Hip Resurfacing vs Total Hip Replacement

Hip resurfacing is a type of hip replacement, but a more bone-sparing one. In a standard hip replacement, the surgeon removes the worn ball at the top of your thigh bone and replaces it with a metal ball on a stem. In hip resurfacing, the ball isn’t removed. Instead it’s trimmed and capped with a smooth metal cover, like putting a crown on a tooth. The worn socket is replaced the same way it would be in a regular hip replacement. Because it keeps more of your natural bone, resurfacing can be a good option for certain younger, active patients who may need another surgery down the road. But it isn’t right for everyone, and most people with hip arthritis still do better with a standard hip replacement. This page explains who’s a good candidate, what the surgery involves, and the trade-offs.

What condition is being treated by a hip resurfacing or replacement:

Like a standard hip replacement, resurfacing treats hip arthritis. Your hip is a ball-and-socket joint, and both surfaces are normally coated with smooth cartilage that lets the joint glide. In arthritis, that cartilage (and the bone underneath) slowly wears away, so the joint gets painful and stiff and makes everyday movement hard. Resurfacing is one way to fix that worn-out joint.

When should you consider surgery:

As with any hip arthritis surgery, a operation is only considered after non-surgical treatments have been tried. This inlcuded several months of pain medicine, physical therapy, injections, activity modification, weight reduction, and assistive devices. If 3-6 months has passed , and the pain is severe enough to warrant a major operation, then surgery should be considered.

But resurfacing has an extra layer of consideration. Not everyone who needs a hip replacement is a good candidate for a resurfracing. It tends to be a better fit for:

• Younger, active patients (usually under 60). Keeping more natural bone helps if they ever need a second surgery later, and the design holds up well for demanding, active lifestyles.
• People with strong, healthy bone, since the natural neck of the thigh bone has to support the metal cap. Weak bone will lead to collapse and fractures.
• People with a misshapen upper thigh bone that can make a standard implant tricky to apply.

It’s generally not a good fit for patients with weaker or thinner bone (such as postmenopausal women or those with bone-thinning conditions), patients with a misshapen socket, patients with noticeably uneven leg lengths, or patients with kidney disease (explained in the risks below). Your surgeon will help you figure out which type of surgery suits your situation.

What happens during surgery:

For hip resurfacing you’ll either be fully asleep under general anesthesia or numbed from the waist down while staying awake but sedated. The surgeon makes a cut, and moves the tissues aside to reach the joint. The hip is exposed. Then we:

1. Reshape the worn ball at the top of your thigh bone and cap it with a smooth metal cover, rather than removing it entirely.
2. Prepare the socket by gently smoothing away the damaged cartilage and bone.
3. Fit a metal cup into the socket. This is either press-fit snugly or held with bone cement.
4. Place the new ball-and-socket together, check that everything moves smoothly and stays in place. We then close the incision in layers.

Then rehab begins. One thing worth knowing: modern hip resurfacing uses a metal cap moving against a metal socket (a “metal-on-metal” design). Older versions that paired metal with plastic wore out too fast and are no longer used.

To get an idea what a total hip replacement surgery looks like, have a look at our total hip replacement page. Below are X-Ray representations of both surgeries.

X-ray showing a total hip replacement on the left hip and an illustration of hip resurfacing on the right hip

What does recovery look like:

Recovery is broadly similar to a standard hip replacement. Physical therapy to rebuild strength and movement, with your surgeon guiding how soon you can put weight on the leg. Resurfacing has a couple of recovery advantages worth noting. The new ball is closer to the size of your natural one, the joint is generally more stable and less likely to slip out of place, and there’s a lower chance of ending up with uneven leg lengths afterward. Your exact timeline depends on your health and activity level, so your surgeon will tailor a plan for you. Most patients start walking the first day after surgery. Most pain is resolved by 6 weeks after surgery, and many patients are walking without canes / walkers. Most patients are back and work and start driving again at this stage. By 3 months most patients are back at their baseline activates. However, it may take 1 year to fully recover.

What are the major risks and complications:

Resurfacing shares the general risks of any hip surgery (such as infection, fractures, dislocations, and blood clots), but it also has a few risks that are specific to this procedure:

• A break in the neck of the thigh bone shortly after surgery. Because the natural neck is kept and now carries the load of your body, it can break. If this happens, the resurfacing may have to be converted to a standard hip replacement.
• Metal particles in the blood. The metal-on-metal design releases tiny amounts of metal ions (cobalt and chromium) into the bloodstream. No clear harm has been proven, but the long-term effects aren’t fully known. These particles build up more in people with kidney disease, since the body can’t clear them as well. This is why we avoid resurfacing in patients with underlying kidney problems.
• A metal allergy in some patients, which can cause irritation around the implant and lead to loosening.
• Extra bone forming in the surrounding muscle This procedure can require more tissue handling, which raises that chance of calcification of muscles/tendons/soft tissues.
• Uneven leg length not being corrected. If your legs were already uneven before surgery because of arthritis, resurfacing may not fix that difference.

It is also worth noting that hip resurfacing is not as commonly done as hip replacement surgery. Thus, we do not have as robust data on issues like longevity of the implants, real complications rates, long term complications specific to resurfacing, and patient specific risk factors.

What if you don’t have surgery:

You don’t have to have surgery right away. Many people manage hip arthritis for a long time with medication, physical therapy, and injections. These are reasonable first steps. But arthritis doesn’t improve with time. It is a slow, chronic, progressive process. The joint tends to keep wearing down. So, for many people the pain / stiffness slowly get worse and daily activities become harder. There’s also a second decision hiding inside this one: even if you do choose surgery, you may not be a candidate for resurfacing. Specifically, in which case a standard hip replacement would likely be the better route. Which path makes sense waiting, resurfacing, or a standard replacement, is a conversation to have with an orthopedic joint replacement surgeon based on your age, activity level, bone health, and how much your hip is affecting your life.