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Evidence to Improve Care

Metal-on-Metal Hip Resurfacing Arthroplasty


Ontario Health Technology Advisory Committee Recommendations

  • Metal-on-metal hip resurfacing arthroplasty (HRA) is a reasonable treatment option for osteoarthritis patients who meet the appropriate criteria

  • Metal-on-metal HRA should only be performed by surgeons who have appropriate training and who have acquired a high level of experience by performing a high annual volume of total hip arthroplasties and metal-on-metal HRAs

Read the full OHTAC Recommendation Report



Total hip replacement has long been considered the treatment of choice for older patients with advanced osteoarthritis of the hip. However, for younger and more active people, some surgeons favour metal-on-metal hip resurfacing arthroplasty. In this technique, a metal cap is placed on the top end of the thigh bone (femur) to cover the damaged surface of the bone, and a metal cup is placed in the hipbone socket. The goal is to preserve the thigh bone and restore movement to the joint.


Health Quality Ontario Reviews Metal-on-Metal Hip Resurfacing Arthroplasty

The worldwide withdrawal of one hip resurfacing implant in 2010, because of higher-than-expected rates of surgeries having to be redone, resulted in some uncertainty regarding other implants. Health Quality Ontario reviewed the evidence and compared the revision rates for hip resurfacing arthroplasty implants with the benchmark set by the National Institute for Clinical Excellence, and explored potential safety issues related to exposure to high levels of metal ions.


Metal-on-Metal Hip Resurfacing Arthroplasty: An Analysis of Safety and Revision Rates (PDF)
August 2012


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The Ministry of Health and Long-Term Care endorses these recommendations.

The Ministry of Health and Long-Term Care has provided the following response: The Ministry agrees with these recommendations and encourages health care professionals to adhere to them. Arthroplasty is an insured service in Ontario.




Health Technology Assessment at Health Quality Ontario

As part of our core function to promote health care supported by the best available evidence, we use established scientific methods to analyze the evidence for a wide range of health interventions, including diagnostic tests, medical devices, interventional and surgical procedures, health care programs and models of care. These analyses are informed by input from a range of individuals, including patients and clinical experts. The Ontario Health Technology Advisory Committee (OHTAC) — a committee of the Health Quality Ontario board of directors — reviews the evidence and makes recommendations about whether health care interventions should be publicly funded or not. Draft recommendations are posted on the Health Quality Ontario website for feedback. Final recommendations are approved by our board of directors and then shared with the Ministry of Health and Long-Term Care. For more detailed information, visit our Evidence to Improve Care pages.


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