Hip Resurfacing (Metal)

For more information, see also Hip Replacement and Ceramic Hip Resurfacing.

What is Hip Resurfacing?

Hip Resurfacing an alternative to conventional Total Hip Replacement used for the management of established osteoarthritis. Hip Resurfacing utilises a bone preserving prosthetic implant with exceptional wear, impact and dislocation resistance and is commonly recommended in younger and higher activity demand people who are experiencing problematic symptoms that are not adequately controlled by non surgical therapies.

What are the differences between Hip Resurfacing and conventional Total Hip Replacement?

In conventional Total Hip Replacement procedures, the femoral head (ball of the hip) is removed and a stem implant (rod) is placed into the central part of the upper thigh bone. Onto the hip replacement stem, a ball component is placed that is free to move within the prosthetic socket (acetabulum).

In Hip Resurfacing, the femoral head bone is retained and no stem implant into the upper thigh is necessary. The hip resurfacing procedure involves removing the damaged arthritic joint cartilage and re-lining the joint surfaces with prosthetic bearing surfaces (hence the name "resurfacing"). 

Left: Conventional Total Hip Replacement.                            Right: Hip Resurfacing. 

Model illustrations of hip resurfacing

Left and Centre: Femoral resurfacing demonstrating preservation of bone beneath the prosthesis. Right: Resurfacing femoral and acetabular implants.

What are the advantages of Hip Resurfacing?

In modern orthopaedic practice, the main advantage of a Hip Resurfacing compared to conventional Total Hip Replacement is preservation of bone at the top of the thigh bone. Should further surgery be required in the future, preserving this bone makes the subsequent revision procedure less complex, thereby shortening the recovery time and potentially improving the durability of the second operation. Preserving bone is therefore most important in younger people with higher activity demands, who may potentially out live an artificial joint of any design.

Metal Hip Resurfacing uses impact and wear resistant bearing surfaces that are more suitable for higher grade activity demands including running and impact sports.

The incidence of dislocation is much lower for Hip Resurfacing in comparison to conventional Total Hip Replacement.

What are the disadvantages of Hip Resurfacing?

Not all people are suitable for Hip Resurfacing. People who are less suitable for metal hip resurfacing devices include those with severe hip deformity or reduced bone strength due to cysts or osteoporosis. Importantly , there is a minimum size requirement for metal hip resurfacing procedures -  hip resurfacing is unsuitable for people where the femoral head is of smaller size (this applies to many women).

Traditionally, Hip Resurfacing uses Metal-on-Metal (MoM) bearing surfaces. While MoM bearings have a very low wear rate and are impact resistant, a small number of people may develop allergic type reactions with this type of bearing. The incidence of this reaction in modern hip resurfacing is approximately 0.5% in appropriately selected candidates. Should Hip Resurfacing be recommended then the merits of this implant in comparison to alternative prosthetic designs will be discussed with you in detail. 

Who is suitable for Hip Resurfacing?

Traditionally, the ideal candidate for Metal Hip Resurfacing is a larger framed male less than 65 years of age with severe osteoarthritis of the hip. Increasing evidence does however support the use of Hip Resurfacing in people older than 65, provided they meet all other requirements for the procedure.

Who is unsuitable for Hip Resurfacing?

People with arthritis due to underlying hip dysplasia (shallow hip socket) are at higher risk of implant failure if treated with Hip Resurfacing. Generally people with significant hip dysplasia are not suitable for hip resurfacing.

Size of the femoral head bone is arguably one of the most important factors determining outcomes after Hip Resurfacing. As smaller implant sizes (less than 48mm for the femoral component) are associated with increased failure rates. Accordingly, many females with hip osteoarthritis do not meet the skeletal size requirements for resurfacing.

Does A/Prof Weinrauch perform hip Resurfacing?

Yes. Hip Resurfacing provides reliably good results in appropriately selected people.

Are other bone preserving hip joint replacement alternatives available?

What other alternatives are available?

Many people with early to moderate hip arthritis are able to improve their symptoms without requiring surgery (see 'Non-Surgical Treatments'). Some people may benefit from hip arthroscopy (key-hole surgery) or other joint preserving surgical procedures. For people who require artificial joint replacement, the alternatives are typically Hip Resurfacing or Conventional Total Hip Replacement. I will recommend a particular treatment based on your requirements.

Illustrations of femoral head preparation in hip resurfacing during surgery

Figures 1-6 (left to right, upper then lower row): Sequence of preparation of bone and implantation of a femoral resurfacing implant.

Related publications

Scientific publications and research initiatives developed by the Brisbane Hip Clinic may be accessed via this link.

This information has been written by A/Prof Patrick Weinrauch for the purposes of patient education. The details provided are of general nature only and do not substitute for professional recommendations based on an individual clinical assessment. © A/Prof Patrick Weinrauch. Brisbane Hip Clinic. 11/16.