Hip resurfacing: Definition, Uses, and Clinical Overview

Posted on February 27, 2026 | by drhip

Hip resurfacing Introduction (What it is)

Hip resurfacing is a type of hip replacement surgery that preserves more of the patient’s thighbone (femur) than a traditional total hip replacement.
It replaces the worn joint surfaces of the hip with metal components shaped to match the joint.
It is most commonly discussed for younger or more active patients with advanced hip arthritis, but candidacy varies by clinician and case.
It is performed by orthopedic surgeons in a hospital or surgical center setting.

Why Hip resurfacing used (Purpose / benefits)

Hip resurfacing is used to treat pain and loss of function caused by damage to the hip joint surface, most often from osteoarthritis and, in select cases, other forms of arthritis or structural hip disease. The goal is to relieve pain, improve mobility, and help patients return to everyday activities by replacing the damaged bearing surfaces where the “ball-and-socket” joint moves.

A key concept is bone preservation. In Hip resurfacing, the femoral head (the “ball”) is not removed and replaced with a stem placed down the femoral canal, as in many total hip replacements. Instead, the surgeon reshapes the surface of the femoral head and covers it with a metal cap, while also placing a metal cup in the acetabulum (the “socket” of the pelvis). Preserving more femoral bone is sometimes considered beneficial if a future revision surgery is needed, although outcomes and revision complexity vary by implant design and patient factors.

Potentially valued features of Hip resurfacing include:

Large femoral head size, which may provide a greater range of motion before impingement in some designs and may influence dislocation risk compared with smaller-head constructs (risk varies by technique and implant).
More “anatomic” loading of the femur, because there is typically no long stem in the femoral canal; how this translates clinically depends on many factors.
Activity goals, where some surgeons consider it for patients aiming to maintain higher activity levels, while balancing risks that can be different from total hip replacement.

Hip resurfacing is not primarily a “quick fix” or a minor procedure; it is a form of arthroplasty (joint replacement) and carries the general benefits and responsibilities of major joint surgery, including the need for rehabilitation and follow-up.

Indications (When orthopedic clinicians use it)

Common scenarios in which orthopedic clinicians may consider Hip resurfacing include:

Advanced hip osteoarthritis causing significant pain and functional limitation despite non-surgical management.
Younger patients with end-stage hip arthritis where bone preservation is a priority (age thresholds vary by clinician and case).
Patients with good femoral head bone quality and a femoral head size that accommodates available implant designs.
Some cases of post-traumatic arthritis (arthritis after a prior injury) when anatomy and bone quality remain suitable.
Select patients with inflammatory arthritis or other diagnoses only when overall risk profile is acceptable (this is often more restrictive and varies by clinician and case).
Patients whose occupation or goals involve high functional demands, when the surgeon believes resurfacing-specific risks are appropriately managed.

Contraindications / when it’s NOT ideal

Hip resurfacing is not suitable for every patient with hip arthritis. Situations where it may be less appropriate, or where another approach may be preferred, include:

Poor bone quality (for example, osteoporosis or significant osteopenia), which can increase risk of femoral neck fracture or component fixation problems.
Large cysts or structural weakness in the femoral head/neck region that reduce support for the femoral cap.
Femoral head deformity or extensive avascular necrosis (loss of blood supply leading to bone collapse), depending on extent and location.
Smaller femoral head size, which can limit implant options and may affect wear and risk profile; this may be more common in smaller-bodied patients.
Known metal sensitivity or a history strongly suggestive of adverse reactions to metal (assessment approaches vary).
Kidney disease or reduced renal function in some cases, because the body clears metal ions through the kidneys and clinicians may be more cautious (policies vary by clinician and case).
Active infection anywhere in the body or prior unresolved infection around the hip.
Pregnancy or potential for pregnancy is sometimes considered in decision-making due to concerns about metal ion exposure; approaches vary by clinician and case.
Complex hip anatomy (for example, certain forms of hip dysplasia) where cup positioning, coverage, or stability may be challenging, though some surgeons may still consider it in select cases.

How it works (Mechanism / physiology)

The hip is a ball-and-socket joint. The ball is the femoral head at the top of the thighbone, and the socket is the acetabulum in the pelvis. In a healthy hip, these surfaces are covered with articular cartilage, a smooth, low-friction tissue that allows movement and helps distribute loads. Arthritis and other degenerative conditions damage cartilage and can alter the underlying bone, leading to pain, stiffness, and mechanical symptoms.

Hip resurfacing works by replacing the damaged bearing surfaces while preserving much of the femoral head and neck:

The acetabular cartilage and a thin layer of bone are removed, and a metal cup is implanted to become the new socket surface.
The femoral head is reshaped, and a metal cap is placed over it to create a smooth new ball surface.

This is a biomechanical solution rather than a biologic treatment. It does not regenerate cartilage; it substitutes the joint’s worn surfaces with engineered components intended to reduce painful bone-on-bone contact and restore smoother motion.

Onset and durability: Pain relief and functional improvement generally occur over a rehabilitation period rather than immediately, and the timeline varies by clinician and case. Longevity depends on multiple factors, including implant design, positioning, bone quality, activity level, and the body’s reaction to wear debris. The procedure is not “reversible” in the sense of returning the hip to its original state, but if needed it can often be converted to a total hip replacement, depending on the condition of the bone and components.

Hip resurfacing Procedure overview (How it’s applied)

Hip resurfacing is a surgical procedure planned and performed through a structured workflow. Exact techniques differ among surgeons and institutions.

Evaluation and diagnosis – History and physical exam focusing on pain pattern, function, gait, and hip range of motion. – Imaging, typically X-rays; additional imaging may be used depending on the case. – Review of health factors that affect surgical risk and implant choice (bone quality, kidney function, prior hip surgery, and others).
Preoperative preparation – Shared decision-making about whether Hip resurfacing or another option fits the patient’s goals and risk profile. – Planning for implant sizing and component positioning based on anatomy. – Perioperative planning for anesthesia, blood management, and postoperative support needs (varies by institution).
Intervention (the operation) – Surgical exposure of the hip joint. – Preparation of the acetabulum and placement of the socket component. – Preparation (“resurfacing”) of the femoral head and placement of the femoral cap component. – Checks for hip stability, leg length, range of motion, and component position using the surgeon’s standard methods.
Immediate postoperative checks – Pain control strategy and early mobility assessment. – Monitoring for early complications and confirmation of implant position as appropriate.
Follow-up and rehabilitation – Progressive rehabilitation focused on restoring walking, strength, and hip function. – Scheduled follow-ups to monitor healing and implant performance; some clinicians also monitor metal ion levels or imaging in select situations, depending on symptoms, implant type, and local protocols.

Types / variations

Most Hip resurfacing systems share the same core concept (a capped femoral head and an acetabular cup), but there are important variations:

Bearing material
Historically, most widely used designs are metal-on-metal (a metal femoral cap articulating with a metal acetabular cup).
The choice of alloy, surface finish, and manufacturing details varies by material and manufacturer and can influence wear behavior.
Fixation method
The acetabular cup is commonly press-fit (bone grows onto/into the surface), though details vary by design.
The femoral cap may be cemented in some systems; other designs and techniques may vary.
Component geometry and sizing
Systems differ in available sizes, head-to-neck coverage, and instrumentation, which can affect which anatomies are suitable.
Surgical approach
Surgeons may use different approaches to access the hip (approach selection varies by clinician and case).
Approach can influence early recovery considerations and soft-tissue handling, though outcomes depend on multiple factors.
Primary vs conversion use
Hip resurfacing is typically a primary procedure for arthritis, but in some circumstances surgeons may consider it in more complex settings; these decisions are highly individualized.

Pros and cons

Pros:

Preserves more femoral bone compared with many stemmed total hip replacements.
Uses a large head size, which can affect stability and motion characteristics depending on implant and positioning.
May allow a more familiar “ball-and-socket” geometry for some patients, though perception varies.
Can be converted to total hip replacement in many cases if needed later (conversion complexity varies).
Often considered for younger, active patients when appropriate, balancing resurfacing-specific risks.

Cons:

Often involves metal-on-metal bearing surfaces, which can produce metal wear debris and elevated metal ions; clinical significance varies by patient and implant.
Risk of adverse local tissue reaction (inflammatory reaction around the hip) in some patients; risk varies by material and manufacturer and by component positioning.
Risk of femoral neck fracture, especially in the early period, influenced by bone quality, anatomy, and technique.
Technique is sensitive to component positioning; suboptimal alignment can increase wear and complications.
Not suitable for many patients due to bone quality, anatomy, kidney function, or metal sensitivity considerations.
Follow-up may involve additional monitoring in some practices, particularly if symptoms develop.

Aftercare & longevity

Aftercare following Hip resurfacing generally focuses on safe healing, gradual return of function, and monitoring for complications. Specific protocols vary by surgeon, implant type, and patient factors, but common themes include:

Rehabilitation and activity progression
Recovery is usually staged, starting with walking and basic mobility and progressing to strengthening and endurance.
The pace of progression depends on pain, gait quality, muscle control, and the clinician’s protocol.
Weight-bearing and movement precautions
Weight-bearing status and early motion limits (if any) depend on the surgeon’s preference, bone quality, and intraoperative findings.
Assistive devices may be used temporarily to support a stable gait pattern.
Wound and general postoperative care
Patients are typically monitored for wound healing and signs of complications such as infection, blood clots, or dislocation (even if dislocation risk differs by construct).
Longevity considerations
Implant longevity is influenced by component positioning, implant design, activity level, body weight, bone quality, and the body’s response to wear particles.
In metal-on-metal systems, some clinicians consider periodic assessment for symptoms and, in certain cases, blood metal ion levels or imaging, but practices vary by clinician and case.
Long-term follow-up
Even when patients feel well, periodic follow-up may be recommended to ensure the implant remains well-positioned and functioning as intended.
New pain, swelling, clicking, instability, or reduced function are typical reasons clinicians reassess the hip.

Alternatives / comparisons

Hip resurfacing is one option within a broader hip-care pathway. Alternatives range from non-surgical management to different surgical reconstructions.

Observation and activity modification
For mild or intermittent symptoms, monitoring combined with targeted activity changes may be used.
This does not correct cartilage loss but may help manage symptoms and function.
Physical therapy and exercise-based care
Often used to improve strength, mobility, and movement patterns around the hip.
It can reduce pain and improve function for some people, particularly earlier in disease, but it does not replace lost cartilage.
Medications
Anti-inflammatory or pain-relieving medications may reduce symptoms.
They do not reverse structural arthritis and may have side effects; selection depends on the patient’s health profile.
Injections
Corticosteroid injections may provide temporary symptom relief for some patients.
Other injection types are sometimes used, but effectiveness and indications depend on diagnosis and practice patterns.
Hip preservation procedures (non-arthroplasty)
In select structural problems (such as certain impingement or dysplasia patterns), surgeons may consider procedures to improve mechanics before end-stage arthritis.
These are generally different from resurfacing and are not options for every stage of disease.
Total hip replacement (total hip arthroplasty)
The most common surgical alternative for end-stage hip arthritis.
Typically replaces the femoral head with a stemmed component and replaces the socket with a cup; bearing options include combinations such as ceramic, metal, and polyethylene (plastic).
Compared with Hip resurfacing, total hip replacement is often suitable for a wider range of patients, including those with poorer bone quality, though each has distinct trade-offs and complication profiles.

Hip resurfacing Common questions (FAQ)

Q: Is Hip resurfacing the same as a total hip replacement?
No. Both are forms of hip arthroplasty, but Hip resurfacing preserves the femoral head and neck and caps the femoral head rather than replacing it with a stemmed implant. The socket is still replaced with a cup, similar to total hip replacement.

Q: Who is typically considered a good candidate?
Candidacy is individualized, but it often centers on patients with advanced hip arthritis who have good femoral bone quality and appropriate hip anatomy. Some surgeons consider it more often in younger, active patients, while others use different selection criteria. Final eligibility varies by clinician and case.

Q: How painful is recovery?
Pain levels vary widely, and early postoperative discomfort is expected with any major hip surgery. Pain control typically uses a combination of methods and improves as healing and mobility progress. The exact course depends on the individual and the rehabilitation plan.

Q: How long does a Hip resurfacing implant last?
Longevity varies by implant design, component positioning, patient anatomy, activity level, and how the body responds over time. Some implants function well for many years, while others may need earlier revision. There is no single guaranteed timeframe.

Q: Are metal ions a concern?
They can be. Many resurfacing systems are metal-on-metal, which can release metal wear debris and lead to measurable metal ions in the blood. The health significance and monitoring approach vary by clinician and case, and symptoms (or lack of symptoms) matter in follow-up decisions.

Q: What is the cost range for Hip resurfacing?
Costs vary widely by country, hospital system, insurance coverage, surgeon fees, implant contracts, and whether additional testing or monitoring is used. Because of these variables, a single typical price is not reliable. Billing departments and insurers are usually the best sources for case-specific estimates.

Q: When can someone drive or return to work?
Timing depends on which side was operated on, pain control, mobility, reaction time, and whether the person is still using medications that impair driving. Return to work varies based on job demands (desk work versus physically demanding roles) and the clinician’s protocol. Many people return in phases rather than all at once.

Q: Will I be fully weight-bearing right away?
Weight-bearing instructions differ among surgeons and depend on bone quality, implant fixation, and intraoperative findings. Some patients may be allowed to bear weight as tolerated, while others may have temporary restrictions. The safest guidance is the protocol used by the treating surgical team.

Q: Can you return to sports after Hip resurfacing?
Many patients aim to resume recreational activities after recovery, but what is reasonable depends on healing, strength, implant type, and surgeon preference. Higher-impact sports may place greater loads across the joint, and recommendations vary by clinician and case. Discussions typically focus on balancing goals with long-term implant considerations.

Q: What happens if Hip resurfacing fails?
If a resurfacing implant has problems—such as loosening, fracture, persistent pain, or adverse tissue reaction—one common next step is revision surgery. In many cases, revision involves converting the hip to a total hip replacement, though the exact plan depends on what failed and how much bone and soft tissue remain healthy.