Hip Resurfacing Shows Lower Metal Ion Levels and Revision Risk Than Large-Head Metal-on-Metal THA

A recent systematic review and Meta-Analysis published in JBJS Reviews compared hip resurfacing arthroplasty (HRA) with large-diameter head metal-on-metal total hip arthroplasty (LDH-THA) across 21 studies.

Key Findings

• Lower revision rates with HRA (7.8%) compared with LDH-THA (16%).

• Significantly lower cobalt and chromium ion levels in patients undergoing hip resurfacing.

• Functional and activity scores tended to favour HRA, although differences were not consistently statistically significant.

JM Comments:

This review emphasizes that, in carefully chosen patients, particularly younger and more active individuals, metal-on-metal hip resurfacing may offer lower systemic metal ion exposure and reduced revision risk compared with large-head metal-on-metal THA. These findings add to the ongoing discussion regarding optimal implant selection in high-demand patients. Careful patient selection, surgical expertise, and ongoing postoperative monitoring remain essential.

Reference:

Shanaa, Jean BS1,a; Amar, Orr BS1; Asad, Shaheryar BA1; Pauli von Treuheim, Theodor Di MD2; Aggarwal, Vinay K. MD2; Marwin, Scott MD2. Hip Resurfacing Arthroplasty Is Associated with Lower Metal Ion Levels and Revision Risk Compared with Large-Head Metal-on-Metal Total Hip Arthroplasty: A Systematic Review and Meta-Analysis. JBJS Reviews 13(12):e25.00204, December 2025. | DOI: 10.2106/JBJS.RVW.25.00204