At least a quarter of a million people in the UK are troubled by arthritic hips — a problem that often comes to light in early middle age when pain and stiffness start to limit activities such as tennis, golf and weekend walks. Surgery is the definitive treatment and works very well for most people, but in the past decade there has been a shift away from conventional hip replacement towards the newer hip resurfacing techniques that are supposed to be better suited to active lifestyles. But is resurfacing all it’s cracked up to be?

I have two friends, one aunt and a handful of patients who have had their hips resurfaced over the past few years and all are doing well, but experiences elsewhere suggest others may not be so lucky, and I am now much more cautious about recommending it than I used to be.

The concept of hip resurfacing has been around for decades but only started to make a significant impact in the UK in the late Nineties. It now accounts for 8 per cent of the 65,000 hip replacements performed every year, and around half of all procedures in patients under the age of 50. But the latest figures suggest that this upward trend is reversing amid concerns that resurfacing has not lived up to the initial hype.

Arthritic joints in younger patients have always presented a challenge to surgeons because artificial hips of all types wear more quickly in active recipients. A typical elderly patient undergoing hip surgery for arthritis can expect their new hip to be trouble free for at least ten years. But for someone aged between 55 and 75 there is a 1 in 14 chance that they will need to have their hip operated upon again (revised) within a decade, and in the under 55s this doubles to around 1 in 7. It was hoped that resurfacing would be the solution to this premature failure.

Conventional hip replacement involves cutting out the arthritic joint and replacing it with an artificial one made up of a metal ball on a stem wedged or cemented into the upper part of the thigh bone, and a smooth cup (typically plastic) inserted on the socket (pelvic) side. In terms of patient satisfaction, it is one of the best operations modern surgery has to offer, but plastic sockets are prone to wear, and both stem and socket can work loose if subjected to too much stress and strain.

Resurfacing involves shaving the arthritic ball side of the joint and covering it with a metal cap, which then fits into a metal socket on the pelvic side. The theory being that this “metal-on-metal” hip will be more durable, and even if it does fail prematurely, it is easier to revise because you can cut off the resurfaced ball and put in a conventional prosthesis.

And so hip resurfacing was marketed as the 21st-century approach to arthritic hips amid claims that it was a stronger, more stable alternative to conventional hip replacement and ideal for active people — a campaign backed by endorsement from numerous sportsmen and celebrities. But more than ten years down the line the picture isn’t looking so rosy.

The latest figures available from the UK National Joint Registry (NJR) show that the three-year revision rate — a measure of the number of artificial hips that fail and require replacement — is nearly four times higher for hip resurfacing than for conventional hip replacement (4.5 per cent versus 1.3 per cent).

Perhaps most worrying of all is that resurfacing appears to be second best even in the group to which it is most actively promoted — men under the age of 55. Data from the NJR suggests that they are at least one and a half times more likely to need a repeat operation within three years if they opt for resurfacing rather than the best of the conventional procedures. And older patients and women fare much worse. A woman aged 65 who opts for resurfacing could be up to ten times more likely to require revision within three years compared with one who had a total hip replacement.

But high failure rates are not the only worry. There is also concern about the side-effects of chromium and cobalt ions released when the resurfaced ball joint rubs against the metal socket in the pelvis. The leaching of these metals into the rest of the body may prove harmless, but there are suspicions that, as well as causing localised tissue and bone damage, it could have a detrimental effect on other organs in the body. Only time will tell.

John Timperley, honorary secretary of the British Hip Society and a consultant orthopaedic surgeon in Exeter, believes that it is time that marketing campaigns were countered by hard fact: “The belief held by many patients that the newer resurfacing technology must be better, simply doesn’t stack up when you examine the evidence — indeed the opposite is true. New in this context means experimental, whereas the prostheses used in the more established hip replacement have been tried, tested and refined over decades. I know which I would choose.”

But as a consultant working at the hospital that developed the leading conventional prosthesis, you might expect him to say that.

Martyn Porter, who chairs the editorial board at the NJR and operates at the Centre for Hip Surgery at Wrightington Hospital in Lancashire, also has reservations about resurfacing but feels that patient selection and the experience of the surgeon are key factors. “Some surgeons have published very low revision rates for resurfacing suggesting that experience and high volumes lead to better results. Even so, it is now probably best reserved for younger men.”

Bottom line? As with all surgery, choosing a good surgeon, experienced in whatever approach they advise, remains the best option. A new hip has to be tailored to the individual — there is no one ideal fix for everyone — so if your surgeon suggests a conventional replacement, don’t push for resurfacing just because you have heard it is better. It is unlikely to be.

For more information visit the National Joint Registry at njrcentre.org.uk.

E-mail questions to drmark@ thetimes.co.uk or write to times2, 1 Pennington Street, London E98 1TT