canada in 2026.
The ReCerf ceramic hip resurfacing system received Health Canada approval in July 2026.
Health Canada subsequently confirmed in August 2026 that the ceramic resurfacing components are licensed medical devices in Canada under Medical Device Licence #115850.
As a result, patient-specific authorization through Health Canada's Special Access Programme is no longer required for the licensed device.
This represents an important change in access to ceramic hip resurfacing for Canadian patients and patients travelling to Montreal for treatment.
Health Canada licensing does not mean that ceramic resurfacing is appropriate for every patient.
It remains a specialized procedure requiring careful patient selection, appropriate anatomy and bone quality, precise surgical technique and ongoing follow-up.
Why Consider Ceramic Hip Resurfacing?
Traditional metal hip resurfacing continues to have an important role and has a substantially longer clinical track record.
However, metal-on-metal resurfacing is not suitable for every patient.
Historically, outcomes with some metal-on-metal systems have been less predictable in certain groups, including:
- Patients with smaller hip anatomy
- Women, who historically experienced higher revision rates with some metal resurfacing systems
- Patients who fall outside traditional component-sizing criteria
- Individuals for whom metal-ion exposure is a particular concern
Ceramic hip resurfacing avoids the metal-on-metal bearing surface and therefore avoids cobalt and chromium ion release from that articulation.
Recent ceramic resurfacing research has also reported encouraging outcomes among women and patients with smaller component sizes.
This suggests that ceramic technology may potentially allow selected patients who would not traditionally have been considered ideal candidates for metal resurfacing to be evaluated for a bone-preserving resurfacing option.
Candidacy still requires careful individual assessment.
Who May Be a Candidate for Ceramic Hip Resurfacing?
Ceramic hip resurfacing may be considered for active patients with significant hip arthritis who want to preserve as much natural bone as possible.
Potential candidates may include patients who:
- Have advanced hip arthritis affecting daily life or physical activity
- Have adequate bone quality
- Have anatomy suitable for hip resurfacing
- Lead an active lifestyle
- Wish to preserve the femoral head and neck
- Prefer to avoid a metal-on-metal bearing surface
- May not fit the traditional profile for metal hip resurfacing
- Understand that ceramic resurfacing has a shorter clinical track record than traditional metal resurfacing or total hip replacement
Age alone does not determine candidacy.
Dr. Antoniou evaluates the patient's imaging, bone quality, anatomy, diagnosis, health, activity level and long-term expectations before recommending ceramic resurfacing.
Can Women Have Ceramic Hip Resurfacing?
Potentially, yes.
Women historically experienced higher revision rates with some metal-on-metal resurfacing systems. Smaller component sizes and other anatomical factors contributed to those differences.
Recent published ceramic-on-ceramic resurfacing research has reported encouraging five-year results in both men and women.
In an international multicentre study involving 604 ceramic hip resurfacing procedures, sex was not associated with a statistically significant difference in revision risk during the study period.
This does not mean every woman is a candidate for resurfacing.
Bone quality, anatomy, diagnosis and other patient-specific factors remain important.
What Do the Latest 5-Year Results Show?
Ceramic hip resurfacing now has published clinical evidence extending through five years of follow-up.
An international multicentre study evaluated 604 consecutive ceramic-on-ceramic hip resurfacings.
The study reported:
The five-year survival estimate was 98.0%.
Encouraging Results in Men and Women
Five-year survivorship was reported at:
The researchers did not identify a statistically significant effect of sex on revision risk.
Encouraging Results Across Implant Sizes
Five-year survivorship was:
The study did not identify a statistically significant effect of implant size on revision risk.
Improvement in Hip Function
Oxford Hip Scores improved substantially following surgery.
Improvement in Activity Levels
UCLA Activity Scores also improved significantly following ceramic resurfacing.
These results are encouraging, particularly because traditional metal resurfacing has historically produced less predictable outcomes in women and patients with smaller implant sizes.
However, ceramic hip resurfacing is newer than traditional metal resurfacing and total hip replacement.
Longer-term follow-up remains important before the long-term durability of ceramic resurfacing can be compared with procedures that have decades of clinical data.
What Does the Evidence Mean for Patients?
The current evidence provides encouraging mid-term information about ceramic hip resurfacing.
Published clinical data now includes:
- Multicentre experience
- More than 600 procedures in a published five-year study
- Men and women
- Different implant sizes
- Significant improvement in patient-reported function
- Significant improvement in activity levels
- High reported implant survivorship through five years
Additional registry data has also reported encouraging five-year outcomes.
The important distinction is that these are mid-term results.
Ceramic resurfacing does not yet have the decades of follow-up available for well-established metal resurfacing systems or modern total hip replacement.
Patients should therefore consider both the potential benefits of the newer technology and the shorter duration of available follow-up.
Ceramic vs Metal Hip Resurfacing
Both ceramic and traditional metal hip resurfacing preserve the femoral head and neck.
The major difference is the bearing material.
Ceramic Hip Resurfacing
Ceramic resurfacing may be considered when a patient:
- Wants a ceramic bearing surface
- Wishes to avoid metal-on-metal articulation
- Has appropriate bone quality and anatomy
- May fall outside the traditional ideal profile for metal resurfacing
- Understands that long-term ceramic resurfacing data is still developing
Metal Hip Resurfacing
Traditional metal resurfacing may remain an excellent option for carefully selected patients who:
- Have excellent bone quality
- Have larger femoral head anatomy
- Lead a highly active lifestyle
- Meet established anatomical criteria
- Prefer an implant system with a much longer clinical track record
There is no single resurfacing implant that is best for every patient.
Dr. Antoniou performs both ceramic and metal hip resurfacing so the recommendation can be based on the individual patient rather than on a single technology.
Ceramic Hip Resurfacing vs Total Hip Replacement
Ceramic hip resurfacing and total hip replacement can both treat advanced hip arthritis, but they reconstruct the hip differently.
With a total hip replacement, the femoral head and neck are removed and a stem is inserted inside the femur.
With hip resurfacing, the femoral head and neck are preserved and the femoral head is reshaped and capped.
Potential reasons a patient may be considered for resurfacing include:
- Preserving more natural femoral bone
- Maintaining a larger femoral head
- Supporting joint stability
- Maintaining high activity levels
- Preserving future surgical options
However, total hip replacement remains the most appropriate treatment for many patients.
Patients with poor bone quality, significant deformity, certain femoral-head abnormalities or other medical and anatomical factors may be better candidates for total hip replacement.
The goal is not to choose the newest procedure—it is to select the procedure most appropriate for the individual patient.
What Are the Alternatives to Ceramic Hip Resurfacing?
Depending on the patient's anatomy, bone quality and diagnosis, alternatives may include:
- Traditional metal hip resurfacing
- Conventional total hip replacement
- Continued non-surgical management when appropriate
Dr. Antoniou considers factors including:
- Age and activity level
- Hip anatomy
- Bone quality
- Diagnosis
- Suitability for bone-preserving surgery
- Implant-related risk factors
- Long-term activity goals
- Patient preferences
A personalized treatment recommendation is made following consultation and imaging review.
What Are the Risks and Considerations?
Ceramic hip resurfacing is a specialized orthopedic procedure, and all surgery carries potential risks.
Potential complications can include:
- Infection
- Blood clots
- Femoral neck fracture
- Implant loosening
- Fracture of a ceramic component
- Nerve or blood-vessel injury
- Persistent pain
- Heterotopic ossification
- Need for revision surgery
Appropriate patient selection and accurate implant positioning are particularly important in hip resurfacing.
Long-term outcome can be influenced by:
- Bone quality
- Anatomy
- Diagnosis
- Implant positioning
- Surgical technique
- Rehabilitation
- Activity after surgery
- Follow-up
The benefits and risks are reviewed individually before surgery.
What Happens if a Ceramic Resurfacing Implant Needs Revision?
If a ceramic hip resurfacing requires revision, conversion to a total hip replacement may be possible.
Because resurfacing preserves the femoral head and neck initially, more femoral bone remains available than after a primary stemmed total hip replacement.
However, revision surgery should not automatically be described as simple or easier.
The complexity of revision depends on:
- The reason for failure
- Condition of the femoral head and neck
- Bone quality
- Acetabular bone
- Implant fixation
- Fracture or other complications
- Individual anatomy
Dr. Antoniou can explain how future revision considerations apply to an individual patient's situation.
How Long Does Ceramic Hip Resurfacing Last?
The long-term lifespan of ceramic hip resurfacing is not yet known.
The current ReCerf ceramic resurfacing system has published results through approximately five years, with encouraging implant survivorship and functional outcomes.
It would therefore be premature to claim that ceramic hip resurfacing will routinely last 15, 20 or more years.
Longer-term clinical and registry follow-up will continue to provide more information.
Traditional metal resurfacing and total hip replacement have substantially longer follow-up histories.
Recovery After Ceramic Hip Resurfacing
Recovery varies according to the patient's health, bone quality, surgical findings and rehabilitation.
In general, the recovery pathway includes:
- Early mobilization after surgery
- Walking with an appropriate aid when needed
- Structured physiotherapy
- Progressive strengthening
- Gradual return to everyday activities
- Ongoing follow-up
- Gradual return to sport based on healing and individual progress
Return to high-impact activity is not based on a fixed timeline.
Running, jumping and other demanding activities should only be resumed after appropriate healing and after discussion with Dr. Antoniou.
The goal of resurfacing is to support an active lifestyle, but postoperative activity recommendations remain individualized.
Travelling to Montreal for Ceramic Hip Resurfacing
Dr. Antoniou evaluates patients from across Canada, the United States and internationally.
For patients living outside Montreal, the process may begin with review of:
- Medical history
- Symptoms
- X-rays and other appropriate imaging
- Previous treatment
- Activity goals
If ceramic resurfacing appears potentially appropriate, the clinic can then provide information about:
- Consultation
- Surgical scheduling
- Travel to Montreal
- Private surgical care
- Postoperative recovery
- Physiotherapy planning
- Return travel
- Follow-up
Patients should discuss their travel plans with the clinic before booking flights or accommodation.
How Much Does Private Hip Resurfacing Cost?
Private hip resurfacing currently starts at:
$29,700 CADThe current private program includes the surgical pathway and related care, with the final treatment plan and price confirmed after the patient's medical information, imaging and individual requirements have been reviewed.
Patients travelling from outside Canada should also consider exchange rates, transportation and accommodation when planning treatment.
Why Choose Dr. John Antoniou for Ceramic Hip Resurfacing?
Dr. John Antoniou, MD, PhD, FRCSC, FAAOS, is an orthopedic surgeon specializing in hip and knee reconstruction and a Professor at McGill University.
His experience includes:
- More than 15,000 orthopedic procedures
- Extensive experience in hip resurfacing
- Experience with both traditional metal and ceramic resurfacing
- Fellowship training in hip and knee reconstruction
- Complex hip reconstruction
- More than 200 peer-reviewed publications
- Past President of the Canadian Orthopaedic Association
- Fellow of the Royal College of Physicians and Surgeons of Canada
- Fellow of the American Academy of Orthopaedic Surgeons
- Membership in both the Hip Society and International Hip Society
Dr. Antoniou's approach is to determine which procedure best fits the individual patient's anatomy, bone quality, health, lifestyle and long-term goals rather than recommending the same implant technology for every patient.
His private practice at Ortho Westmount provides consultation, surgery, postoperative care and rehabilitation planning within a dedicated orthopedic setting in Montreal.
Frequently Asked Questions About Ceramic Hip Resurfacing
Is ceramic hip resurfacing licensed in Canada?
Yes.
The ceramic hip resurfacing system used by Dr. Antoniou is licensed in Canada under Medical Device Licence #115850.
Health Canada confirmed in August 2026 that patient-specific authorization through the Special Access Programme is no longer required for the licensed ceramic resurfacing components.
Does ceramic hip resurfacing still require Health Canada Special Access?
No.
The device is now licensed in Canada, so patient-specific Special Access authorization is no longer required for the licensed system.
Is ceramic hip resurfacing FDA-approved in the United States?
The ReCerf system has received FDA Breakthrough Device Designation, but Breakthrough Device Designation is not the same as FDA marketing approval.
At the time of this update, patients in the United States interested in ceramic hip resurfacing may therefore consider travelling to jurisdictions such as Canada where the device is licensed and available to appropriately selected patients.
Is ceramic hip resurfacing safer than metal hip resurfacing?
It is more accurate to say that ceramic resurfacing avoids risks specifically associated with the metal-on-metal bearing surface, including cobalt and chromium ion exposure from that articulation.
That does not mean ceramic resurfacing is universally safer for every patient.
Both ceramic and metal resurfacing have potential risks, and traditional metal resurfacing has a considerably longer clinical track record.
The most appropriate option depends on the individual patient.
Does ceramic hip resurfacing release metal ions?
Ceramic-on-ceramic hip resurfacing avoids the cobalt-chromium metal-on-metal bearing articulation responsible for metal ion generation in traditional metal resurfacing.
Can women have ceramic hip resurfacing?
Potentially, yes.
Published five-year ceramic resurfacing research has reported encouraging outcomes in women.
However, candidacy still depends on bone quality, anatomy, diagnosis, overall health and other individual factors.
Can patients with smaller hip anatomy have ceramic resurfacing?
Potentially.
Published five-year research reported encouraging results across different component sizes and did not find a statistically significant association between component size and revision risk during the study period.
Individual assessment is still required.
What evidence supports ceramic hip resurfacing?
An international multicentre study of 604 consecutive ceramic hip resurfacing procedures reported 98% survivorship at five years together with significant improvements in Oxford Hip Scores and UCLA Activity Scores.
Additional clinical and registry evidence has also reported encouraging outcomes.
Longer-term follow-up remains important.
How long will a ceramic hip resurfacing last?
We do not yet have decades of follow-up for modern ceramic hip resurfacing.
Published results currently extend through approximately five years and are encouraging.
Long-term durability will become clearer as additional follow-up data accumulates.
What is the difference between ceramic and metal hip resurfacing?
The main difference is the bearing surface.
Traditional hip resurfacing uses cobalt-chrome metal-on-metal articulation.
Ceramic hip resurfacing uses ceramic-on-ceramic bearing surfaces.
Both procedures preserve the femoral head and neck and are intended for carefully selected patients.
What happens if ceramic hip resurfacing fails?
Depending on the reason for failure and the condition of the bone, ceramic resurfacing may be revised to a total hip replacement.
The complexity of revision varies and cannot be predicted solely from the fact that bone was preserved during the original resurfacing.
Is ceramic hip resurfacing considered experimental?
Ceramic hip resurfacing is newer than traditional metal resurfacing and total hip replacement.
The ReCerf device is now licensed in Canada, and peer-reviewed studies have reported clinical outcomes through five years.
However, longer-term follow-up remains important because the technology does not yet have the decades of outcome data available for older procedures and implant systems.
Can U.S. patients travel to Canada for ceramic hip resurfacing?
Yes.
Dr. Antoniou evaluates patients from the United States who are considering ceramic hip resurfacing in Montreal.
The process can begin with review of the patient's medical history and appropriate imaging to determine whether hip resurfacing may be suitable.
If the patient is an appropriate candidate, the clinic can then provide additional information regarding consultation, surgery, scheduling, travel and postoperative follow-up.
How much does ceramic hip resurfacing cost?
Private hip resurfacing currently starts at $29,700 CAD.
The final price and treatment plan are confirmed after individual evaluation.
Considering Ceramic Hip Resurfacing?
If advanced hip arthritis is limiting your activity and you are interested in preserving more of your natural bone, a consultation can help determine whether ceramic hip resurfacing, traditional metal resurfacing or total hip replacement is the most appropriate option.
Dr. Antoniou evaluates patients from Montreal, across Canada, the United States and internationally.
Request a ConsultationA consultation can help:
- Review your diagnosis and imaging
- Assess your bone quality and anatomy
- Determine whether hip resurfacing is appropriate
- Compare ceramic and metal resurfacing
- Compare resurfacing with total hip replacement
- Discuss expected recovery and activity goals
- Review private surgery availability and pricing
- Plan treatment and travel when required
Have your case reviewed to determine whether ceramic hip resurfacing is appropriate for your anatomy, lifestyle and long-term goals.
Medical References for Final Page
- Koh CK, et al. Influence of head size and sex on the five-year survival of ceramic-on-ceramic hip resurfacing: an international multicentre study. Bone & Joint Journal. 2025.
- MatOrtho – ReCerf Hip Resurfacing
- MatOrtho – ReCerf Hip Resurfacing Receives Health Canada Approval
- Health Canada – Medical Device Licence #115850 / confirmation that Special Access authorization is no longer required for the licensed components