The procedure consists of placing a cap (usually made of cobalt-chrome metal), which is hollow and shaped similarly to the cap of a mushroom, over the head of the femur while a matching metal cup (similar to what is used with a THR) is placed in the acetabulum (pelvis socket), replacing the articulating surfaces of the person's hip joint and removing very little bone compared to a THR.

When the person moves the hip, the movement of the joint induces synovial fluid to flow between the hard metal bearing surfaces lubricating them when the components are placed in the correct position.

[3] Hip resurfacing has the potential of being a solution for life, allows a normal ROM (range of movement) and minimizes the amount of "stress shielding", compared with THR.

[3] Due to the retention of the person's complete femoral neck other advantages exist: Surgeon induced discrepancies in leg length (as could happen with THR) are now minimized.

Also, the toe-in or toe-out faults that could occur interoperatively with THR are now over because the femoral neck that determines foot direction is left undisturbed with hip resurfacing.

[3] Metal-on-metal resurfacing systems are generally unsuitable for women of child-bearing age due to unknown effects of metal ion release on the fetus.

The main advantage of the hip resurfacing surgery is that when a revision is required, there is still an intact femur bone left for a THR stem.

This means that with hip resurfacing the femur's upper portion fully retains its natural mechanical characteristics under load, also ensuring less disturbance of the processes that take place inside bone that is alive.

Starting around 2008, a body of research was conducted around metal-on-metal bearings in general and questioning their value, finding (for instance) failures associated with metal ions due to fretting and corrosion.

[19]It has been suggested that research in the area at the time focused on metal-on-metal bearings “as a class” and insufficiently distinguished the role of prosthesis design and surgical technique.