- Total hip replacement removes the femoral head and resurfaces the socket with artificial components.
- Hip resurfacing reshapes and caps the femoral head rather than removing it, preserving more natural bone.
- Resurfacing may suit selected younger, active patients with good bone quality, but is not recommended for everyone.
- Total hip replacement has over 20 years of follow-up data, whereas modern ceramic resurfacing options have a shorter track record.
- There is no universally “better” option; the right choice is an individual decision made with your surgeon.
Hip resurfacing and hip replacement are both effective options for treating a painful, damaged hip, but they are different procedures, and the terms shouldn’t be used interchangeably. Understanding how they differ, and who each suits, helps make sense of the choice. Which is appropriate for you is ultimately an individual decision made with your surgeon.
The Key Difference
| Aspect | Total Hip Replacement | Hip Resurfacing |
|---|---|---|
| What’s removed | Both the femoral head (ball) and the damaged acetabular surface (socket) are removed and replaced. | The femoral head is reshaped and capped rather than removed; the socket is also resurfaced. |
| Bone preserved | Less natural bone is retained. | More of the patient’s own femoral bone is preserved. |
| Materials | Metal, plastic, or ceramic components. | Smooth metal or ceramic covering. |
| Typically considered for | A broad range of patients. | Selected younger, more active patients with good bone quality. |
Total hip replacement removes both the femoral head (the ball, at the top of the thigh bone) and the damaged surface of the acetabulum (the socket), replacing them with components made from metal, plastic, or ceramic.
Hip resurfacing preserves more of the natural bone. Instead of removing the femoral head, it is reshaped and capped with a smooth metal or ceramic covering, while the socket is also resurfaced. Because more of the patient’s own bone is retained, it is sometimes considered for selected younger, more active patients, though, as below, it is suitable only for a specific group.
Potential Advantages of Resurfacing
In suitable patients, hip resurfacing may offer:
- Bone preservation — less bone is removed from the femur, which can be an advantage if revision surgery is needed in future.
- A larger femoral head size that more closely mimics the natural joint, which may be associated with a lower dislocation risk.
- Movement patterns that some studies suggest are close to natural gait, though the differences compared with total replacement are often small.
Important Considerations and Risks of Resurfacing
Resurfacing also carries specific considerations that are important to weigh up:
- Limited data. Modern ceramic-on-ceramic, or ceramic-on-polyethylene hip resurfacings only have limited years of follow-up, so the long-term data on them compared to total hip replacement is limited, as there is over 20 years of follow-up on total hip replacements, tracked through national joint replacement registries.
- Fracture risk. A small proportion of patients may experience a fracture of the femoral neck after resurfacing. If this happens, it can usually be converted to a total hip replacement.
- Implant longevity. As with any implant, resurfacing components can wear over time. If revision is needed, the preserved femur may make it more straightforward, but this should be discussed individually.
- Not suitable for everyone. Resurfacing is generally not recommended for people with small or weaker bones, abnormal bone structure, or lower activity levels. For these patients, a total hip replacement is usually more appropriate.
Recovery and Outcomes
Both procedures aim to reduce pain, improve mobility, and help people return to everyday activities. Recovery approaches are broadly comparable, though the specifics depend on the individual and the procedure. Both are well-established operations that can deliver good outcomes in the right patients; the key is matching the procedure to the person.
Choosing Between Them
There is no single “better” option; the right choice depends on your individual situation. Your surgeon will assess your condition, age, activity level, bone quality and structure, and overall health to advise which is more suitable for you. Because hip surgery of this kind is elective, there is usually no need to rush the decision; if you’re not ready now, it can often be planned for a later stage. To discuss which option may suit you, arrange a consultation.
Frequently Asked Questions
Is hip resurfacing better than a replacement?
Neither is universally better. Resurfacing preserves more bone and may suit selected younger, active patients, but it carries specific considerations and isn’t suitable for everyone. Total replacement is appropriate for a broader range of patients. The right choice is individual.
Who is hip resurfacing suitable for?
It is generally considered for selected younger, more active patients with good bone quality. It’s typically not recommended for people with significant hip deformities, weaker or abnormal bone, or lower activity levels, for whom total replacement is usually more appropriate.
What is the concern with metal-on-metal in resurfacing?
The metal-on-metal bearing can release small amounts of metal ions through friction, which in some people can cause pain, swelling, or an adverse tissue reaction that may require revision. Metal-on-metal resurfacings are no longer performed by Dr Slattery, and ceramic-on-ceramic resurfacings are performed instead.
Medical Disclaimer: The information on this page is intended as general patient education and does not constitute medical advice. Whether hip resurfacing or replacement is appropriate depends on your individual circumstances, and not everyone is suitable for resurfacing. Please discuss the options with your own surgeon for advice tailored to you.
