Hip resurfacing arthroplasty: Definition, Uses, and Clinical Overview

Posted on February 27, 2026 | by drhip

Hip resurfacing arthroplasty Introduction (What it is)

Hip resurfacing arthroplasty is a type of hip replacement surgery that preserves more of the patient’s femoral bone.
Instead of removing the entire femoral head, the surgeon caps it with a smooth metal covering.
The socket (acetabulum) is also resurfaced with a matching implant liner or shell.
It is most commonly discussed for active patients with advanced hip arthritis who may benefit from bone preservation.

Why Hip resurfacing arthroplasty used (Purpose / benefits)

Hip resurfacing arthroplasty is designed to relieve pain and improve function in a hip joint that has been damaged by arthritis or other degenerative conditions. In a healthy hip, the femoral head (ball) glides smoothly inside the acetabulum (socket) with the help of cartilage and joint fluid. When cartilage wears down or the joint becomes deformed, motion can become painful and limited.

Compared with a traditional total hip arthroplasty (total hip replacement), hip resurfacing aims to:

Preserve femoral bone by keeping most of the femoral head and neck intact, which may be relevant for some patients who could need future surgery over a lifetime.
Restore hip mechanics using a larger “ball” size, which can influence stability and range of motion in some cases.
Maintain activity goals for certain patients whose work or sports place high demands on the hip, recognizing that activity recommendations vary by clinician and case.
Provide a revision pathway that may allow conversion to a standard total hip replacement if resurfacing fails, although revision complexity varies.

The overall problem it addresses is symptom relief and functional restoration when non-surgical options no longer control pain or when joint damage significantly limits daily activities.

Indications (When orthopedic clinicians use it)

Hip resurfacing arthroplasty is typically considered in scenarios such as:

Advanced hip osteoarthritis causing persistent pain and reduced function despite appropriate non-surgical care
Post-traumatic arthritis after prior hip injury
Certain forms of inflammatory arthritis in carefully selected patients (selection varies by clinician and case)
Patients who are younger or more active where femoral bone preservation is a priority (not a guarantee of better long-term results)
Good femoral bone quality and anatomy that can support a resurfacing cap
Situations where a larger femoral head size is desired to reduce the chance of instability, recognizing outcomes vary

Contraindications / when it’s NOT ideal

Hip resurfacing arthroplasty is not suitable for every hip or every patient. Situations where it may be less ideal include:

Poor bone quality (for example, significant osteoporosis), which may increase the risk of femoral neck fracture or inadequate fixation
Large areas of femoral head damage (such as extensive avascular necrosis or cystic changes), depending on size and location
Anatomy that limits implant positioning or makes accurate alignment difficult
Known or suspected metal sensitivity in cases where a metal-on-metal bearing is planned (evaluation approaches vary by clinician and case)
Impaired kidney function in some scenarios, because metal ion handling and monitoring considerations may differ (varies by clinician and case)
Women of childbearing potential are sometimes approached cautiously with metal-on-metal bearings due to metal ion concerns; recommendations vary by clinician, implant type, and evolving evidence
Active infection, uncontrolled systemic illness, or other general surgical risk factors that may make elective joint replacement less appropriate
Situations where another bearing surface or implant design is preferred (for example, ceramic or polyethylene options more commonly used in total hip arthroplasty)

How it works (Mechanism / physiology)

Hip resurfacing arthroplasty works by replacing the damaged bearing surfaces of the hip joint while preserving much of the femoral bone.

Biomechanical principle

The procedure aims to recreate a low-friction joint surface by placing a smooth cap over the femoral head and a corresponding component in the acetabulum.
By using a large-diameter femoral head (closer to the patient’s native size than many traditional total hip heads), resurfacing can change joint stability characteristics, though stability depends on many factors including implant position and soft-tissue function.

Anatomy involved

Key structures include:

Femoral head and femoral neck: The “ball” portion of the hip. Resurfacing keeps most of this bone and places a cap over the femoral head.
Acetabulum: The “socket” in the pelvis. The damaged cartilage is removed and a metal shell (and bearing surface) is fixed in place.
Articular cartilage and labrum: Typically already worn or damaged in advanced arthritis; resurfacing replaces the worn cartilage surface rather than repairing cartilage.
Hip capsule and surrounding muscles (gluteals, rotators): These soft tissues contribute to stability and gait mechanics and are affected by surgical approach and rehabilitation.

Onset, duration, and reversibility

Pain relief and functional improvement, when achieved, generally develop over weeks to months as tissues heal and strength returns. The timing varies by clinician and case.
Longevity depends on implant design, positioning, bone quality, activity level, and biological response. There is no single “expected lifespan” that applies to all patients.
The procedure is not reversible in the sense of returning the joint to its original anatomy, but it can be revised to another reconstructive option (most commonly total hip arthroplasty) if needed.

Hip resurfacing arthroplasty Procedure overview (How it’s applied)

Hip resurfacing arthroplasty is a surgical procedure performed in an operating room with sterile technique. Specific methods vary by surgeon training, implant system, and patient anatomy. A simplified workflow looks like this:

Evaluation and diagnosis – History (pain pattern, stiffness, function), physical exam, and imaging (commonly X-rays; other imaging may be used in selected cases). – Review of non-surgical treatments already tried and assessment of overall health and surgical readiness.
Preoperative planning – Implant sizing and alignment planning based on imaging and anatomy. – Discussion of bearing surfaces, potential benefits, and risks, including implant-specific considerations (varies by material and manufacturer).
Preparation on surgery day – Anesthesia selection and positioning. – Measures to reduce infection risk and manage blood loss according to institutional protocols.
Intervention (core surgical concept) – The acetabulum is prepared and fitted with a socket component. – The femoral head is shaped to accept a resurfacing cap, which is fixed in place (fixation method varies by implant design). – Hip stability, leg length, and range of motion are checked during surgery.
Immediate checks and early recovery – Postoperative monitoring, pain control, and early mobilization. – Imaging may be obtained to confirm component position based on routine practice.
Follow-up and rehabilitation – Scheduled follow-ups to assess wound healing, gait, strength, and functional progress. – Some patients may have additional monitoring based on implant type (for example, evaluation for metal wear concerns in metal-on-metal systems), depending on clinician preference and symptoms.

Types / variations

Hip resurfacing arthroplasty can vary by implant design, bearing materials, and surgical approach. Common variations include:

Bearing surface (what rubs against what)
Metal-on-metal (MoM): Historically common in hip resurfacing. These designs have specific considerations regarding wear debris and metal ions. Surveillance practices vary by region, implant, and patient factors.
Other materials: Some resurfacing concepts have explored alternative bearings (such as ceramic-related designs), but availability and clinical adoption vary by material and manufacturer.
Fixation method
Cemented femoral component: Some systems use cement to fix the femoral cap.
Cementless or hybrid concepts: Socket components are often press-fit and may allow bone ingrowth; details vary across designs.
Implant geometry and instrumentation
Differences in cap thickness, stem design (if present), and shell geometry can influence bone preparation and fit. Performance characteristics vary by manufacturer and case.
Surgical approach
Surgeons may use different pathways to access the hip (approach selection depends on training and patient anatomy). Approach can influence soft-tissue handling and early recovery patterns, but outcomes depend on many factors.

Pros and cons

Pros:

Preserves more femoral bone compared with many total hip replacement techniques
Uses a larger head size, which may support stability in some patients
Can provide meaningful pain relief and functional improvement when successful
May be appealing for certain active individuals with good bone quality (varies by clinician and case)
Leaves options for revision to total hip arthroplasty if needed, though revision complexity varies

Cons:

Not appropriate for all patients, especially those with poor femoral bone quality
Femoral neck fracture is a recognized complication risk in resurfacing (risk varies by case and technique)
Metal wear debris and metal ion concerns are important for metal-on-metal systems, with monitoring practices that vary
Component positioning is technically demanding; malposition may increase wear or complications
Some patients may require revision surgery due to pain, loosening, adverse local tissue reactions, or other issues (causes vary by implant and case)

Aftercare & longevity

Aftercare following Hip resurfacing arthroplasty generally focuses on safe healing, restoring strength and mobility, and monitoring for complications. Exact timelines and precautions differ by surgeon, implant system, and individual risk factors.

Factors that commonly affect outcomes and longevity include:

Underlying diagnosis and severity: Advanced deformity, bone cysts, or femoral head damage may affect fixation and durability.
Bone quality: Strong femoral neck bone can be important for resurfacing, while weaker bone may increase mechanical risk.
Implant positioning and surgical technique: Alignment and soft-tissue handling can influence stability, wear patterns, and symptoms.
Rehabilitation and activity progression: Regaining hip strength and normal gait mechanics often requires structured rehab and gradual return to activities. Overly rapid progression may not be appropriate for every patient; plans vary by clinician and case.
Body size and activity demands: Higher loads and impact activities can increase wear and stress, though the relationship is individualized.
Comorbidities: Conditions affecting bone health, healing, or infection risk can influence recovery.
Device choice and materials: Wear behavior and monitoring needs vary by material and manufacturer.
Follow-up surveillance: Some patients—particularly those with metal-on-metal bearings—may have periodic clinical review and additional testing when symptoms occur or when monitoring protocols recommend it. The need and frequency vary by clinician and case.

Longevity is best described as variable. Many patients do well for years, while others require earlier revision due to mechanical issues, pain, loosening, or biological reactions. No single timeframe applies to everyone.

Alternatives / comparisons

Hip pain and arthritis can be managed using a range of approaches. The right comparison depends on diagnosis, symptom severity, imaging findings, and patient goals.

Observation and activity modification
May be reasonable for mild symptoms or earlier-stage arthritis.
Does not change joint structure but can help some patients manage symptoms.
Medication-based symptom management
Options may include anti-inflammatory medicines or analgesics, selected by a clinician based on overall health and risks.
Generally aimed at pain control rather than restoring joint cartilage.
Physical therapy and exercise-based care
Often used to improve strength, mobility, and gait mechanics.
Can be helpful before surgery and during recovery, but may not fully control pain in end-stage arthritis.
Injections
Corticosteroid or other injections may be used for short-term symptom relief in some cases.
Effects are variable and typically temporary; they do not rebuild cartilage.
Hip arthroscopy
A minimally invasive procedure used more often for labral tears or femoroacetabular impingement (FAI) in selected patients.
Not typically a solution for advanced, diffuse arthritis where cartilage loss is extensive.
Osteotomy or hip preservation surgery
In select younger patients with structural hip problems, reshaping procedures may improve mechanics and delay replacement.
Appropriateness depends on anatomy and cartilage status.
Total hip arthroplasty (total hip replacement)
The most common surgical alternative for end-stage arthritis.
Replaces both the femoral head (with a stem and ball) and the acetabular socket, with multiple bearing surface options (ceramic, metal, polyethylene).
Compared with Hip resurfacing arthroplasty, it removes more femoral bone but avoids some resurfacing-specific issues; trade-offs vary by patient and implant choice.

Hip resurfacing arthroplasty Common questions (FAQ)

Q: Is Hip resurfacing arthroplasty the same as a total hip replacement?
No. Hip resurfacing arthroplasty preserves most of the femoral head and neck and caps the femoral head, while total hip replacement typically replaces the femoral head with a stemmed implant. Both resurface the acetabulum, but the femoral reconstruction differs.

Q: How painful is recovery after hip resurfacing?
Pain levels vary widely by individual factors, surgical approach, and pain-control plan. Many patients report that pain changes substantially over the first several weeks as tissues heal, with continued improvement during rehabilitation. Persistent or worsening pain should be evaluated by a clinician.

Q: How long do the results last?
Longevity varies by clinician and case, and depends on implant design, positioning, patient anatomy, and activity demands. Some implants function well for many years, while others require earlier revision due to mechanical or biological issues. There is no single “guaranteed” lifespan.

Q: Is Hip resurfacing arthroplasty considered safe?
It is a widely performed orthopedic procedure, but it has specific risks and is not ideal for everyone. Safety depends on patient selection, surgeon experience, implant type, and follow-up practices. Metal-on-metal bearings in particular may involve additional considerations related to wear debris and metal ions.

Q: Will I be able to return to sports or a physically demanding job?
Return to activity depends on healing, strength, implant positioning, and clinician guidance. Some patients resume higher-demand activities, while others are advised to limit impact or repetitive heavy loading. Recommendations vary by clinician and case.

Q: When can someone drive or go back to work after surgery?
Timing varies based on which hip was operated on, pain control, reaction time, type of work, and functional recovery. Driving is generally considered only when a person can safely control the vehicle and is not impaired by medications. Work return ranges from earlier for sedentary roles to longer for physically demanding jobs, depending on recovery progress.

Q: Will I need to use crutches or limit weight-bearing?
Early mobility plans vary by surgeon and by intraoperative findings. Some patients are allowed to bear weight relatively early, while others may have restrictions to protect bone and soft-tissue healing. The safest plan is individualized and depends on clinician protocols.

Q: What are metal ion issues, and should I worry about them?
Some Hip resurfacing arthroplasty systems use metal-on-metal bearings that can release small amounts of metal wear particles. In certain cases, metal debris can contribute to local tissue reactions or elevated blood metal ion levels, and monitoring practices vary by clinician and region. Not every patient experiences problems, and evaluation is typically based on symptoms, exam findings, and implant factors.

Q: Can a hip resurfacing be revised if it fails?
Yes, revision is possible, often to a total hip arthroplasty. The complexity of revision depends on why the implant failed, bone quality, and the condition of surrounding tissues. Outcomes vary by clinician and case.

Q: How do clinicians decide whether resurfacing or total hip replacement is a better fit?
Decision-making usually includes age, bone quality, anatomy, diagnosis, activity goals, and the risks associated with different bearing surfaces. Surgeon experience with specific implant systems can also matter. The final choice is individualized and based on balancing benefits and trade-offs for a particular patient.