Hip Resurfacing

What is hip resurfacing?

Hip resurfacing is a bone-conserving alternative to conventional total hip replacement that is particularly well-suited to younger, active patients. Rather than removing the entire femoral head as in a standard hip replacement, hip resurfacing preserves the bone of the femoral head and simply resurfaces it with a metal cap. On the socket side, a metal cup is inserted into the acetabulum.

The key difference from total hip replacement is that the femoral head is retained — significantly more bone is preserved, an important advantage in younger patients who may require revision later in life.

Bearing surfaces

• Metal-on-metal (MoM): low wear and excellent durability, but releases small amounts of cobalt and chromium ions; lifelong blood metal ion surveillance is required.
• Ceramic-on-ceramic (CoC): extremely low wear with no metal ion release; exceptionally hard-wearing and biocompatible.

Pros

• Bone preservation — femoral head retained for any future revision
• Reduced dislocation risk thanks to large femoral head size
• Excellent function and near-normal hip mechanics
• Many patients report a very natural, stable feel
• Future revision is technically easier

Cons

• Metal ion concerns with MoM bearings — lifelong surveillance required
• Rare risk of femoral neck fracture unique to resurfacing
• Technically demanding — requires specific surgical experience
• Poor bone quality (e.g. osteoporosis) is a contraindication

Who is this for?

• Younger, active patients (typically under 65) with osteoarthritis
• Patients with good bone quality and no osteoporosis
• Patients wishing to return to sport or heavy manual activity
• Patients who want to preserve as much bone as possible for future surgery

Planning & approach

• Bearing surface selected based on anatomy, bone quality, and patient preference
• Posterior approach with sciatic nerve monitored and protected
• CT templating for optimal component sizing and positioning
• Available at: Meriden Nuffield Health Hospital and University Hospitals Coventry & Warwickshire

Risks

• Dislocation
• Leg length discrepancy
• Injury to nerves and vessels
• Deep vein thrombosis (DVT) and pulmonary embolism (PE)
• Further surgery
• Failure of the implant
• Infection
• Fracture

Recovery

Recovery is similar to conventional hip replacement, with most patients mobilising the following day. The larger femoral head means dislocation precautions are generally less restrictive. Return to high-impact sport is possible at 3–6 months in most patients.