Skip to main content

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


Use of this site, and the interpretation of the information contained here, is subject to important terms and conditions. Use of this site and information except in accordance with these terms and conditions is expressly prohibited.


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.



Let’s make our health system healthier

Join Our Patient, Family and Public Advisors Program

Patients, families and the public are central to improving health quality.


Man smiling

Sign up for our newsletter

Are you passionate about quality health care for all Ontarians? Stay in-the-know about our newest programs, reports and news.

Health Quality Connect - Health Quality Ontario's newsletter - on an iPad and a cell phone