The progressive breakdown of hip cartilage (arthritis) often leads to chronic pain and significant mobility issues. When non-surgical treatments fail, a surgical solution is necessary to restore function. Hip resurfacing is a joint-preserving technique that offers an alternative to traditional joint replacement for individuals with severe hip damage. This procedure focuses on capping the damaged bone surfaces rather than removing the entire joint, appealing to a specific, active patient demographic.
What Hip Resurfacing Entails
Hip resurfacing is a specialized orthopedic procedure addressing damaged joint surfaces. The hip is a ball-and-socket joint, where the ball is the femoral head and the socket is the acetabulum in the pelvis. The procedure involves surgically accessing the joint to prepare both components.
The surgeon removes damaged cartilage and a small layer of bone from the acetabulum, which is then fitted with a prosthetic metal shell, typically made of cobalt-chrome alloy. The femoral head is not removed; instead, it is reshaped to receive a smooth, hollow metal cap.
This metal cap is cemented or press-fitted over the prepared femoral head. The bone-sparing philosophy retains the patient’s natural femoral neck and most of the original bone stock. The new metal-on-metal components articulate smoothly, restoring the ball-and-socket action and relieving pain caused by friction.
Key Differences From Total Hip Replacement
The fundamental difference between hip resurfacing and a total hip replacement (THR) is the degree of bone preservation in the femur. During a traditional THR, the entire femoral head and a portion of the neck are removed, and a long stem anchors the new prosthetic ball. Resurfacing removes only a small amount of bone from the femoral head surface, leaving the femoral neck and canal intact.
This preservation offers two main advantages. The first is potentially easier future revision surgery, as the surgeon has more native bone when converting the resurfacing to a THR. The second is improved joint stability, as the resurfaced femoral head retains a size closer to the natural anatomy, which may reduce the risk of dislocation compared to a standard hip replacement.
The larger bearing surface size in hip resurfacing may allow for a more natural range of motion and walking pattern. However, the use of metal-on-metal components introduces a specific risk: the release of tiny metal ions (cobalt and chromium) from the articulating surfaces. This metallosis requires monitoring and is a factor in patient selection, particularly for those with kidney issues or metal sensitivities.
Determining Patient Suitability
Hip resurfacing is not appropriate for all patients and is reserved for a specific profile. The ideal candidate is typically a younger individual, often under 60, who maintains an active lifestyle and wishes to return to high-impact activities or sports. This procedure is often recommended for those likely to outlive a traditional hip replacement prosthesis.
A crucial requirement is high-quality bone density and stock to support the femoral cap and prevent a fracture of the remaining femoral neck. Absolute contraindications include severe osteoporosis, osteonecrosis affecting more than 50% of the femoral head, or large cysts in the bone.
Other medical conditions can disqualify a patient, including impaired kidney function, which affects the body’s ability to clear released metal ions. Historically, resurfacing was favored for men, as smaller components used for women were associated with higher rates of metal-related complications. A comprehensive evaluation by an orthopedic surgeon is necessary to review bone quality, overall health, and specific risk factors.
The Surgical Process and Rehabilitation
The hip resurfacing procedure typically lasts between 90 minutes and three hours and is performed under general or spinal anesthesia. The surgeon makes an incision to access the joint. After preparing the acetabulum and securing the metal socket, the femoral head is reshaped before the metal cap is cemented or press-fitted onto the bone.
Physical therapy begins quickly, often within 24 to 48 hours, focusing on gentle movement and circulation exercises. Patients are encouraged to start walking with a walker or crutches immediately, though initial weight-bearing restrictions may apply to protect the femoral neck. A typical hospital stay is short, often just one to two days.
Recovery involves a structured rehabilitation program to regain strength and range of motion. Most patients transition from crutches to a cane within two to three weeks and can often walk independently by four to six weeks post-surgery. While daily activities resume around six weeks, a full return to high-level sports generally takes three to six months.