What is a total hip resurfacing? 

In a total hip replacement, the surgeon removes the head of the thigh bone and the damaged hip socket. These bones are then replaced with a new head and socket. The head is usually metal and the socket hard plastic. 

Hip resurfacing is just a variation on a total hip replacement. In a hip resurfacing procedure, the femoral head is left in place but is trimmed down and covered with a smooth metal piece. It is similar to how a dentist would cap a tooth. Hip resurfacing surgeries are uncommon and usually reserved for younger patients who would be expected to need a second surgery in the future.

Partial Hip Resurfacing

The hip is a joint with a ball and socket. The top of the thigh bone (femoral head) is a smooth, rounded surface that fits into the hip socket (acetabulum). The bones are covered with smooth cartilage. This lets them glide against each other when you move.

It’s common for this joint to experience wear and tear as you get older. For example, many people develop arthritis as they age. Osteoarthritis is a kind of arthritis that happens at the ends of the bones. It breaks down cartilage, causing swelling, pain, and deformity. Another problem some people have as they get older is brittle bones (osteoporosis). People with osteoporosis can break a hip or femur if they have a bad fall.

Hip Replacement
If hip pain is having a serious negative impact on your ability to get around and enjoy life, your doctor may talk to you about hip replacement. Hip replacement surgery in general is for people with serious hip damage, such as a broken hip or advanced arthritis of the hip. During any hip replacement operation, the surgeon removes the damaged bone and cartilage from your hip joint and replaces them with man-made parts.

In a traditional total hip replacement, the surgeon removes the head of the thigh bone and the damaged hip socket. These bones are then replaced with a new head and socket. The head is usually metal (or sometimes ceramic) and the socket hard plastic or metal.

In a hip resurfacing procedure, the femoral head is left in place but is trimmed down and covered with a smooth metal piece.

  • With total hip resurfacing, any damaged bone and cartilage within the hip socket is also removed and replaced with a metal socket.
  • In partial hip resurfacing, only the top of the femur is replaced. No cup is placed in the socket.

A hip replacement can help your hip work better, relieve your pain, and improve walking and motion of your leg. Your doctor will help you understand your options and which surgery is best for your situation.

What are the risks and/or side effects?

Any hip surgery should be the last resort after trying nonsurgical options. It should only be considered if your hip is having a large negative effect on your quality of life.

Partial hip resurfacing is an older procedure that isn’t the best solution today. The metal ball at the top of the femur wears down the bone of the hip socket as they rub against each other over time. Your doctor will talk to you about the risks and benefits of the hip procedures you might be a good candidate for, including total hip resurfacing.

Although total hip resurfacing may have many benefits, it is not for everyone. Resurfacing works best on patients who:

  • Are larger-framed patients (usually male)
  • Are younger than 60
  • Have strong, healthy bones

Patients who have a smaller frame, are older, are female, or who have weaker bones are not good candidates for resurfacing and are more at risk of negative side effects. Many of the disadvantages of total hip resurfacing are the same for partial hip resurfacing. These include:

  • A few patients eventually break the thigh bone just below its head, at the femoral neck. When this happens, you must have a second surgery to convert the hip resurfacing into a traditional hip replacement.
  • When a hip replacement must be revised, the surgeries are more difficult and usually do not have results as good as the first surgery.
  • With total hip resurfacing, over time, the rubbing of the metal ball against the metal socket can wear down and release metal ions in the blood. These can be dangerous if they reach high levels. With partial hip resurfacing, the metal at the top of the femur can rub against the hip socket and wear the bone down.
  • Compared to resurfacing, hip replacement surgery usually lasts longer. Total hip replacement is often done later in life. The life of the components (20 years or longer) better matches the life span of the patient.
  • Hip resurfacing is a more difficult surgery than total hip replacement. Because of this, patients should carefully screen their potential surgeon and their experience for the best possible results.

Complications of Surgery
Although complications are rare, the most common potential issues are:

  • Infection. The surgeon will give you antibiotics before your procedure to help fight off infection.
  • Blood clots. Blood clots are the most common complication of hip resurfacing surgery. They can form in the deep veins of the pelvis and the legs. Your doctor may give you blood-thinning medicine to help prevent blood clots from forming.
  • Hip dislocation.
  • Femoral neck fracture.
  • Possible risks from anesthesia.
  • Nerves or blood vessels could possibly be injured during the procedure.

What are the benefits?

Orthopedic surgeons do not agree on the benefits of hip resurfacing in general. They are still studying it. One of the things they have found is that total hip resurfacing was an improvement for many patients over partial hip resurfacing. The benefits of total hip resurfacing include:

  • Although the hip resurfacing surgery requires a larger incision than traditional hip replacement, it usually has a faster recovery because less bone is removed. Patients are up and walking within a couple of days and discharged quicker from the hospital.
  • Hip resurfacings are mechanical parts that wear out over time, usually between 10 and 20 years after the procedure. If your hip implant fails, you may need another procedure called a revision. But since hip resurfacing removes less bone than a traditional hip replacement, many surgeons believe it is easier to change out implants that fail.
  • Some studies have shown that walking patterns are more normal after hip resurfacing compared to traditional hip replacement.
  • It is usually harder for a patient who’s had hip resurfacing to dislocate their hip, since the size of the ball is larger than in a traditional hip replacement.

How do I prepare?

Your surgeon will give you instructions on how to prepare. An anesthesiologist [ann-ess-TEE-see-AH-loh-JIST] will review your medical history and go over the anesthesia choices you made with the surgeon. Your surgeon will also see you before surgery and verify that they are operating on the correct hip.

How is it done or administered?

The surgeon makes an incision (cut) in your thigh at the hip joint. The femoral head is dislocated from the socket. The head is trimmed using special power tools. A metal cap is cemented on top of the femoral head.

The femoral head is relocated back into the socket, and the surgeon closes and stitches up the incision.

After your operation, you will be taken to a recovery room and monitored by nurses as you come out of anesthesia.

When will I know the results?

It will take time to heal and regain strength in your leg muscles. However, many people can get back to their regular activity level about 6 weeks after surgery.

Most patients can go home 1-4 days after surgery. Your doctor may instruct you to start walking and putting weight on the leg right away. You may need a walker, crutches, or a cane at first.

What are follow-up requirements and options?

You will continue to have follow-up visits with your surgeon regularly. You will also meet with a physical therapist, who will give you exercises that help restore your strength and range of motion.