Hip Resurfacing vs Total Hip Replacement

Total hip replacement is a highly successful surgery mostly used as surgical management of hip arthritis. With the advent of modern hip replacement implants and techniques, most hip replacement surgeries today last 15-20 years or more.

Hip resurfacing surgery is a kind of hip replacement in which only the ball of the diseased hip is cut and replaced with a prosthetic implant. The socket is replaced in a similar fashion to a total hip replacement.

The hip joint is a large weight-bearing ball and socket joint. The ball (head of the femur) of the joint is formed by the upper part of the thighbone (femur). The ball is attached to the body of the thighbone through a bony neck. The ball rotates inside a bony socket formed by the pelvic bone (acetabulum).

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

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

The surface of the head of the femur and the acetabulum are covered with articular cartilage. The articular cartilage along with the bone is gradually destroyed in osteoarthritis. The destruction of the bone and cartilage leads to pain and disability. Hip replacement surgery is offered when all other nonsurgical treatments have been tried without relief. The non-surgical options include pain medications, therapy, cortisone injection, etc.

Hip Resurfacing Surgery

During a hip resurfacing surgery, the patient usually sleeps through the procedure while being under general anesthesia. Spinal anesthesia may also be used where the patient remains awake but is numb waist down. The surgeon gives a skin incision usually from the back.

The surgeon separates/cuts various tissues to reach the diseased joint. The surgeon then proceeds to cut the head of the femur. The head of the femur is removed and the acetabulum is prepared. The preparation of the acetabulum involves serially reaming the acetabulum surface to remove the diseased cartilage and the bone.

A metallic cobalt-chromium alloy prosthetic acetabulum shell may be press-fit or cemented in the socket. The surgeon then prepares the neck of the femur by contouring its shape.

A prosthetic metal alloy head of the femur is then capped over the contoured neck of the femur. The prosthetic joint is then relocated and checked for stability. The incision is closed in layered and a rehabilitation process is started.

The hip resurfacing previously was done by the use of a metallic head of the femur over a plastic (polyethylene) cup. The metal over poly design faced high rates of accelerated wear and failure. The newer hip resurfacing is only done with a metal-on-metal design.

Hip Resurfacing Vs Total Hip Replacement

While patients with hip arthritis who may need replacement surgery are usually candidates for total hip replacement, not all patients are candidates for hip resurfacing. The candidates for hip resurfacing usually are:

  • Young patients under 60 years of age, as younger patients have a higher chances of requiring a second surgery (revision hip replacement) secondary to wear and tear. The patients in the younger age group are also more active with a more physically demanding lifestyle.
  • The hip resurfacing requires boney strength of the femur as the neck of the femur bears the stress of the implanted prosthetic head. Therefore, postmenopausal women, patients with metabolic disease, patients with short stature are not ideal candidates for hip resurfacing surgery.
  • Patients with a deformed upper thigh bone who may need a hip replacement surgery may benefit from a hip resurfacing procedure.
  • Patients with a deformed acetabulum or patients with significant leg length discrepancy are not good candidates for hip replacement surgery.
  • Patients with chronic kidney disease are also not good candidates for hip resurfacing as the metal ions accumulate in the body

Although relatively a newer procedure as compared to a total hip replacement, hip resurfacing offers several advantages as compared to a traditional total hip replacement.

  • The bone stock is relatively preserved in hip resurfacing as compared to total hip replacement. The preservation of bone is helpful in young patients who might need revision surgery due to activity-related wear and tear.
  • Hip resurfacing avoids possible complications of implant migration and stress shielding. Stress shielding of the femoral stem in traditional implants may lead to unrelenting thigh pain and loosening.
  • Hip resurfacing allows the surgeon to implant a larger diameter head of the femur. The implant diameter in hip resurfacing is almost similar to the natural head of the femur. A larger head of the femur is less likely to dislocate.Hip replacement dislocation occurs when the prosthetic head of the femur pops out of the socket. A large diameter head has to travel a greater distance before it can dislocate therefore allows a larger safe range of motion.
  • Hip resurfacing also leads to a more accurate restoration of the leg length after the surgery. There is less chance of a leg length discrepancy occurring as a result of replacement surgery.
Intraoperative image showing instruments used in total hip replacement.

Intraoperative image showing instruments used in total hip replacement.

The hip resurfacing may however be associated with a number of unique complications.

  • There is a small chance of a fracture occurring in the immediate postoperative period. The break in the bone occurs commonly in the femoral neck that may require the conversion of hip resurfacing to a total hip replacement.
  • The surgery may require greater exposure that may warrant more cutting/separating of the tissues. Greater cutting and manipulation of the soft tissues may increase the chances of heterotrophic calcification. In heterotrophic calcification, there is an abnormal formation of bone tissue in the muscles surrounding the joint.
  • If a leg length inequality exists before the surgery due to arthritis, the difference may not be corrected in a hip resurfacing surgery.
  • Since the hip resurfacing surgery involves a metal-on-metal design, cobalt and chromium metal ions concentration increases in the blood. Although, no side effects of the increased metal ions have been seen they may potentially cause adverse effects in a long term.The metal ions may also increase substantially in patients with prior kidney disease as the ions may not be eliminated from the body.
  • Some patients may be allergic to metal ions that may cause inflammation around the implant and subsequent loosening.

Hip resurfacing is a relatively new technique compared to the highly successful total hip replacement. Hip resurfacing offers several advantages over total hip replacement but the majority of the patients may not be candidates for hip resurfacing.

Further, long-term safety and results of hip resurfacing have not been adequately studied compared to a total hip replacement. Speak with your orthopedic joint replacement surgeon regarding which type of surgery may be best suited in your case.

Do you have more questions? 

Are there any specific lifestyle modifications or restrictions that patients should follow after undergoing hip resurfacing surgery, and for how long should these precautions be maintained?

Patients may need to follow certain lifestyle modifications or restrictions after hip resurfacing surgery to promote proper healing and prevent complications. These may include avoiding high-impact activities, maintaining a healthy weight, and adhering to postoperative rehabilitation guidelines. These precautions may need to be followed for several weeks to months, depending on individual recovery progress.

What are the key differences in postoperative pain management between hip resurfacing surgery and total hip replacement, and how does this impact the patient’s recovery experience?

Postoperative pain management strategies may differ between hip resurfacing surgery and total hip replacement, depending on factors such as surgical technique and patient preferences. Understanding these differences can help patients prepare for their recovery experience and manage pain effectively during the healing process.

How long does it typically take for patients to resume normal daily activities, such as walking, driving, and returning to work, after undergoing hip resurfacing surgery?

The time it takes for patients to resume normal daily activities after hip resurfacing surgery can vary depending on individual factors such as overall health, surgical technique, and postoperative rehabilitation progress. Patients should discuss their specific recovery timeline with their surgeon to set realistic expectations and plan accordingly.

What are the potential signs of complications or implant failure that patients should watch out for after undergoing hip resurfacing surgery, and when should they seek medical attention?

Patients should be aware of potential signs of complications or implant failure after hip resurfacing surgery, such as persistent pain, swelling, instability, or limited range of motion in the hip joint. It’s important to seek medical attention promptly if any concerning symptoms arise to ensure timely evaluation and appropriate management.

Are there any long-term lifestyle modifications or precautions that patients should consider adopting to prolong the lifespan of their hip resurfacing implant and minimize the risk of complications?

Adopting long-term lifestyle modifications or precautions can help prolong the lifespan of a hip resurfacing implant and reduce the risk of complications. These may include maintaining a healthy weight, engaging in regular low-impact exercise, avoiding activities that place excessive stress on the hip joint, and attending regular follow-up appointments with the surgeon for monitoring.

How does the cost of hip resurfacing surgery compare to total hip replacement, and are there any factors that may influence the overall cost, such as insurance coverage or hospital fees?

The cost of hip resurfacing surgery may vary depending on factors such as geographic location, surgeon experience, hospital fees, and insurance coverage. Patients should consult with their healthcare provider and insurance company to understand the potential costs associated with the procedure and explore available financing options or assistance programs if needed.

What are the potential benefits of undergoing hip resurfacing surgery in terms of preserving bone stock and facilitating future revision surgeries, particularly for younger patients?

– Hip resurfacing surgery offers potential benefits in terms of preserving bone stock and facilitating future revision surgeries, which may be particularly advantageous for younger patients who are more likely to require additional procedures over their lifetime. Understanding these benefits can help patients make informed decisions about their treatment options.

How does the rehabilitation process after hip resurfacing surgery differ from that of total hip replacement, and what specific exercises or activities are typically recommended to promote optimal recovery?

The rehabilitation process after hip resurfacing surgery may differ from that of total hip replacement based on factors such as surgical technique and patient factors. Physical therapy exercises and activities may be tailored to the individual patient’s needs and goals, focusing on improving strength, flexibility, and mobility in the hip joint while minimizing stress on the surgical site.

What are the potential risks or complications associated with delaying or avoiding hip resurfacing surgery for patients who may benefit from the procedure, and how can patients weigh the risks and benefits of treatment timing?

Delaying or avoiding hip resurfacing surgery for patients who may benefit from the procedure can carry risks such as worsening symptoms, decreased quality of life, and potential progression of joint damage. Patients should work closely with their healthcare provider to assess the risks and benefits of treatment timing based on their individual circumstances and treatment goals.

Are there any alternative treatments or therapies available for patients who may not be suitable candidates for hip resurfacing surgery, and how do these options compare in terms of effectiveness and risks?

Patients who are not suitable candidates for hip resurfacing surgery may have alternative treatment options available, such as total hip replacement, conservative management, or other surgical interventions. These options should be discussed with a healthcare provider to determine the most appropriate course of action based on the patient’s individual needs and preferences.

What are the key factors that patients should consider when deciding between hip resurfacing surgery and total hip replacement, and how can patients weigh these factors to make an informed decision?

– Patients should consider factors such as age, bone quality, activity level, anatomical considerations, and potential long-term outcomes when deciding between hip resurfacing surgery and total hip replacement. Consulting with a healthcare provider and discussing the risks, benefits, and potential outcomes of each procedure can help patients make an informed decision that aligns with their individual needs and goals

How does hip resurfacing surgery impact the range of motion and stability of the hip joint compared to total hip replacement, and what implications does this have for patients’ functional abilities and activities of daily living?

Understanding how hip resurfacing surgery affects the range of motion and stability of the hip joint compared to total hip replacement can help patients anticipate changes in their functional abilities and activities of daily living postoperatively. Patients may need to adjust their expectations and lifestyle based on these differences to optimize their recovery and overall outcomes.

What are the potential limitations or contraindications for hip resurfacing surgery, and how does the presence of certain medical conditions or anatomical factors influence candidacy for the procedure?

Identifying potential limitations or contraindications for hip resurfacing surgery is crucial for determining patient candidacy and minimizing the risk of complications. Factors such as underlying medical conditions, bone quality, anatomical abnormalities, and lifestyle considerations may impact eligibility for the procedure and should be carefully evaluated during the preoperative assessment.

How does the recovery timeline for hip resurfacing surgery compare to that of total hip replacement, and what factors contribute to variations in recovery duration among patients?

Understanding the typical recovery timeline for hip resurfacing surgery and the factors that influence variations in recovery duration can help patients set realistic expectations and monitor their progress postoperatively. Factors such as surgical technique, preoperative health status, adherence to rehabilitation protocols, and individual healing responses can all affect the pace and success of recovery.

Are there any specific dietary recommendations or nutritional considerations that patients should follow before and after undergoing hip resurfacing surgery to support optimal healing and recovery?

Nutrition plays a critical role in supporting optimal healing and recovery after hip resurfacing surgery. Patients may benefit from following a balanced diet rich in protein, vitamins, and minerals to promote tissue repair, immune function, and overall health. Consulting with a healthcare provider or registered dietitian can help patients develop personalized dietary recommendations based on their individual needs and surgical goals.

What are the potential effects of hip resurfacing surgery on patients’ mobility, independence, and quality of life compared to total hip replacement, and how do these factors influence treatment decisions and patient satisfaction?

Assessing the potential effects of hip resurfacing surgery on patients’ mobility, independence, and quality of life relative to total hip replacement can inform treatment decisions and enhance patient satisfaction. Patients may prioritize different outcomes based on their lifestyle, preferences, and treatment goals, and understanding the potential impact of each procedure can help align expectations and optimize postoperative outcomes.

How does the risk of implant wear and failure differ between hip resurfacing surgery and total hip replacement, and what factors contribute to the long-term durability of each type of implant?

Comparing the risk of implant wear and failure between hip resurfacing surgery and total hip replacement can help patients understand the factors that influence the long-term durability of each type of implant. Factors such as implant design, material composition, patient activity level, and surgical technique can all affect the risk of wear and failure over time and should be considered when evaluating treatment options.

What are the potential implications of hip resurfacing surgery for patients’ future joint health and mobility, particularly in terms of the risk of revision surgery, implant longevity, and functional outcomes over time?

Understanding the potential implications of hip resurfacing surgery for patients’ future joint health and mobility is important for informed decision-making and long-term treatment planning. Patients should consider factors such as the risk of revision surgery, implant longevity, and functional outcomes over time when weighing the benefits and risks of the procedure and discussing their preferences with their healthcare provider.

How does the skill and experience of the surgeon performing hip resurfacing surgery impact patient outcomes and the risk of complications, and what criteria should patients consider when selecting a surgeon for the procedure?

The skill and experience of the surgeon performing hip resurfacing surgery can significantly influence patient outcomes and the risk of complications. Patients should carefully evaluate a surgeon’s expertise, training, and surgical volume when selecting a provider for the procedure to ensure optimal results and minimize the risk of adverse events.

What are the potential implications of hip resurfacing surgery for patients’ participation in high-impact activities, sports, or strenuous physical occupations, and how should patients approach returning to these activities postoperatively?

Patients considering hip resurfacing surgery should be aware of the potential implications for their participation in high-impact activities, sports, or strenuous physical occupations. While hip resurfacing may offer certain advantages for younger, more active patients, it’s essential to discuss realistic expectations and activity modifications with a healthcare provider to minimize the risk of implant wear, dislocation, or other complications during recovery and beyond.

What ongoing monitoring or follow-up care is typically recommended for patients after undergoing hip resurfacing surgery, and how does this contribute to the long-term success and durability of the implant?

Ongoing monitoring and follow-up care are essential components of postoperative management for patients who have undergone hip resurfacing surgery. Regular appointments with a healthcare provider allow for the assessment of implant function, detection of potential complications, and implementation of preventive measures to optimize long-term success and durability. Patients should adhere to recommended follow-up schedules and communicate any concerns or changes in symptoms to their healthcare team promptly.

Suhirad-Khokhar-MD

My name is Dr. Suhirad Khokhar, and am an orthopaedic surgeon. I completed my MBBS (Bachelor of Medicine & Bachelor of Surgery) at Govt. Medical College, Patiala, India.

I specialize in musculoskeletal disorders and their management, and have personally approved of and written this content.

My profile page has all of my educational information, work experience, and all the pages on this site that I've contributed to.