Ceramic Hip Resurfacing Implant Introduced at Cleveland Clinic London

LONDON: Cleveland Clinic London surgeons have begun performing hip resurfacing with ceramic implants, becoming one of the first in the world to provide this alternative to metal-on-metal hip resurfacing.

The H1 ceramic implant – approved by the UK’s Medicines and Healthcare Products Regulatory Agency in 2025 – was developed at Imperial College London, led by Cleveland Clinic London surgeon Prof Justin Cobb.

Traditionally, metal-on-metal hip resurfacing is recommended only for patients with larger femoral heads. With hip resurfacing, patients retain the femoral head and neck, allowing them to resume activities they did with their healthy, native hip.The new ceramic implant aims to make hip resurfacing an option for more patients, including patients with smaller bones who have had no resurfacing option for a decade.

“Patients with smaller bones, including many females, were more likely to report pain after metal-on-metal hip resurfacing and required early revision,” said Prof Cobb. “The pain was often due to soft tissue impingement on the oversized components or the tissue’s reaction to metal ion particles released with wear. These problems led to metal-on-metal resurfacings being withdrawn from use in women and smaller men in 2015.”

To address these challenges, Prof Cobb and a team of developers have designed an innovative ceramic hip resurfacing implant, the H1, tailored specifically for patients with smaller hips and pelvises.

“Between 1991 and 2005, I mostly looked after teenagers with bone tumours that were often fatal,” Prof Cobb said. “If they survived their disease, these young people who had large segments of limb removed were left with significant, long-term disability. That led me to seek better ways of doing surgery, trying to avoid excising healthy tissue if at all possible.”

Prof Cobb and one of his Ph.D. students at Imperial College London collaborated on studying the shape of the hip and its position in the pelvis. They explored differences in the curves and contours of men’s and women’s hips and described these differences mathematically. {Dandachli et al 2007}. A second paper showed how hip resurfacing products currently in clinical use were not designed for patients with smaller hips. {Cobb et all 2011}

Following that publication, Prof Cobb and a team started working toward designing implants, first in metal and later in ceramic, contoured for smaller hips. After four years of preclinical testing to show safety and efficacy, clinical trials of the H1 ceramic implant began in 2017.

A 2023 clinical study in Gait & Posture found that women receiving the H1 had postoperative biomechanics similar to healthy women without hip surgery, while women who had total hip arthroplasty (THA) had worse biomechanics. The study compared 15 patients with H1 hip resurfacing and 15 patients with conventional THA. The patients who received the H1 had higher functional scores after surgery, improved walking speed and achieved symmetrical gait patterns at higher speeds, something never reported in patients with THA.

“All patients had improved function after surgery compared to before surgery, whether THA or hip resurfacing with the H1 implant,” Prof Cobb says. “However, only those with the H1 implant achieved postsurgical function comparable to people with healthy hips. Those having THA had shorter steps, weaker force and more asymmetry after surgery compared with healthy controls.”

Hip resurfacing offers several advantages, including a lower risk of dislocation, infection, and periprosthetic fracture. It also allows patients to retain their femoral head and neck, enabling them to engage in high-impact activities.

The H1 ceramic implant broadens the scope of patients who can benefit from hip resurfacing, particularly those with smaller bone structures, and provides a less-invasive option for patients.

Approval of the H1 ceramic implant by the U.S. Food and Drug Administration is pending. The implant is currently available in the U.K. under compassionate use, with a wider European launch planned for early in 2026.