In the long term, many problems relate to osteolysis from acrylic bone cement debris, and/or wear debris. An inflammatory process causes bone resorption and subsequent loosening or fracture often-requiring revision surgery. Very hard ceramic bearing surfaces are being used in the hope that they will have less wear and less osteolysis with better long-term results. Large metal heads (metal-on-metal hip arthroplasty) are also used for similar reasons as these also have excellent wear characteristics and benefit from a different mode of lubrication.

However, large fixed metal heads, such as the Austin Moore devices, can result in protrusio acetabuli. A greater head neck ratio also contributes to stability. These new prostheses do not always have the long-term record of accomplishment of established metal on poly bearings. As metal-on-metal arthroplasty becomes more widespread, concerns are being raised about the potential dangers of metal particulate debris. There are new publications that have demonstrated development of pseudotumors, soft tissue masses containing necrotic tissue, around the hip joint. It appears these masses are more common in women and these patients show a higher level of iron in the blood. The cause is unknown and is probably multifactorial. There may be a toxic reaction to an excess of particulate metal wear debris or a hypersensitivity reaction to a normal amount of metal debris.

Postoperative sciatic nerve palsy is another possible complication.