Hip resurfacing is a bone-conserving alternative to total hip replacement. Instead of removing the entire ball at the top of your thighbone, the surgeon reshapes it and caps it with a smooth metal shell that fits into a matching metal cup placed in the hip socket. This preserves most of your natural bone, which is the key distinction from a standard hip replacement and the main reason younger, active patients seek it out.
How It Differs From Total Hip Replacement
In a total hip replacement, the surgeon cuts off the femoral head (the ball) and a portion of the femoral neck, then drives a metal stem down into the hollow center of the thighbone. A new ball is attached to that stem. In hip resurfacing, the femoral head stays in place. The surgeon trims it down and fits a hollow metal cap over it, like a crown on a tooth. The socket side of the joint gets a metal lining in both procedures.
Because the femoral head and neck remain intact, resurfacing leaves you with more of your original bone structure. That matters if you ever need a revision later in life: converting a resurfacing to a total hip replacement is generally more straightforward than revising one total hip replacement into another, since there’s more healthy bone to work with.
Who Is a Good Candidate
Hip resurfacing works best for a specific profile. The American Academy of Orthopaedic Surgeons outlines the ideal candidate as younger than 60, larger-framed (often male), and with strong, healthy bone. The procedure is typically recommended once osteoarthritis has progressed enough that nonsurgical options like physical therapy, injections, and activity modification no longer control pain or maintain quality of life.
Patients who are older, female, or smaller-framed face higher complication rates. Smaller anatomy generally means a smaller implant, and survivorship data bears this out: implants with a femoral head size of 48 mm or larger showed 95.8% survival at 15 years, while those under 48 mm dropped to 91.3%. Bone quality also matters. Conditions that weaken the femoral head, like osteonecrosis (where bone tissue dies from reduced blood supply), make resurfacing a poor choice. Large cysts inside the femoral head have also been flagged as a risk factor for early failure, though smaller cysts filling less than a third of the prepared bone surface may not rule out the procedure.
The Metal-on-Metal Factor
Both FDA-approved resurfacing systems in the United States use metal-on-metal bearings: the Birmingham Hip Resurfacing (BHR) System from Smith & Nephew and the Cormet Hip Resurfacing System from Corin. The bearing surfaces are cobalt-chromium alloy. Every time you walk or run, those metal surfaces slide against each other and release microscopic metal particles. Some of those particles dissolve, sending cobalt and chromium ions into your bloodstream.
For most well-positioned implants in appropriate candidates, metal ion levels stay low and don’t cause problems. But in some patients, the accumulation of metal debris triggers tissue reactions around the joint. The FDA refers to this as an adverse reaction to metal debris (ARMD). Symptoms include pain, swelling, and soft tissue damage that can loosen the implant and require revision surgery. Because of this risk, patients with metal-on-metal hip implants typically need periodic monitoring, which may include blood tests to check cobalt and chromium levels and imaging to look for tissue changes around the joint.
Long-Term Implant Survival
When performed on the right patient by an experienced surgeon, hip resurfacing delivers strong long-term results. A study tracking men with at least 15 years of follow-up found an overall survivorship rate of 95.1%. That means roughly 95 out of 100 implants were still functioning well after a decade and a half without needing revision. The best results came from patients with larger implant sizes, reinforcing why candidate selection matters so much.
Recovery and Return to Activity
One of the biggest draws of hip resurfacing is the potential for returning to high-impact activities. In a prospective study, patients were cleared for unrestricted sports by six weeks after surgery. The average time to actually resuming sports was about 15 weeks, with some patients back as early as seven weeks and others taking up to 29. Ninety-eight percent of patients returned to sports of some kind, and 82% returned to high-impact activities like jogging and court sports.
That return-to-sport rate is notably higher than what’s typically reported after total hip replacement, where surgeons often advise patients to avoid high-impact loading permanently. Because resurfacing preserves the natural geometry of the hip and keeps the femoral head intact, it closely replicates normal joint mechanics, which translates to a more natural feel during athletic movement.
Risks and Complications
The most serious early complication specific to hip resurfacing is a fracture of the femoral neck. Because the neck is preserved rather than replaced with a metal stem, it remains a potential weak point. These fractures typically occur within the first nine weeks after surgery, during the period when bone is still adapting to the implant. The risk is higher in patients with weaker bone, smaller anatomy, or poor implant positioning.
Other complications overlap with those of any hip replacement: infection, blood clots, leg-length discrepancy, and implant loosening over time. The metal-on-metal concerns described above add another layer of long-term monitoring that ceramic or plastic bearing surfaces in total hip replacements don’t require.
What Happens if Resurfacing Fails
If a resurfacing eventually fails, it can be converted to a standard total hip replacement. The bone that was preserved during the original surgery gives the revision surgeon more to work with. Outcomes depend on the reason for failure. Patients revised for a femoral neck fracture or simple loosening tend to do very well, with some studies reporting near-perfect functional scores at over two years of follow-up. Revisions done for metal-related tissue damage or infection are more complex and carry higher re-revision rates. One study found a cumulative re-revision rate of 26% at ten years after conversion, highlighting the importance of catching problems early through routine monitoring.
This is part of why surgeons emphasize selecting the right patient from the start. When resurfacing is matched to a young, active, larger-framed individual with good bone quality, it offers a durable solution that preserves bone and supports a physically demanding lifestyle for years.