Background of metal-on-metal resurfacing.

Hip resurfacing is not a new concept and attempts to treat hip arthritis without resecting the femoral head and neck have been made since the 1950s. The resurgence of new and better-engineered metal-on-metal bearings has provided the means to develop a viable prosthetic solution from a concept that was once abandoned. The lessons drawn from the early resurfacing era led to modern designs all using a cementless fixation of the acetabular component and a short metaphyseal stem designed for component alignment on the femoral side. Currently, only metallic devices can be manufactured with sufficient strength as a thin one-piece shell, combining excellent wear properties for large femoral heads and a bone-conserving device on the acetabular side. The early results of these new designs are extremely encouraging but the rapid development of the procedure needs to be controlled by appropriate training programmes to ensure its future success.