Hip Replacement vs Hip Resurfacing

Total Hip Replacement

Total hip replacement removes the entire femoral head and replaces it with a metal or ceramic ball on a stem. The socket is lined with a metal cup and plastic or ceramic liner. It is the most common and versatile hip procedure — performed on over 450,000 patients per year in the US. Best for: Patients of any age with hip arthritis, avascular necrosis, fracture, or inflammatory joint disease. Multiple bearing options (ceramic, polyethylene, metal) allow customization for each patient.

Hip Resurfacing

Hip resurfacing preserves the femoral head by capping it with a metal shell instead of removing it. The socket receives a matching metal cup. This bone-conserving approach maintains more natural anatomy. Best for: Active males under 60 with good bone quality, no femoral neck cysts, and arthritis limited to the joint surface. Resurfacing preserves bone stock for easier revision if needed decades later.

Comparison

Factor	Total Hip Replacement	Hip Resurfacing
Bone preservation	Femoral head removed	Femoral head preserved
Dislocation risk	1-3%	Less than 1%
Implant lifespan	25-30 years	15-25+ years
Candidacy	Nearly universal	Select patients only
Bearing options	Ceramic, poly, metal	Metal-on-metal only
Leg length equality	Good (surgeon-dependent)	Excellent (natural anatomy)
Revision if needed	Standard revision	Convert to total hip (easier)
Metal ion risk	Minimal (ceramic options)	Yes (requires monitoring)

Making the Decision

For most patients, total hip replacement is the safer, more versatile choice with excellent long-term results. Hip resurfacing is worth considering if you are a younger, active male with good bone quality who wants maximum bone preservation and plans to be very active. Find a surgeon who is experienced with both options and can give an unbiased recommendation based on your imaging and goals.

Frequently Asked Questions

Can women get hip resurfacing?

While technically possible, hip resurfacing has higher failure rates in women, primarily because smaller femoral heads produce worse results with metal-on-metal bearings. Most surgeons recommend total hip replacement for women.

Which allows more activity?

Both allow return to low-impact activities. Resurfacing patients may have fewer restrictions for higher-impact activities because the natural femoral head geometry is preserved, but evidence is mixed. Neither procedure is recommended for running or contact sports.

What if my resurfacing fails?

A failed resurfacing is revised to a total hip replacement. Because the femoral bone was preserved during resurfacing, the revision is generally straightforward — more like a primary total hip than a complex revision.

Is resurfacing cheaper?

Costs are similar to total hip replacement ($30,000-$60,000 before insurance). Resurfacing implants may cost more, but surgical time and facility fees are comparable.

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