Resurfacing a Hip Instead of Replacing It

What is the difference between resurfacing and replacing a hip?

In a total hip replacement, the surgeon removes the worn ball at the top of the thigh bone, along with the short neck beneath it, and rebuilds the joint with a metal or ceramic ball on a stem seated inside the thigh bone, resting in a smoothed-out socket. In hip resurfacing, that ball is not removed — it is trimmed and capped with a metal shell, the way a crown covers a tooth, which preserves more of your own bone and the femoral neck. The core difference is how much of your natural femur is kept. Both operations treat the same underlying problem: a hip joint whose cartilage has worn away, the condition called osteoarthritis 1Ref 1American Academy of Orthopaedic Surgeons (OrthoInfo) (2024).Osteoarthritis of the Hip.Hip osteoarthritis is progressive wear of joint cartilage, and initial management is nonsurgical, with surgery an option when those measures no longer control symptoms.. Both resurface the socket side as well. So the honest way to picture them is not two different repairs but the same repair done with more or less of your original bone left in place.

Why does either operation come last, not first?

Neither operation is where treatment starts. Hip osteoarthritis is a slow, degenerative wearing of the smooth cartilage that lines the joint, and it is most common with age and after decades of use 2Ref 2National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) (2023).Osteoarthritis.Osteoarthritis is a slow, degenerative breakdown of joint cartilage that is more common with age.. Because it develops gradually, there is almost always time to try less invasive care first. Orthopaedic guidelines are explicit about the order: education, exercise, weight management, and medication come first, and joint replacement is reserved for hips that no longer respond to those measures 3Ref 3American Academy of Orthopaedic Surgeons (AAOS) (2023).Management of Osteoarthritis of the Hip — Clinical Practice Guideline.Nonsurgical measures come first for hip osteoarthritis, with joint replacement appropriate once those measures no longer control symptoms.. Major osteoarthritis guidelines put the same structured, non-drug care at the centre of treatment across the range of the disease 4Ref 4Bannuru RR, Osani MC, Vaysbrot EE, et al. (2019).OARSI guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis.Education and structured land-based exercise are core treatments for hip osteoarthritis.. Reaching for an operation before that groundwork is not a faster route — it skips the part that helps many people stay comfortable, and delay or avoid surgery entirely. Understanding your hip pain and what is driving it is the start of that road, not the end.

What does non-surgical care for an arthritic hip involve?

Non-surgical care for an arthritic hip is more than resting and waiting. The core of it is movement: a structured, land-based exercise program that strengthens the muscles around the hip and keeps it mobile, which is recommended across osteoarthritis guidelines 4Ref 4Bannuru RR, Osani MC, Vaysbrot EE, et al. (2019).OARSI guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis.Education and structured land-based exercise are core treatments for hip osteoarthritis.. Physical therapists add manual therapy, gait work, and education tailored to how the hip actually behaves during walking and stairs 5Ref 5Cibulka MT, Bloom NJ, Enseki KR, et al. (2017).Hip Pain and Mobility Deficits—Hip Osteoarthritis: Revision 2017.Physical therapy for hip osteoarthritis includes patient education, manual therapy, and exercise.. Weight management matters because body weight is multiplied across the hip with every step. Anti-inflammatory medication can quiet flares. None of this regrows cartilage, but for a great many people it buys years of comfortable function — and it is exactly the care an honest surgeon wants to see tried before scheduling an operation. This is the sequence of care that runs underneath every sound orthopaedic decision.

When is hip surgery clearly the right call?

Surgery becomes the right call when severe, structural arthritis keeps limiting your life despite an honest trial of the care above. The signals are consistent: groin or hip pain that wakes you at night, a joint that has shrunk your walking distance and made dressing or pulling on socks hard, and X-rays showing advanced loss of joint space with bone rubbing on bone. When those line up, replacement reliably relieves pain and restores function, and orthopaedic guidelines describe it as appropriate once non-surgical measures no longer control symptoms 3Ref 3American Academy of Orthopaedic Surgeons (AAOS) (2023).Management of Osteoarthritis of the Hip — Clinical Practice Guideline.Nonsurgical measures come first for hip osteoarthritis, with joint replacement appropriate once those measures no longer control symptoms.. Learning the hip replacement indications — the specific findings and limits that justify an operation — is what separates a well-timed surgery from one done too early or endured too long. Surgery here is not a failure of conservative care; it is the correct next step in the sequence once the joint has genuinely run out of road.

Who is hip resurfacing usually considered for?

Resurfacing is considered for a narrower group than replacement. Because it keeps the natural femoral head and more bone, it has traditionally been discussed mainly for younger, active people with strong bone who want to preserve bone stock for the future. It is not offered for every hip, and whether your anatomy, bone quality, and activity goals suit it is a judgment your surgeon makes with your imaging in front of both of you.

That phrase — preserving bone stock — deserves unpacking, because it is the whole argument for resurfacing and it is rarely explained. No hip implant is eternal. If you have your first operation in your forties, there is a reasonable chance you will need a second one decades later, and every operation on a hip spends some of the bone that is left. The logic of resurfacing is that by capping the femoral head rather than removing it, you keep more bone in reserve for that future surgery. It is a bet about the decades ahead, not just a choice about this year's pain — which is precisely why age and activity weigh so heavily in the conversation.

This page will not hand you a revision-rate table, because the honest comparison depends on the specific implant, the surgeon's experience with it, and your own body — figures a good surgeon walks through with you, not numbers to settle from a search result. What matters before that conversation is whether the joint truly warrants an operation at all.

How do you know it is time, and whether it worked?

The clearest way to know it is time — and later, whether the operation helped — is to measure the hip the same way before and after. Clinicians use short questionnaires for this. The hoos questionnaire, or Hip disability and Osteoarthritis Outcome Score, asks about pain, other symptoms, daily activities, sport and recreation, and hip-related quality of life, and it was validated as responsive to change in people undergoing hip replacement 6Ref 6Nilsdotter AK, Lohmander LS, Klässbo M, Roos EM (2003).Hip disability and osteoarthritis outcome score (HOOS)—validity and responsiveness in total hip replacement.The HOOS is a validated patient-reported outcome with five subscales, responsive to change in people undergoing total hip replacement.. A shortened version, hoos jr., is often used to follow a replaced joint over time, and the oxford hip score does a similar job in a dozen questions. Scoring yourself before any surgery and again through recovery turns a vague sense of progress into something you can actually see. And if you do proceed, learning the hip replacement recovery timeline in advance — the early weeks of protected movement, then the gradual return of strength — makes the months afterward far less frightening.