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🔬 Surgery Guide2024-01-20

Hip Resurfacing: An Alternative to Total Hip Replacement

Hip resurfacing is a bone-conserving alternative to total hip replacement that caps the femoral head with metal rather than removing it. Learn who is a candidate, what the procedure involves, and how it compares to total hip replacement.

Educational content only. This article is not medical advice. Always consult a qualified orthopedic surgeon or physician for diagnosis and treatment.

What Is Hip Resurfacing?

Hip resurfacing arthroplasty (HRA) is a surgical procedure for hip arthritis in which the femoral head (ball) is reshaped and covered with a metal cap rather than being removed and replaced with a prosthetic stem. The acetabular (socket) component is the same metal shell used in total hip replacement.

The key distinction from total hip replacement (THA): the femoral head is preserved rather than removed, and no stem is placed down the femoral canal.

Implant Design

Femoral component: A metal cap (cobalt-chromium alloy) placed over the reshaped femoral head — similar to a dental crown on a tooth

Acetabular component: Metal shell with a metal liner — this creates a metal-on-metal bearing, which is the specific bearing combination used in hip resurfacing

Who Is a Candidate?

Hip resurfacing is most appropriate for:

  • Young, active patients (typically male, under 60)
  • Adequate femoral head bone quality (no significant avascular necrosis or cysts)
  • Normal femoral head size and shape
  • High activity demands that would stress a standard THA implant
  • Desire for high-impact activity (some resurfacing patients return to running)

Contraindications:

  • Female patients of childbearing potential (metal ion concerns)
  • Femoral head cysts or osteonecrosis
  • Osteoporosis
  • Kidney disease (reduced metal ion clearance)
  • Small femoral head size

Potential Advantages Over THA

  • Bone preservation: The femoral head is retained — if revision is ever needed, a standard THA is still possible
  • Natural hip feel: Larger femoral head allows a more natural range of motion
  • Lower dislocation risk: Larger ball-socket ratio
  • Better proprioception: Some patients report more natural hip feel

Concerns and Limitations

Metal ions: Metal-on-metal bearings generate metal (cobalt and chromium) ions that enter the bloodstream. While most patients tolerate this well, some develop adverse reactions to metal debris (ARMD — adverse reaction to metal debris), causing soft tissue damage around the hip. Regular monitoring of serum metal ion levels is required.

Femoral neck fracture: A unique complication; the resurfaced femoral head is at risk for fracture at the neck — rate approximately 1%

Not appropriate for all patients: Strict patient selection is essential

Surgery Day and Recovery

Surgery is similar to THA — posterior or anterior approach, general or spinal anesthesia, 1–2 night hospital stay. Recovery follows a similar protocol to THA with slightly earlier rehabilitation milestones in some cases.

Return to sport: 3–6 months. Some resurfacing patients return to running and high-impact activities, though this remains controversial given long-term wear concerns.

Monitoring After Surgery

  • Annual X-rays to assess component positioning
  • Serum metal ion levels (cobalt and chromium) monitored annually
  • If metal ions rise significantly, further investigation with MRI (MARS protocol) is performed

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