Hip Resurfacing vs Hip Replacement: Key Differences

Executive Summary

• Hip resurfacing and hip replacement are two completely different procedures with distinct surgical techniques and implant designs, but both are intended to relieve joint pain and restore mobility.
• Hip resurfacing preserves more natural bone and is often considered for younger, active patients with strong bone density.
• Total hip replacement has a long track record of success and is suitable for a broader range of patients; it can be especially beneficial for those with advanced arthritis or weaker bone quality.
• When deciding between hip resurfacing vs hip replacement, surgeons must consider their patients’ age, unique anatomy, activity goals, and bone health to choose the most fitting procedure.

Why Surgical Approach Matters for Hip Pain Relief

Unfortunately, about 14.3% of individuals aged 60 years and older report having significant hip pain on most days. This chronic hip pain can affect nearly every aspect of life. Things that used to be done effortlessly, like walking, climbing stairs, exercising, and even sleeping, may become difficult when a joint is damaged by injury or a degenerative condition such as arthritis. 

When conservative treatments like injection therapy no longer provide relief from hip pain, surgery may become the most effective path forward—two of the most commonly discussed surgical options are hip resurfacing and total hip replacement. Although both procedures can reduce pain and improve mobility, they differ significantly in how they are performed and in whom they are best suited.

Understanding hip resurfacing vs hip replacement is essential because the route you choose will ultimately influence everything from your recovery time and future activity levels to joint mechanics and long-term implant durability. A personalized evaluation is the best way to determine which treatment fits your needs, but the guide below can help you tailor your expectations.

What Sets Hip Resurfacing Apart

Hip resurfacing is one of the most common alternatives to total hip replacement because it often preserves more of the femur’s natural bone structure. 

Instead of removing the entire femoral head, the surgeon reshapes and caps it with a smooth metal component. They also fit the damaged socket with a replacement surface. For many patients, this strategic approach to addressing hip complications can yield substantial benefits.

Potential Advantages of Hip Resurfacing

Three of the most frequently reported advantages of opting for hip resurfacing vs total hip replacement are:

1. More natural-feeling joint biomechanics after recovery, since more of the femur is retained than in a full replacement.
2. Greater stability and a lower risk of dislocation when the surgery increases the femoral head size with an implant
3. More revision options if the patient needs follow-up surgery down the line, since there is more natural bone left after hip resurfacing vs hip replacement

Who Usually Gets Hip Resurfacing Surgery?

Some classifications of people for whom hip resurfacing has been used the most are:

• Younger patients
• Highly active individuals
• Patients with strong bone density
• People with a larger bone structure

Even if you fall under one of the categories above, keep in mind that hip resurfacing is not ideal for everyone. Bone quality and anatomy are critical considerations, making an individualized medical evaluation crucial.

Even if you have already been advised to have your hip resurfaced, you may want to get a second opinion from an industry expert like Dr. Shane Martin. You may be surprised to find that a total hip replacement suits you better.

How Total Hip Replacement Works

Total hip replacement is a common type of arthroplasty that can be boiled down into these three steps:

1. The removal of the damaged femoral head
2. The replacement of the femoral head with a prosthetic ball attached to a stem that is inserted into the femur
3. The replacement of the damaged socket with an artificial cup and liner

Although this procedure has more complexities than what is mentioned in the steps above, it has been performed for decades. It is widely regarded as one of the most successful operations in modern orthopedics and is often recommended by world-class facilities, such as the Joint Replacement Center of Scottsdale.

Why Hip Replacement Is Commonly Recommended

Some of the main reasons total hip replacement is often chosen are:

• Its extensive long-term success data
• How reliable it has proven to be with pain relief outcomes
• How long modern hip implants last, thanks to their impressive durability
• The wide range of implant material options

In addition to the reasons mentioned above, hip replacement surgery has broad eligibility across many age groups, though the average age for a hip replacement is roughly 65.

What Conditions Usually Require a Total Hip Replacement?

A total hip arthroplasty is frequently advised when patients have conditions like:

• Advanced osteoarthritis
• Bone deformity
• Femoral head collapse
• Osteoporosis or weaker bone quality
• Significant joint damage

When weighing hip resurfacing vs total hip replacement, joint specialists focus on safety and predictability based on their patients’ situations.

Key Differences in Procedure and Implant Design

Although both surgeries replace damaged joint surfaces and use artificial cups as socket components, many mechanics are quite different. The table below outlines the main differences between hip resurfacing vs total hip replacement surgical approaches and implant designs.

Implant Materials

Historically, resurfacing often used metal-on-metal bearings. Because of concerns about metal ion wear in some cases, candidacy and implant selection require careful evaluation in the modern-day practice of this surgery.

To avoid metal ion wear, total hip replacement may use combinations such as:

• Ceramic-on-polyethylene
• Ceramic-on-ceramic
• Metal-on-polyethylene

Nevertheless, material selection for both procedures depends on age, anatomy, and surgeon preference.

Which Procedure Feels More Natural?

Because this procedure preserves the femoral neck and uses a larger head size, many patients describe hip resurfacing outcomes as feeling natural. However, many modern total hip replacement patients also report excellent function and forget they even have an implant in their daily lives.

Some factors that affect how the operated hip feels are:

• Surgical accuracy
• Muscle recovery
• Strength rebuilding
• Flexibility
• Individual perception

Who Is a Candidate for Each Procedure?

One of the most important differences in hip resurfacing vs total hip replacement is candidacy. Read through the sections below to get a better understanding of where your doctor may direct you after you have your one-on-one evaluation.

Hip Resurfacing Candidates

As mentioned earlier, the top candidates for hip resurfacing are:

• Younger adults
• Highly active patients
• Individuals with strong bone density
• Larger-framed patients
• Patients seeking bone preservation

Total Hip Replacement Candidates

In general, total hip replacement suits a wider patient population, including groups like:

• Older adults
• Patients with osteoporosis
• Individuals with severe arthritis that causes joint pain
• Patients with femoral head deformity
• Those with bone loss or fractures

Other Influencing Factors

The classifications mentioned above are not definitive. Some additional variables that should be factored into the patient’s and their surgeon’s decision include:

• Gender and anatomy
• Body size
• Kidney function
• Metal sensitivity
• Prior surgeries
• Overall medical health

Because each case is unique, a detailed orthopedic consultation is essential. Consider scheduling an appointment with the Joint Replacement Center of Scottsdale today to get a customized treatment plan with the highest likelihood of success.

Recovery and Return to Activity

As with any surgery, recovering from either hip procedure, resurfacing or replacement, can look different based on the individual. Nevertheless, you can expect each to involve rehabilitation, walking progression, and muscle strengthening as foundational elements.

Early Recovery Expectations

During the first few weeks following surgery, five elements that rehabilitation plans commonly focus on are:

1. Controlling pain
2. Reducing swelling
3. Developing safe walking mechanics
4. Restoring range of motion
5. Returning to daily activities

What Activity Return Looks Like

A structured physical therapy plan is essential for both hip resurfacing and total hip replacement. During which, a medical provider will encourage low-impact exercises for joint health, such as walking, to achieve significant improvements. 

Even though resurfacing patients may be more likely to return to demanding athletics due to bone preservation, plenty of famous athletes have gotten hip replacements and have been able to return to hobbies and exercises like:

• Hiking
• Cycling
• Golf
• Swimming
• Strength training

For both procedures, post-surgery activity depends heavily on how well the patient’s body heals, making it important to follow your surgeon’s guidance.

Longevity and Long-Term Outcomes

Both procedures can provide durable pain relief for many years when matched to the right patient. However, many factors can positively or negatively affect the longevity of both procedures.

Factors That Affect Longevity

Both hip resurfacing and hip replacement implant lifespan can depend on factors like:

• Age and weight
• Activity level
• Bone quality
• Surgical precision and implant design
• Adherence to follow-up care

Many total hip replacements last 15 to 20 years or longer, with some lasting substantially longer. Hip resurfacing can also have strong long-term outcomes in carefully selected patients.

Revision Considerations

Younger patients may eventually need another surgery simply because they statistically place more years of use on the implant. Needing hip revision surgery does not mean the original surgery failed—it may simply reflect demands placed on the joint over time.

With the potential for revision in mind, surgeons often weigh things like:

• Expected implant lifespan
• Future revision complexity
• Bone preservation needs
• Lifestyle demands

Questions to Ask During Your Consultation

When comparing your options, consider asking your care team these five questions:

1. Is my bone quality strong enough for hip resurfacing?
2. Which option offers the best long-term durability for me?
3. What activities will I likely be able to return to after the chosen procedure?
4. What are the risks in my specific case?
5. What should I expect from the recovery process?

The questions above can spark conversations that will help align your treatment with your overarching goals.

Take the Next Step Toward Hip Pain Relief

On one hand, hip resurfacing can offer bone preservation and a path back to higher activity levels. However, total hip replacement may still be the safest and most reliable route to long-term relief and restored mobility, given your situation.

Since there is no universal answer in the hip resurfacing vs hip replacement discussion, you should work with a qualified doctor to assess your anatomy and bone health, then balance that information with your current lifestyle and long-term goals.

If hip pain is limiting your life, the team at the Joint Replacement Center of Scottsdale can help you explore your options and create a personalized treatment plan. If you and our team decide to go with a total hip replacement, we will use cutting-edge robotic technology, such as Mako SmartRobotics and the CORI surgical system, to make the procedure as minimally invasive as possible and improve your surgical outcome.

Contact our team today to schedule a consultation and move toward lasting relief from hip pain.