Hip Resurfacing Arthroplasty

Overview

Hip resurfacing is a bone-conserving alternative to total hip replacement that involves capping the femoral head with a metal covering rather than removing it entirely. A metal cup is placed in the acetabulum, creating a metal-on-metal bearing surface. The procedure preserves more of the patient's natural bone and may be suitable for younger, active patients with hip arthritis.

Indications

This procedure may be considered when:

• •Hip osteoarthritis in younger, active patients (typically males under 60)
• •Avascular necrosis with preserved femoral head bone quality
• •Inflammatory arthritis in selected cases
• •Patients desiring bone preservation and potentially easier revision options
• •Larger femoral head size (more commonly performed in males)
• •Patients who wish to maintain higher activity levels

How It Works

The procedure typically involves several coordinated steps:

• •Preoperative evaluation includes imaging to assess bone quality and femoral head morphology
• •The procedure is performed under general or regional anesthesia
• •A posterior or posterolateral approach is typically used
• •The femoral head is dislocated and the acetabulum is prepared
• •A metal cup is press-fit or cemented into the acetabulum
• •The femoral head is shaped and prepared to receive the femoral component
• •A metal cap is cemented onto the prepared femoral head
• •The hip is reduced and stability is assessed
• •The incision is closed in layers

Risks

As with any surgical procedure, potential risks include:

• •Femoral neck fracture (higher risk than total hip replacement)
• •Metal ion release from the bearing surface
• •Adverse local tissue reactions to metal debris
• •Osteonecrosis of the femoral head under the component
• •Component loosening or failure
• •Infection
• •Dislocation (generally lower rate than total hip replacement)
• •Blood clots
• •Leg length discrepancy
• •Need for revision to total hip replacement
• •Higher failure rates in females and those with smaller femoral heads

Recovery Expectations

Recovery follows a gradual progression:

• •Hospital stay is typically 1 to 3 days
• •Weight bearing is often allowed immediately or with minimal restrictions
• •Many patients walk with a cane or walker for the first few weeks
• •Physical therapy focuses on gait training, strengthening, and range of motion
• •Return to driving may occur within 2 to 4 weeks
• •Return to desk work may occur within 2 to 4 weeks
• •Return to more strenuous activities may require 3 to 6 months
• •Monitoring of metal ion levels may be recommended long-term

Alternatives

Depending on individual circumstances, alternatives may include:

• •Total hip arthroplasty (removes and replaces the femoral head)
• •Conservative management with physical therapy, medications, and injections
• •Hip arthroscopy for early disease without significant arthritis
• •Osteotomy procedures for selected young patients with dysplasia or deformity
• •Activity modification and lifestyle changes

Sources

• AAOS OrthoInfo – Hip Resurfacing
• Cleveland Clinic – Hip Resurfacing
• Johns Hopkins Medicine – Hip Replacement