Metal on metal hip resurfacing arthroplasty: Where are we now?

Metal on metal hip resurfacing arthroplasty (HRA) was introduced in an attempt to address potential limitations regarding return to sport, return to high functional activity and premature wear in young patients requiring standard total hip replacement (THR). Around 12% patients undergoing hip replacement surgery are under 55 years of age. By more closely mimicking natural anatomy, and having a metal on metal (MoM) bearing, it was hoped that HRA would address the issues. However, concern has emerged about early failure, high revision rates from local adverse reactions to metallic wear debris and potential systemic consequences of metal ion cardiotoxicity. In this article, we discuss the existing literature in the field, the current clinical evidence surrounding HRA, its indications, clinical outcomes, and risk factors for failure and conclude if it still has a role within orthopaedic hip surgery.