Sunshine Coast Orthopaedic Group

Procedure · Hip · Alternative to replacement

Hip resurfacing.

Capping the femoral head rather than removing it. A once-popular alternative to hip replacement with a complicated history, and not an operation performed in this practice.

Call (07) 5493 8038 How it is performed
Reviewed by Professor Daevyd Rodda Orthopaedic Surgeon · MBBS, Dip. Surg Anat, FRACS, FAOrthA Last reviewed: 21 August 2026
What it is
Metal cap on the femoral head, metal socket
Bone preserved
More femoral bone than a replacement
Bearing
Metal on metal
Registry position
Higher revision rate than total hip replacement
Who it may suit
Younger men with large femoral heads
In this practice
Not performed

What it is.

In a total hip replacement, the femoral head is removed and replaced by a stem and ball. In hip resurfacing the head is kept and capped, like a crown on a tooth, and a matching metal socket is fixed to the pelvis.

The appeal was real. More of the patient's own bone is preserved, the head is larger and therefore more stable, and the theory was that a future revision would be easier because less had been removed. Through the 2000s it was widely performed, particularly in younger, active men.

What happened

Resurfacing requires a metal-on-metal bearing, because the cap has to be thin. Over the following decade metal-on-metal bearings were found to release metal wear particles and ions, and in a proportion of patients this produced an adverse local tissue reaction: inflammation, fluid collections and destruction of surrounding soft tissue and bone, sometimes without pain until damage was advanced.

Registry data, including from the AOANJRR, showed higher revision rates for resurfacing than for total hip replacement, with results markedly worse in women, in smaller femoral head sizes, and with certain designs. Several devices were withdrawn.

The result is that resurfacing is now performed in far smaller numbers, by a small number of surgeons, in a narrow group of patients: typically younger men with large femoral heads and good bone.

How it is performed.

This practice does not perform hip resurfacing. The reasoning is stated plainly rather than left implicit.

  • Registry data reports higher cumulative revision rates than for total hip replacement across the broad population.
  • The metal-on-metal bearing carries a risk of adverse local tissue reaction that requires lifelong monitoring, including blood metal ion levels.
  • The bone preservation argument has weakened. Modern total hip replacement uses bone-conserving stems, larger heads and highly cross linked polyethylene, which has narrowed the gap the resurfacing argument depended on.
  • Outcomes in resurfacing are strongly surgeon-volume dependent, and this practice's volume is in hip and knee replacement.

If you have specifically been considering resurfacing, that is a reasonable thing to discuss, and it is a reasonable thing to seek an opinion from a surgeon who does perform it. You will be told that rather than talked out of it.

Recovery timeline.

Not applicable in this practice. For patients who already have a resurfacing in place, see the surveillance section below.

Outcomes.

If you already have a hip resurfacing

Many people with a well-functioning resurfacing continue to do well, and having one is not a reason for alarm. It does mean surveillance matters.

  • Stay under review. Metal-on-metal bearings warrant ongoing follow-up with radiographs, and blood metal ion levels where indicated. Adverse reactions can progress without pain.
  • Report new symptoms promptly. New groin pain, a limp, clicking, swelling or a sense of instability should be assessed rather than watched.
  • Revision is well established. Where a resurfacing does fail, it is converted to a total hip replacement. See revision hip replacement.

If your resurfacing was performed elsewhere and you no longer have a surgeon reviewing it, that is worth resolving. Ask your GP for a referral for surveillance.

Rehabilitation.

Not applicable. Rehabilitation after conversion of a resurfacing to a total hip replacement follows the revision hip replacement protocol.

Questions worth asking at your consultation.

Every one of these is a fair question and none of them should be awkward to ask. Print them or bring them on your phone.

  • Am I a good candidate for hip resurfacing, and what would make me a poor one?
  • What are the alternatives, including doing nothing for now?
  • How many of these do you perform in a year?
  • What does the Australian registry say about the implant you would use for someone my age?
  • What does a realistic result look like for me specifically, and what will I still not be able to do?
  • What is your plan if it does not go well?

Frequently asked questions.

Does Professor Rodda perform hip resurfacing?

No. Registry data reports higher revision rates than total hip replacement across the broad population, the metal-on-metal bearing requires lifelong monitoring, and modern bone-conserving total hip replacement has narrowed the advantage resurfacing was built on. If you want to consider it, seek an opinion from a surgeon who performs it.

I already have a resurfacing. Should I be worried?

Not automatically. Many resurfacings function well for many years. What matters is staying under surveillance with periodic radiographs and, where indicated, blood metal ion levels, because adverse reactions can progress without causing pain.

What symptoms should I report?

New groin pain, a new limp, clicking, swelling or a sense of instability. Report them rather than waiting for a scheduled review.

Can a resurfacing be converted to a hip replacement?

Yes, and it is a well-established operation. The femoral head is removed and a standard stem and head implanted. Where there has been an adverse tissue reaction, the affected soft tissue is also addressed.

Was resurfacing a mistake?

It was a reasonable idea that a decade of registry data judged less favourably than expected in the broad population, while remaining defensible in a narrow group. That is how orthopaedic evidence usually works, and it is a good argument for registries.

References.

  1. Australian Orthopaedic Association National Joint Replacement Registry. Annual Report. Adelaide: AOA.
  2. Smith AJ, Dieppe P, Vernon K, et al. Failure rates of stemmed metal-on-metal hip replacements: analysis of data from the National Joint Registry of England and Wales. Lancet. 2012;379(9822):1199-1204.

This page provides general information about a medical condition and a surgical procedure. It is not individual medical advice and does not replace consultation with a qualified practitioner. Outcomes vary between individuals and all surgery carries risk. A referral is needed for a consultation with Professor Daevyd Rodda; without one, you can start with the practice nurse practitioner, who can provide it.