Surgeons at Metropolitan General clinic in Greece have introduced a ceramic hip resurfacing technique for active patients suffering from severe joint degeneration.
The procedure, known as Hip Resurfacing Anterior Approach (HRAA), was carried out for the first time in the country in June 2026 by orthopedic surgeon Athanasios Koukakis and his team. Dr Koukakis, who serves as Director of the Department of Robotic Knee and Hip Arthroplasty at Metropolitan General, performed the operation on a group of patients aged between 40 and 65 who were suffering from advanced hip osteoarthritis.
Unlike standard total hip replacement surgery, which requires removing the entire head of the thigh bone, the new ceramic-on-ceramic method preserves the natural bone. Surgeons cap the head of the femur with a high-technology ceramic shell, which rotates smoothly inside a matching ceramic socket insert.
Osteoarthritis is a chronic condition that damages joint cartilage, leading to pain, stiffness and reduced mobility. The condition affects approximately 10 percent of people over the age of 60 to 65, but it can also strike younger adults due to genetic factors, prior joint trauma or rheumatic diseases. Traditional surgical treatment for severe cases relies on total joint replacement, where surgeons remove damaged bone tissue and insert a long titanium stem directly into the femur canal.
Preserving bone for active patients
The ceramic resurfacing technique is designed specifically for active younger men and women under 65, including individuals who participate in sports. By fitting a low-profile ceramic cap instead of a large titanium implant, the procedure retains the patient's existing bone structure. Dr Koukakis said that preserving residual bone is a major advantage for younger patients, as it leaves sufficient healthy tissue intact should revision surgery become necessary later in life.
The procedure also eliminates health concerns associated with older metal-on-metal resurfacing implants, which could release metal ions into surrounding tissues over time. The advanced ceramic material exhibits zero wear, preventing joint degradation. Patients benefit from a lower risk of joint dislocation compared to standard replacements, as well as joint movement that feels very close to natural function.
Recovery times are significantly shorter, with patients typically discharged after one to two days in hospital. The medical team uses fast-track mobilization protocols, which encourage early walking and movement to accelerate healing and reduce the risk of surgical complications.
Technical demands and European context
However, the procedure is not suitable for everyone. Dr Koukakis noted that the surgery is contraindicated for patients with advanced osteoporosis or severe hip dysplasia. The implants are also expensive, and the surgery carries a higher technical difficulty that demands specialized surgical expertise.
Ceramic-on-ceramic hip resurfacing has been performed for seven years in specialized medical centers across Belgium and the United Kingdom, where it has gradually replaced older metallic implants. With the launch of the HRAA program at Metropolitan General, Greece becomes one of the first European nations to adopt this advanced surgical option.
