Hip Resurfacing was developed as a new and innovative operation for Osteoarthitis of the hip. It evolved because developments in bearing surfaces manufactured from articulating metal on metal (MoM)surfaces occurred, allowing MoM Hip resurfacing components. Hip resurfacing was first available in Australia in 1999, as the "Birmingham Hip Resurfacing" prosthesis, but a number of other similar designs have since become available.

While the traditional treatment of total hip replacement worked well for the older patient, it was considered the more "bone conservative" option of Hip Resurfacing would provide the younger more active patient a comparable result but allow greater physical activity, and an easier revision option if failure of the femoral side should occur..

Proposed Advantages:
Many advantages were suggested for a resurfacing hip when compared to the traditional full hip replacement: These claims are that it is a smaller prosthesis, has a larger femoral ball head, and so will be more stable, and also provide a greater range of hip movement. It has also been suggested that the hip resurfacing operation has lower complication rates and a shorter recovery time.

How It Works:
The hip is structurally complex. The bones that comprise the joint are covered with a thin lining of articular or hyaline cartilage.  Articular cartilage acts as a shock absorber and enables the joint to move smoothly in its range of movement. It is the wearing out of this ''shock absorber' that causes the problem.

The Hip Resurfacing technique sought to improve the function of the hip by resurfacing, or retreading, only the bone that has worn out its articulating cartilage.

Experience with Hip Resurfacing:  While hip resurfacing offered an exciting new prospect for younger people needing surgical treatment for their arthritic hips, this innovative type of surgery has required some time to be evaluated  further. Quicker recovery from operation and better range of movement and function does not necessarily occur. Data from the Australian Joint Replacement Registry, and personal experience with patient follow up for 10 years confirms that many patients have acheived the expected early outcomes for this operation. However, there is a much higher incidence of revision operation needed in this group of patients compared to standard total hip replacements; up to 20% of patients requiring re-operation before 8 years.The reasons for failure are now becoming evident:- fracture of the femoral neck, loosening and displacement of the femoral component, and metal hypersensitivity/allergy reactions causing synovitis (joint inflammation) and osteolysis (bone resorption) have been noted. Much publicity relating to Metal/Metal bearings, and particularly Hip Resurfacing was generated by a recent television documentary presented in Australia on the "Four Corners" program.

As a result of the knowledge gained from this experience, the guidlines (indications) for hip resurfacing have changed, with smaller, older patients and females now considered unsuitable for the operation. Routine standard total hip replacements have improved bearing surfaces e.g. newer ceramic, polyethylene and metal bearings, and excellent results with cementless components , especially the femoral stems, cause us to question whether Hip resurfacing offers the claimed advantages. Mr. Lowe has had significant experience using the Hip resurfacing operation, but in view of the accumulating evidence of problems and failure to provide a predictable longer term result, now does not recommend the procedure, except in unusual cases where there may be no alternative. While the present controversy exists regarding Metal/Metal bearings,  this bearing option has limited  application now,  and alternative bearings can be chosen.