Hip Resurfacing: A Complete Guide for Patients

Introduction to Hip Resurfacing

Hip resurfacing is an innovative surgical alternative to traditional total hip replacement (THR), designed to preserve more of the patient’s natural bone. Unlike THR, where the entire femoral head is removed, hip resurfacing involves placing a metal cap over the damaged femoral head and a matching metal socket in the pelvis. This approach is particularly beneficial for younger, active patients who want to maintain an active lifestyle post-surgery.

The procedure was developed to address the limitations of hip replacements in younger individuals, as traditional implants may wear out faster under high physical demand. Hip resurfacing offers greater stability, range of motion, and durability, making it a preferred choice for athletes and physically active individuals. However, not everyone is a candidate—factors like bone quality, age, and underlying conditions play a crucial role in eligibility.

Over the years, advancements in surgical techniques and implant materials (such as highly polished metal-on-metal components) have improved outcomes, though the procedure still carries some risks. If you're considering hip resurfacing, understanding its benefits, limitations, and recovery process is essential for making an informed decision.

Who Needs Hip Resurfacing? (Candidates & Eligibility)

Hip resurfacing is not for everyone, and proper patient selection is critical for success. Ideal candidates are typically:

• Younger patients (under 60) with strong, healthy bone structure.
• Active individuals (athletes, runners, weightlifters) who need a durable joint solution.
• Those with non-inflammatory arthritis (e.g., osteoarthritis) rather than rheumatoid arthritis.
• Patients with good bone density—those with osteoporosis may not qualify.

However, certain factors may disqualify someone from hip resurfacing, including:

• Severe bone loss or deformity in the hip joint.
• Kidney dysfunction (due to potential metal ion release from implants).
• Women of childbearing age (due to unknown effects of metal ions on pregnancy).
• Allergies to metal components (e.g., cobalt or chromium).

A thorough evaluation by an orthopedic surgeon—including imaging tests like X-rays and MRIs—helps determine if hip resurfacing is the right option. If not, alternatives like total hip replacement or conservative treatments may be recommended.

Hip Resurfacing vs. Total Hip Replacement: Key Differences

While both procedures aim to relieve hip pain and restore mobility, they differ significantly in technique, recovery, and long-term outcomes.

Hip resurfacing is often preferred for younger, active individuals who want to maintain a high level of physical activity, whereas THR may be better suited for older patients or those with advanced joint degeneration.

The Hip Resurfacing Procedure: Step-by-Step

Hip resurfacing is a major surgery performed under general or spinal anesthesia. Here’s what happens during the procedure:

1. Preoperative Preparation: You’ll undergo blood tests, imaging scans, and possibly a cardiac evaluation. Antibiotics are given to prevent infection.
2. Incision & Exposure: The surgeon makes an incision (usually 8-10 inches) on the side or front of the hip to access the joint.
3. Femoral Head Reshaping: The damaged femoral head is trimmed and smoothed to fit a metal cap (like a tooth crown).
4. Socket Preparation: The hip socket (acetabulum) is cleaned and fitted with a metal cup.
5. Implant Placement: The metal components are secured—sometimes with cement, though most modern implants are press-fit for bone integration.
6. Closure: The muscles and skin are stitched back, and a sterile dressing is applied.

The surgery typically takes 2-3 hours, followed by a short stay in the recovery room. Most patients spend 2-4 days in the hospital before transitioning to physical therapy.

Recovery & Rehabilitation: What to Expect

Recovery from hip resurfacing is generally faster than total hip replacement, but it still requires patience and commitment to rehabilitation.

First 2 Weeks:

• Pain management with prescribed medications.
• Limited weight-bearing (crutches or walker needed).
• Early physical therapy to prevent stiffness and blood clots.

Weeks 3-6:

• Gradual increase in weight-bearing activities.
• Continued physical therapy focusing on strength and mobility.
• Most patients can resume light desk work by week 4-6.

Months 3-6:

• Return to low-impact exercises (swimming, cycling).
• Improved gait and reduced reliance on assistive devices.

Beyond 6 Months:

• Most patients can resume high-impact activities (running, sports) if approved by their surgeon.
• Full recovery may take up to 12 months.

Adhering to your surgeon’s guidelines and attending all follow-up appointments ensures the best possible outcome.

Benefits & Risks of Hip Resurfacing

Advantages:

• Bone Preservation: Less bone is removed, making future revisions (if needed) easier.
• Greater Stability: Lower dislocation risk compared to THR.
• Active Lifestyle: Better suited for high-impact sports and heavy labor.
• Longer Implant Life: May outlast traditional hip replacements in young patients.

Potential Risks:

• Metal Ion Release: Small amounts of cobalt/chromium may enter the bloodstream (rarely causes issues).
• Femoral Neck Fracture: A small risk (1-2%) of the femoral neck breaking post-surgery.
• Infection or Blood Clots: Standard surgical risks, minimized with proper care.
• Implant Loosening: Rare but possible over time.

Discussing these pros and cons with your surgeon helps in making an informed decision.

Success Rates & Long-Term Outcomes

Studies show that hip resurfacing has a 90-95% success rate at 10 years in well-selected patients. Key factors influencing outcomes include:

• Surgeon Experience: High-volume surgeons report better results.
• Implant Type: Modern metal-on-metal designs have improved durability.
• Patient Factors: Age, activity level, and bone quality play a role.

Long-term studies indicate that 70-80% of implants last 20+ years in active patients. However, some may eventually require a conversion to total hip replacement if the resurfaced joint wears out.

Regular follow-ups and imaging help monitor implant health over time.

FAQs About Hip Resurfacing