Your Guide to Hip Resurfacing Arthroplasty

Hip resurfacing may be an effective alternative to hip replacement for younger active people with arthritis. It preserves more bone and might offer quicker recovery and better mobility. Still, it comes with some unique risks.

Hip arthroplasty, also called a “hip replacement,” is a procedure in which a surgeon replaces damaged tissue in your hip joint with an artificial implant. The traditional version of this surgery is called “total hip replacement,” which involves replacing the entire ball-and-socket joint of your hip.

Hip resurfacing is an alternative procedure that involves removing less tissue. During hip resurfacing, the ball of your femur is covered with a thin metal material instead of being completely removed.

Medical professionals originally developed hip resurfacing in the 1970s , but early surgeries provided poor results due to excess wear on the joint and bone loss.

Modern advances in materials and surgical techniques have made it a workable alternative to total hip replacement for young and active people. The technology is still developing, and experts expect new hip-resurfacing devices to be launched over the next decade.

In this article, we break down everything you need to know about hip resurfacing.

Language matters

You’ll notice that the language used to share stats and other data points is pretty binary, fluctuating between the use of “male” and “female” or “men” and “women.”

Although we typically avoid language like this, specificity is key when reporting on research participants and clinical findings.

Unfortunately, the studies and surveys referenced in this article didn’t report data on, or include, participants who were transgender, nonbinary, gender nonconforming, genderqueer, agender, or genderless.

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According to current literature, doctors usually perform hip resurfacing on physically active males, as they tend to have higher and more stable bone density than females. Candidates typically:

• are younger than 60 years of age
• have large bone frames
• have strong and healthy bones

Doctors primarily use hip resurfacing to treat osteoarthritis, but they may also use it to treat:

• rheumatoid arthritis
• ankylosing spondylitis
• osteonecrosis

According to research, people who generally don’t make good candidates are:

• assigned female at birth
• have smaller bone structures
• older adults
• people who wish to become pregnant

Hip-resurfacing implants currently available in the United States use metal-on-metal bearing surfaces. Metalion debris from these implants could be unsafe for a fetus.

According to a 2022 review, surgeons sometimes consider hip resurfacing for younger females. Risks associated with the implant are more common in people who receive small implants. Females are more likely to need smaller implants, so they have an elevated risk.

Hip resurfacing preserves more bone than a total hip replacement. A hip total hip replacement involves replacing your entire hip joint including:

• the head of your femur
• the neck of your femur just below the ball
• the socket and damaged cartilage

Hip resurfacing involves replacing the surface of the head of the femur instead of the entire head.

There’s conflicting evidence about whether hip resurfacing is linked to better outcomes for eligible people. Short-term studies have found comparable results between the two surgeries.

According to a 2022 review of the 50 most cited studies, research suggests promising results. Some studies show that hip resurfacing may offer better daily living and sports participation scores.

In a 2020 study , researchers found that hip resurfacing is linked to better sports participation than total hip replacement after 2 years in 251 people with an average age of 53.6 years. Hip resurfacing was also linked with greater surgery satisfaction.

In a 2021 study , researchers found evidence that both hip resurfacing and total hip replacement provided good outcomes for people under the age of 35 years.

But hip resurfacing may have higher revision rates than total hip replacements, which means more people may need to have surgery to correct a failed implant. Metal-on-metal implants may cause metal ion debris, leading to pseudotumors that can complicate revision surgery and increase the risk of death.

Here’s a look at some of the pros and cons of hip resurfacing versus replacement:

Pros of hip resurfacing

• easier to revise
• decreased risk of hip dislocation
• allows you to walk with a more natural gait
• better postoperative hip mobility
• better chance of returning to low impact sports and recreation

Cons of hip resurfacing

• risk of femoral neck fracture, which usually requires a traditional hip replacement
• friction from metal, which may damage other tissue around the joint
• risk of pain and swelling, caused by metal ions released from the metal-on-metal implant, possibly leading to pseudotumors and the need for revision surgery