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:

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

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
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You’ll either receive general or spinal anesthesia for hip-resurfacing surgery. General anesthesia puts you asleep during the procedure. Spinal anesthesia blocks sensation from the waist down but doesn’t put you asleep.

The procedure usually lasts between 1.5 to 3 hours.

During the procedure, the surgeon will:

  1. make an incision in your thigh to reach your hip
  2. dislocate the ball of your hip from the socket
  3. trim the head of your femur with special tools
  4. place a metal cap over your femoral head and fix it into place with cement
  5. use a tool called a “reamer” to remove the cartilage that lines the socket
  6. push a metal cup into the socket
  7. close the incision with stitches
  8. take you to a recovery room for monitoring

Serious problems from hip resurfacing are rare. The most common issues are:

  • infection
  • blood clots
  • injury to blood vessels or nerves
  • femoral neck fractures
  • dislocation
  • allergic reaction to anesthetic

Even though complications are rare, hip-resurfacing surgery still has higher rates of failure than total hip replacements.

You can usually go home 1 to 4 days after your procedure. You may need to walk with a supportive device such as crutches, a cane, or a walker for days to weeks. The doctor will likely recommend physical therapy to help you regain your typical range of motion.

You may have some pain for several weeks, and the doctor will likely prescribe pain medication to take as needed. It usually takes about 6 weeks to resume your regular daily activities.

In a 2018 study, researchers found that 20% of a group of 30 people who had received hip resurfacing needed revision surgery within 8 years.

Here are some frequently asked questions that people have about hip resurfacing.

How long does it take to recover from hip resurfacing?

It usually takes about 6 weeks to return to your regular daily activities after hip resurfacing. People can often return to low intensity sports at 3 months.

Hip-resurfacing implants aren’t designed for high intensity activity. Check with a doctor about what activities you may be able to resume and when.

How long does a resurfaced hip last?

In a 2022 study, researchers found implant survival rates of 97.7% in men and 73.4% in women at a follow-up of an average of 14.9 years after surgery.

In a 2021 study, researchers found the following implant survival rates in 33 teenagers:

  • 100% at 5 years after surgery
  • 97% at 10 years after surgery
  • 89.9% at 15 years after surgery

How much does hip resurfacing cost?

In a 2021 study, researchers found that the average insurance reimbursement for total hip replacement at local hospitals was $50,000, and the average for hip resurfacing was $26,000. What you pay out of pocket will depend on what your insurance plan covers.

Hip resurfacing is a type of surgery that replaces the surface of the head of your femur and the socket with an artificial implant. Doctors usually reserve the procedure for younger and physically active men with osteoarthritis.

Hip resurfacing isn’t as common as total hip replacement, but some research suggests it may offer benefits for eligible people, such as a better return to sport and better hip mobility.

Still, compared with total hip replacement, hip-resurfacing surgery may have a slightly higher risk of failure and the need for revision surgery. Metal-on-metal debris from hip-resurfacing implants can significantly increase the likelihood of complications.

Check with a doctor about which procedure might be best for you.