After the Metal-on-Metal Era: Can Contemporary Bearings Revive Hip Resurfacing for Young and Active Patients?

Hip resurfacing arthroplasty (HRA) preserves femoral bone and was widely adopted for young, active patients with hip osteoarthritis before the decline of large-diameter metal-on-metal (MoM) bearings, which was driven by adverse reactions to metal debris (ARMD) and raised cobalt and chromium levels. New bearing couples, notably ceramic-on-ceramic (CoC) and metal-on-polyethylene (MoP), together with lessons learned from registries, have renewed interest in the procedure. This narrative review summarizes the historical evolution of HRA, current indications and contraindications, the learning curve, and the documented biomechanical and functional advantages (bone preservation, sta-bility, return to sport, gait), and compares contemporary implants using registry and published data. Long-term registry data support selected MoM implants only in men with large femoral heads (Birmingham Hip Resurfacing: 88.5% survival at 20 years; ADEPT: 94.1% at 15 years). The CoC ReCerf (MatOrtho) shows 5-year survival of 98.0–99.6% irrespective of sex and head size, but follow-up is short (mean 4 years) and evidence is limited to level III–IV. Data on cementless CoC H1 (Zimmer) and metal-on-polyethylene designs remain preliminary. HRA should be restricted to experienced surgeons in high-volume centres, with rigorous patient selection. Long-term registry surveillance and prospective comparative studies, including comparisons with short-stem and dual-mobility total hip arthroplasty, are needed.