Hip Resurfacing vs Total Hip Replacement: Is Resurfacing for You?

Short answer: hip resurfacing can be a reasonable option for some younger, active patients with good bone and a suitable hip shape, in the hands of a surgeon who does it often. For many people, though, a modern total hip replacement is the more predictable choice, and the decision should come from your anatomy and imaging, not from a preference for the word "resurfacing".

This guide explains what resurfacing actually preserves, why it fell out of favor for a period, which risks are specific to it, and how to plan years of follow-up when your surgeon is in Colombia and you live somewhere else.

What resurfacing is and what it preserves

In a standard total hip replacement, the surgeon removes the ball at the top of the thigh bone (the femoral head) and part of the neck below it, then fixes a metal stem down inside the thigh bone. A new ball sits on top of that stem and moves inside a new socket in the pelvis.

In hip resurfacing, the femoral head is not removed. The surgeon shapes it and fits a metal cap over it, a bit like capping a tooth. A short peg guides the cap into position, and a matching cup lines the socket. Because there is no long stem, the bone of the femoral neck and the upper thigh stays largely intact.

That preserved bone is the main argument for resurfacing. Supporters point to three potential advantages:

• Bone stock for the future. A younger patient may need another operation decades later. If the resurfacing fails, converting to a total hip can be more straightforward because the thigh bone has not been reamed for a stem.
• A large ball. The resurfacing cap is close to the size of your natural femoral head, which is thought to help stability and lower the chance of dislocation.
• A more natural feel. Some patients and surgeons describe the hip as feeling closer to normal, although modern total hips with large heads have narrowed this gap.

Resurfacing vs total hip at a glance

General comparison only. Implant choices, risks and follow-up schedules vary by surgeon, device and patient.

Who has historically done best

Joint registries and published series have repeatedly shown that resurfacing results vary a lot depending on who receives it. Surgeons who still offer the procedure tend to describe the best candidate in similar terms:

• Younger and active, often below their sixties, with demands that make bone preservation appealing
• Larger femoral head size; smaller components have been linked to higher failure rates
• Good bone quality, without osteoporosis or large cysts in the femoral head
• No significant loss of blood supply to the femoral head (avascular necrosis can rule it out)
• A hip shape that allows the cap to be placed in the right position
• Normal kidney function, because the body clears metal ions through the kidneys

Historically, men have done better than women in registry data, largely because women tend to have smaller femoral heads and are more likely to have lower bone density. Many surgeons have become very cautious about offering metal-on-metal resurfacing to women, especially those who may become pregnant, because of uncertainty about metal ions.

The metal-on-metal history you should know

Most resurfacing devices have used a metal ball moving inside a metal cup. In the 2000s, metal-on-metal hips, including several resurfacing and large-head total hip systems, were used widely. Problems then emerged with some designs.

The best-known example is the DePuy ASR system. In August 2010, DePuy recalled both its ASR hip resurfacing system and its ASR XL total hip cup worldwide after data showed higher than expected revision rates. That recall, together with wider registry findings, changed how metal-on-metal implants are viewed and monitored.

The concern is wear. As metal surfaces rub, tiny particles and metal ions (mainly cobalt and chromium) are released. In some patients this causes:

• Adverse local tissue reactions, sometimes called pseudotumors: inflammation and fluid or soft-tissue masses around the joint, which can damage muscle and bone.
• Raised blood levels of cobalt and chromium. Regulators have advised monitoring, and rare whole-body effects have been reported.
• Pain or loosening that can lead to revision surgery.

These problems can develop without obvious symptoms, which is why follow-up for metal-on-metal hips often includes blood metal ion tests and, when needed, specialized imaging such as ultrasound or MRI with metal artifact reduction.

What about newer non-metal designs?

Because of the metal concerns, manufacturers and researchers have been developing resurfacing implants with ceramic bearing surfaces. Early results have been reported in some centers, but long-term data take many years to build. If you are offered a newer design, ask how long it has been in use, which registries track it, and what the surgeon's own follow-up results show.

Risks specific to resurfacing

Resurfacing shares the general risks of any hip surgery: infection, blood clots, nerve injury and anesthesia-related problems. It also has a few that are more specific to it.

Femoral neck fracture

Because the natural femoral neck is kept and now carries the cap, it can break. This usually happens in the first months after surgery and is linked to factors such as bone quality, how the cap was positioned, and notching of the neck during surgery. A fracture usually means converting to a total hip replacement. Surgeons often give specific guidance on protected weight-bearing and activity during early recovery to reduce this risk.

Avascular necrosis of the remaining head

The remaining femoral head bone needs a blood supply. If that supply is disrupted, the bone under the cap can collapse over time, leading to loosening.

Wear-related problems

With metal bearings, the tissue reactions described above are the main long-term concern. Cup position matters a great deal: a cup placed at a steep angle can increase edge wear.

Why the surgeon matters even more here

Resurfacing is technically demanding. The surgeon has to position the cap precisely on the femoral head and the cup at the right angle in the pelvis, with less room for correction than in a total hip. Published experience suggests results improve with surgeon volume, and many general hip surgeons no longer offer the procedure at all.

Questions to ask a resurfacing surgeon

• How many resurfacing operations do you perform in a typical year, and for how long?
• Which device do you use, which bearing, and why that one for me?
• What has your own revision and complication experience been, and how do you track patients?
• Would you recommend a total hip instead if you were in my position? Why or why not?
• What follow-up schedule do you recommend, including blood tests and imaging?
• Who would perform a conversion to total hip if it were ever needed?

A good surgeon will be comfortable explaining when not to resurface. If every patient who asks is told they are a candidate, take that as a reason to get a second opinion.

Resurfacing is a decision about the next twenty years of monitoring, not just the next six weeks of recovery.

Follow-up when your surgeon is in Colombia

This is the part international patients most often underestimate. A resurfaced hip, especially one with metal bearings, usually needs scheduled reviews for many years. If your surgeon is in Medellín or Bogotá and you live in the US or Canada, you need a plan before surgery.

1. Find a home orthopedic contact firstAsk a local hip surgeon whether they will monitor a resurfaced hip done abroad, including ordering metal ion tests and imaging. Some will, some will not.
2. Get the full implant recordDevice name, sizes, bearing, lot numbers and the operative report, translated into English if needed.
3. Agree on a scheduleAsk your Colombian surgeon to write down the recommended review intervals and what tests should be done at each one.
4. Set up remote reviewAsk whether the surgeon will review X-rays and lab results sent by email or telemedicine, and whether there is a fee.
5. Check your insuranceFind out whether your home insurer will cover monitoring and any future revision of an implant placed abroad.

Ask too how long you should stay in Colombia after surgery. Because of the early fracture risk, some surgeons prefer to see you again before you fly, and you will want clear written instructions about weight-bearing for the trip home.

For a broader look at implant choices, compare this guide with our article on hip implant fixation and bearings, and read up on how to ask about implant brands before you accept a quote.