Hip resurfacing is a bone-conserving alternative to total hip replacement where a metal cap is placed over the femoral head (rather than removing it) and a metal cup is placed in the acetabulum. It preserves more bone and is suited to younger, active male patients.
Through an incision over the hip (typically posterior approach), the femoral head is reshaped and capped with a metal (cobalt-chrome) resurfacing component. A metal cup is impacted into the acetabulum. The metal-on-metal bearing allows a large-diameter head, providing excellent stability and range of motion. The operation takes one and a half to two hours.
Hip resurfacing is considered for younger male patients (under 55–60) with good bone quality, adequate femoral head size, and an active lifestyle who wish to preserve bone stock and maintain high activity levels. It is particularly suitable for patients wanting to return to sport.
Physiotherapy, injection, activity modification. Total hip replacement (ceramic-on-polyethylene or ceramic-on-ceramic) is the main surgical alternative.
X-rays and MRI to assess femoral head vascularity and size. CT may be used for component planning. Patient selection is critical — best outcomes in men with large femoral heads.
Bone conservation, excellent stability (virtually no dislocation risk), near-normal proprioception and gait, and high activity levels including sport. Well-selected male patients have excellent long-term results — over 95% survival at fifteen years in specialist centres.
Cobalt and chromium levels rise. Lifelong monitoring is needed.
Results are highly surgeon-dependent.
Adverse reaction to metal debris causing soft tissue damage. More common in women and with smaller heads. Risk approximately 1–5%.
Early post-operative fracture. Risk approximately 1–2%.
Femoral or acetabular component loosening.
If the femoral head blood supply is compromised.
Prosthetic joint infection approximately 1%.
General or spinal anaesthesia.
Hospital one to three days. Walking with crutches from day one. Driving at four to six weeks. Return to sport at three to six months. No restrictions on activity once recovered — unlike some THR bearing surfaces. Lifelong metal ion monitoring annually.
Annual blood metal ion levels (MHRA requirement). X-rays at one year then as needed. MARS-MRI if symptoms develop or metal ions rise.
Women generally have smaller femoral heads, which generate more metal debris per step due to higher bearing surface pressures. This increases the risk of ARMD. Men with larger heads have much better outcomes.
Yes — this is one of the key advantages. Hip resurfacing preserves natural proprioception and bone stock, allowing return to running, cycling, football, and other high-demand activities. Many resurfacing patients are more active than THR patients.