Hip Resurfacing

Hip resurfacing is a bone-conserving alternative to total hip replacement designed primarily for younger, active patients with hip arthritis or other sources of hip pain. Unlike traditional total hip replacement, hip resurfacing preserves more of the patient’s natural bone and can allow a very active lifestyle after recovery.

Who May Be Candidates for Hip Resurfacing or Hip Replacement?

Patients with advanced arthritis of the hip may be candidates for either:

• Traditional total hip replacement (total hip arthroplasty)
• Hip resurfacing (hip resurfacing arthroplasty)

Both are types of hip replacement surgery, but important differences exist in how much bone is removed and how the hip is reconstructed. Each patient’s case is evaluated individually to determine which option best matches their age, bone quality, activity level, and goals.

When Do We Recommend Considering Hip Replacement?

Hip replacement or hip resurfacing may be recommended when hip pain:

• Persists despite pain medication
• Worsens with walking, even when using a cane or walker
• Interferes with sleep
• Makes going up or down stairs difficult
• Makes it hard to rise from a seated position
• Limits daily activities, recreation, or certain sports

Hip conditions are not limited to older adults. Many patients in their 20s, 30s, 40s, and beyond can be candidates for hip replacement or resurfacing if pain significantly affects their quality of life.

What Is the Difference Between Total Hip Replacement and Hip Resurfacing?

In a traditional total hip replacement:

• The femoral head (ball of the thighbone) is removed
• The hip socket (acetabulum) is resurfaced and fitted with a metal shell and liner
• A new metal ball attached to a metal stem is placed down the femur

In hip resurfacing:

• The femoral head is preserved, then trimmed and capped with a smooth metal covering
• The damaged bone and cartilage in the socket are removed and replaced with a metal shell, similar to total hip replacement

Hip resurfacing preserves more of the patient’s natural femoral bone and maintains more normal hip biomechanics.

How Do We Decide Between Hip Replacement and Hip Resurfacing?

The choice between total hip replacement and hip resurfacing is based on:

• Age
• Bone quality
• Body size and frame
• Activity level
• Occupational and recreational demands

Patients are generally grouped into two lifestyle categories.

1. Non-Active Lifestyle

For patients who do not lead a physically demanding lifestyle, traditional hip replacement is typically recommended. Total hip replacement:

• Relieves pain and restores hip function
• Allows return to most recreational and sports activities
• May require caution with high-impact activities such as running and jumping

2. Active Lifestyle

For patients with very active lifestyles and higher physical demands, hip resurfacing may be preferred. Hip resurfacing:

• Preserves more natural bone
• Does not significantly alter leg length or hip mechanics
• Often feels more like a natural hip
• Allows many patients to return to high-level activities

This option can be especially beneficial for:

• Military personnel
• Police officers and firefighters
• EMTs and other first responders
• Construction workers and laborers
• Highly active men who participate in demanding sports

Many patients in their 40s, 50s, and 60s return to activities such as competitive tennis, triathlons, and distance running after hip resurfacing, when appropriate.

Advantages of Hip Resurfacing

Advantages of hip resurfacing compared to traditional total hip replacement may include:

• Bone conservation: less bone is removed from the femur
• Easier revision surgery if needed later, due to preserved bone stock
• Larger femoral head size, which may reduce the risk of dislocation in some patients
• More natural-feeling hip mechanics and walking patterns in certain cases

However, these potential advantages are still an area of debate among orthopaedic surgeons, and not every patient will experience all of these benefits.

Hip resurfacing implants are typically metal-on-metal, which can be more durable in certain patients but may carry risks such as metal reactions or elevated metal levels in the blood. A thorough evaluation is needed to determine whether hip resurfacing is appropriate.

Ideal Candidates for Hip Resurfacing

Hip resurfacing is not suitable for everyone. Ideal candidates generally include:

• Younger patients (often under age 60)
• Larger-framed male patients
• Individuals with strong, healthy bone
• Patients with advanced osteoarthritis who have not responded to non-surgical treatment

Patients who are older, smaller-framed, or who have weaker bone are at higher risk for complications such as femoral neck fracture and may be better served by traditional hip replacement.

A comprehensive evaluation, including imaging and discussion of lifestyle goals, is essential to determine if hip resurfacing is the right option.

Hospital Stay and Recovery

Recovery following hip resurfacing is often similar to contemporary hip replacement protocols.

Typical expectations:

• Many patients go home the day of surgery, depending on overall health and support at home
• Weight bearing on the operated leg often begins immediately, based on bone strength and surgeon preference
• A walker, cane, or crutches may be used for the first few days or weeks
• A physical therapist will guide exercises to maintain motion and build strength
• Follow-up visits with the orthopaedic surgeon occur at regular intervals
• Most patients resume routine daily activities within 6 to 12 weeks, with continued improvements over time

Jeffrey C. Davis, M.D. is an orthopaedic surgeon at Andrews Sports Medicine & Orthopaedic Center in Birmingham, AL. Dr. Davis has an interest in minimizing exposures for joint replacement and performing procedures limiting bone removal, particularly for younger patients. He has developed the largest hip resurfacing practice and has the most experience of any surgeon in the region, performing more than 600+ hip resurfacing procedures since 2008. The results to date show high levels of satisfaction and patients return to active lifestyles. The failure rate has been <3% in hip resurfacing over the first 14 years. Dr. Davis has training in anterior hip approaches along with limited incision posterior approaches to the hip, and both allow quicker recoveries.

For more information, contact Andrews Sports Medicine & Orthopaedic Center at (205) 939-3699 and request to speak with Dr. Davis's appointment scheduler.

To request an appointment online, CLICK HERE or contact Andrews Sports Medicine & Orthopaedic Center at (205) 939-3699.