Many patients don’t know there are two main choices when looking at hip surgery – Hip Resurfacing and Total Hip Replacement (THR). I’ve spent years studying both procedures and helping patients understand their options through the Surface Hippy website.

Hip resurfacing saves most of your natural bone. The surgeon only removes the damaged surface of your femoral head (the ball of your hip) and covers it with a metal cap. THR takes a different approach – the surgeon removes the entire top of your thigh bone and puts in an artificial ball with a long stem that goes down into your thigh bone.

The choice between these two procedures really matters. Your natural bone is precious – once it’s removed, it’s gone forever. That’s why younger, active patients often do better with hip resurfacing. I’ve seen many athletes and active people return to their sports after hip resurfacing.

** The differences between these surgeries affect important things like:**

• How much bone you keep
• Your recovery time
• Whether you might need another surgery later
• Getting back to sports and activities without restrictions

My personal surgeon, Dr. De Smet, even told me that hip resurfacing takes more skill than a regular hip replacement. That’s why finding the right surgeon with enough experience is so important. Information about very experienced hip resurfacing surgeons can be found here – https://surfacehippy.info/hip-resurfacing-doctors-over-1000-hip-resurfacing-surgeries/

I want to help you understand what makes these procedures different. We’ll look at who makes a good candidate for each surgery, what the research shows about long-term results, and how to choose what’s best for your situation. Having gone through hip resurfacing myself in 2006, I know how important it is to have clear, honest information when making this decision.

Who Makes a Good Candidate for Hip Resurfacing?

Selection of the right patient is crucial for successful hip resurfacing. After reading thousands of patient stories and emails over the years, I’ve observed clear patterns about who does best with this surgery.

Age and Physical Build really matter for hip resurfacing. Medical studies show that candidates under 60 years old with larger frames have the best results [4]. Your bone strength is very important too – doctors MUST do bone density tests to check if your bones are strong enough for the procedure [4].

Men typically do better with hip resurfacing than women [4]. I’ve seen this pattern repeatedly in patient outcomes posted on our Hip Talk Discussion Forum. Your weight matters too – doctors usually want patients to have a BMI under 35 [4].

Women are also candidates for hip resurfacing with the newer Ceramic on Ceramic Devices like the ReCerf Ceramic on Ceramic or H1 Ceramic on Ceramic devices or even the crosslinked polyethylene devices like the Polymotion Device.

Some medical conditions mean you should NOT get hip resurfacing:

• Metal allergies
• Kidney problems
• Severe bone loss
• Inflammatory arthritis [4]

The quality of your bone is really important [4]. Your surgeon will check your bone carefully before surgery. Something interesting – studies show that bone density usually drops three months after surgery but then gets even stronger than before by one year [6].

Active people often make the best candidates for hip resurfacing [1]. I personally feel this makes sense because hip resurfacing lets you keep more of your natural bone and movement. But remember – your surgeon needs to plan everything carefully based on YOUR specific situation [7].

My personal surgeon, Dr. De Smet, always stressed how important patient selection is. He would carefully evaluate each person’s unique characteristics before deciding if hip resurfacing was right for them.

Birmingham Hip Resurfacing Results

The Birmingham Hip Resurfacing (BHR) device leads the world in hip resurfacing implants [8]. Since starting in 1997, doctors and researchers have carefully tracked how well it works through many studies and national registries.

The numbers really tell the story about BHR success. Medical studies show a 95.5% survival rate at 10 years [9]. Results get even BETTER for certain groups of patients. Men under 65 with larger hip sizes (50mm or bigger) have especially good outcomes [8]. The Australian joint registry found that BHR had very few problems – only 6.6% needed revision after 10 years [8].

When BHR operations do need fixing, here’s what usually goes wrong:

• Parts coming loose without infection (20.1% of revisions)
• Problems from metal wear (20.1%)
• Broken neck of femur
• Components getting loose [9]

Men and women get different results with BHR – this is VERY IMPORTANT to understand. Men’s results are impressive – 99% of implants still working at 10 years and 92.5% at 21 years. Women’s numbers aren’t as good – 90% at 10 years and 81.3% at 21 years [10]. Patients with osteoarthritis do best, with 95% still going strong at 22 years [10].

The BHR hasn’t changed its design since it started – it still works well just as it is [11]. For active men with osteoarthritis, the failure rate is tiny – only 0.5-2% at 10 years [11]. These results show why I chose BHR for my own surgery in 2006, and why it remains a great choice for the right patients.

Choosing Between Hip Resurfacing and THR

Selection of a surgeon for hip resurfacing is a personal choice. The surgery itself shows how different these two operations really are [12]. THR removes the whole top of your thigh bone, while hip resurfacing shapes your own bone to fit a metal cap [12].

Your lifestyle and physical build should guide your choice. Active people often do better with hip resurfacing because it feels more natural when moving [13]. Medical studies back this up – hip resurfacing patients can walk faster and get back to their regular activities sooner [14].

Here’s what you need to think about when deciding:

• Saving your bone for possible future surgeries
• Less chance of hip coming out of socket with resurfacing
• How active you want to be
• How long the surgery will last [12]

Both operations can be done as outpatient procedures [15]. But here’s something VERY IMPORTANT – hip resurfacing needs more surgical skill [12]. Not every surgeon has trained enough to do it well. That’s why finding a really experienced hip resurfacing surgeon matters so much.

New technology helps both kinds of surgery. Doctors now use robots and computers to place parts more exactly [16]. They even have smart sensors and custom-made parts to fit your exact hip shape [16]. But remember – even with all this new technology, your surgeon’s experience still matters most [16].

I realize that choosing between these operations isn’t easy. Talk to several surgeons, ask lots of questions, and trust your instincts. It’s your hip and your life – take time to make the right choice for YOU.

Talk with others who have had a hip resurfacing or are about to. Join the Hip Talk Discussion Forum.

https://surfacehippy.info/hiptalk/

Final Thoughts About Hip Surgery Choices

After 19 years with my own Birmingham Hip Resurfacing, I still believe hip resurfacing is a great choice for the right person. The numbers tell the story – 95.5% of BHR implants still working after 10 years, especially in men under 65. And Patients with osteoarthritis do best, with 95% still going strong at 22 years [10].

Picking the right surgery depends on YOU:

• Your age and bone quality
• How active you want to be
• What your surgeon recommends

The most IMPORTANT thing I’ve learned from running Surface Hippy is that surgeon experience really matters. Visit Surface Hippy’s guide on selecting a hip resurfacing surgeon to help find the right doctor for your situation.

New technology like robots and smart sensors helps both kinds of surgery. But remember – these are just tools. The surgeon’s skill and experience matter most.

Talk to several doctors. Ask lots of questions. Read other patients’ stories on our Hip Talk Discussion Forum. Take time to make the right choice for YOUR situation.

I personally feel that hip resurfacing can give younger, active patients their lives back. But you need the right surgeon and the right situation. Trust your instincts when making this important choice – it’s your hip and your future.

FAQs

Q1. What are the main advantages of hip resurfacing over total hip replacement? Hip resurfacing preserves more natural bone and uses a larger diameter ball, which can lead to better joint stability and a more natural range of motion. This makes it particularly beneficial for younger, active patients who want to maintain high levels of physical activity.

Q2. Who is the ideal candidate for hip resurfacing? The ideal candidate for hip resurfacing is typically a male patient under 60 years old with a larger frame, good bone density, and a BMI under 35. Active individuals seeking to maintain high activity levels often make excellent candidates for this procedure.

Q3. What is the long-term success rate of Birmingham Hip Resurfacing? The Birmingham Hip Resurfacing system has shown impressive long-term results, with a 95.5% survival rate at 10 years. Male patients under 65 years with larger femoral head sizes have particularly good outcomes, with some studies reporting up to 99% implant survivorship at 10 years.

Q4. What are the potential risks or disadvantages of hip resurfacing? Potential risks of hip resurfacing include femoral neck fractures, metal ion concerns, and the need for a more technically demanding surgical procedure. The procedure may also lead to increased acetabular bone stock loss compared to total hip replacement.

Q5. How does the recovery process differ between hip resurfacing and total hip replacement? Hip resurfacing patients often experience faster recovery times and quicker return to regular physical activities. Studies have shown that hip resurfacing patients achieve faster walking speeds and can more readily return to high-performance activities compared to those who undergo total hip replacement.

References

[1] – https://stjoseph.stlukeshealth.org/services/orthopedics-sports-medicine/orthopedic-procedures/hip-resurfacing
[2] – https://www.grossortho.com/bone-health-hip-resurfacing
[3] – https://www.andrewssportsmedicine.com/conditions-treatments/-hip-resurfacing-surgery
[4] – https://shine365.marshfieldclinic.org/bone-joint/hip-resurfacing/
[5] – https://pmc.ncbi.nlm.nih.gov/articles/PMC8516816/
[6] – https://pmc.ncbi.nlm.nih.gov/articles/PMC3167457/
[7] – https://pmc.ncbi.nlm.nih.gov/articles/PMC9788147/
[8] – https://pmc.ncbi.nlm.nih.gov/articles/PMC7571983/
[9] – https://pmc.ncbi.nlm.nih.gov/articles/PMC10959564/
[10] – https://orthopedicreviews.openmedicalpublishing.org/article/77745-hip-resurfacing-arthroplasty-past-present-and-future
[11] – https://roh.nhs.uk/services-information/hips/birmingham-hip-resurfacing
[12] – https://www.sosbones.com/hip-resurfacing-vs-total-hip-replacement/
[13] – https://www.drmclawhorn.com/2024/08/31/hip-resurfacing-vs-total-replacement-which-procedure-is-best-for-you/
[14] –
[15] – https://www.ibji.com/blog/orthopedic-care/whats-the-difference-between-hip-resurfacing-and-hip-replacement/
[16] – https://www.hss.edu/conditions_latest-technologies-used-in-total-joint-replacement-surgery-hss.asp