Hip Resurfacing vs Hip Replacement: Which Is Right for You?

Hip resurfacing caps the worn ball of your hip with a smooth metal cover instead of cutting it off. A total hip replacement removes the ball and puts in a new ball on a stem inside the thighbone. Both fit a new socket.

Resurfacing suits a NARROW group best: younger, active men with a large ball and strong bone. For most other people, a total hip replacement is the more predictable choice.

Day-to-day recovery is similar. The big differences are who each operation suits, the metal wear question, and the follow-up you’ll need for years afterward.

What’s actually different

Resurfacing: the ball is trimmed and capped, and the neck of the thighbone is kept. Less bone is removed from the thigh
Total hip replacement: the ball and neck are removed and a stem goes down the inside of the thighbone. It’s one of the most reliable operations in orthopedics
Bearing surfaces: most resurfacing uses metal on metal. Total hip replacements usually pair ceramic or metal with plastic, or ceramic with ceramic. Newer non-metal resurfacing designs are being studied, with only short-term results so far
Ball size: the resurfaced ball stays close to your natural size, which makes the hip more stable

Who resurfacing suits

Men, usually under about 55 to 60, who want to stay very active
A large natural hip ball and a larger frame
Good bone quality, with no thinning bones
A healthy weight
A surgeon and center that do a lot of resurfacing. Results depend heavily on experience and on the socket being placed exactly right

It’s usually NOT advised for women of childbearing age, people with smaller hips, thin bones, kidney problems or metal allergy, or a large area of dead bone in the ball. See avascular necrosis of the hip. Women and people with smaller components have had higher failure rates.

The metal wear question

Tiny metal particles are released as the two metal surfaces rub. These raise the levels of cobalt and chromium in your blood
Most people have no problems. In roughly 1 in 10, blood levels rise above the level doctors watch for, and a smaller number develop a reaction in the soft tissue around the hip that can need a revision (redo) operation
Serious whole-body effects are rare. Large studies haven’t found higher rates of cancer, heart failure or death in people with metal-on-metal hips compared with other hip replacements
Some older designs were withdrawn because of high failure rates. Surgeons today use far fewer designs, in more carefully chosen patients
Lifelong follow-up: in the UK, regulators advise yearly checks for the life of the implant, with blood metal tests. Ask your surgeon what follow-up they’ll arrange

Resurfacing isn’t a better hip replacement. It’s a different operation for a particular kind of hip.

Other pros and cons

Lower dislocation risk with resurfacing, because of the larger ball
A redo may be simpler, since more thighbone was kept
Thighbone neck fracture: a risk unique to resurfacing, in about 1 to 2 in 100. It usually happens in the first months and is less common with experienced surgeons
Walking and activity: some people report the hip feels more natural. Measured function scores in trials are broadly similar between the two
High-impact sport: resurfacing is often chosen by people hoping to run or play sport hard. Many surgeons allow more with it, but advice varies. Ask yours before you decide

Recovery differences

Hospital stay: usually 1 to 4 days for either, often less
First weeks: walking with support, then building strength around the hip. See hip replacement recovery week by week
Protecting the neck after resurfacing: some surgeons ask you to take it steadier with crutches or impact in the early months, to lower the fracture risk. Follow your surgeon’s protocol
Movement rules: these depend more on the surgical approach than the implant. See anterior vs posterior hip replacement
Back to normal activities: around 6 weeks for many people, with strength and confidence still improving for months

Questions to ask your surgeon

Am I a good candidate for resurfacing, and why?
How many resurfacing operations do you do each year?
What bearing surface will you use, and what follow-up and blood tests will I need?
What activities will I be allowed with each option?

AAOS OrthoInfo sets out who hip resurfacing suits and its trade-offs. For more to raise at your appointment, see questions to ask before orthopedic surgery.

Go to the emergency department if

After surgery, you suddenly can’t put weight on the leg, or feel a crack or give in the hip
The leg looks shorter than the other, or turned in or out
You have chest pain or sudden shortness of breath