Hip Resurfacing vs Total Hip Replacement

Hip resurfacing is a surgical alternative to total hip replacement, offering a less invasive approach to managing hip arthritis. While total hip replacement involves the complete removal of the femoral head, hip resurfacing preserves the femoral neck, capping the head of the femur with a prosthetic. This procedure is ideal for younger, more active patients who wish to preserve as much bone as possible, which is important for future procedures if necessary.

How Common It Is and Who Gets It? (Epidemiology)

Hip resurfacing is typically recommended for younger patients (under 60 years) with hip arthritis, especially those who are more active and have good bone strength. Patients with a higher BMI or those with significant deformities may not be suitable candidates. It is especially beneficial for individuals with a good quality femur and for those who may need a future hip replacement revision.

Why It Happens – Causes (Etiology and Pathophysiology)

The most common cause of hip arthritis leading to hip resurfacing is osteoarthritis, where the articular cartilage deteriorates, causing bone-on-bone friction. Other causes include trauma (e.g., fractures or dislocations), childhood hip diseases, or conditions like avascular necrosis. In these cases, the femoral head loses its smooth surface, leading to pain, stiffness, and difficulty in performing daily activities.

X-ray showing a total hip replacement on the left hip and an illustration of hip resurfacing on the right hip.

How the Body Part Normally Works? (Relevant Anatomy)

The hip joint is a ball-and-socket joint, where the femoral head (ball) fits into the acetabulum (socket) of the pelvis. The smooth articular cartilage on the ball and socket allows frictionless movement. In hip arthritis, this cartilage is worn away, resulting in painful bone friction, affecting joint function.

What You Might Feel – Symptoms (Clinical Presentation)

• Pain: Particularly in the groin, outer thigh, or buttocks.

• Stiffness: Difficulty bending, squatting, and walking.

• Loss of mobility: Limited range of motion in the affected hip.

• Night pain: Some patients experience pain even when not bearing weight on the hip.

How Doctors Find the Problem? (Diagnosis and Imaging)

• Physical examination: To assess joint range of motion and areas of tenderness.

• X-rays: To visualize joint space narrowing and signs of arthritis.

• MRI: For a detailed view of soft tissues and early-stage changes in the hip joint.

Procedure Types or Techniques (Classification)

• Hip Resurfacing: Replaces only the ball of the femur, preserving the femoral neck and socket.

• Total Hip Replacement (THR): Involves replacing both the femoral head and acetabulum (socket) with prosthetic components.

Other Problems That Can Feel Similar (Differential Diagnosis)

• Trochanteric bursitis: Inflammation of the bursa on the outside of the hip can mimic hip pain.

• Labral tears: A tear in the hip labrum can cause hip pain and limited range of motion.

• Low back issues: Conditions like sciatica or lumbar spine problems may cause referred pain to the hip area.

Treatment Options

Non-surgical: Includes medications (NSAIDs, acetaminophen), physical therapy, weight management, and cortisone injections.

Surgical: If non-surgical treatments fail, surgery (hip resurfacing or THR) is considered.

Recovery and What to Expect After Surgery

• Initial recovery: Hospital stay for 1-2 days, with most patients able to bear weight on the hip immediately following surgery (with crutches).

• Physical therapy: Begins shortly after surgery, focusing on strength, mobility, and regaining range of motion.

• Full recovery: Most patients see significant improvement within 3-6 months, with the potential for resuming normal activities like walking, swimming, and golfing.

Possible Risks or Side Effects (Complications)

• Fractures: A small risk of femoral neck fractures post-surgery.

• Infection: A risk with any surgical procedure.

• Metal ion release: As hip resurfacing involves a metal-on-metal implant, some patients may experience elevated levels of metal ions in their blood, leading to inflammation or implant loosening.

• Leg length discrepancy: May occur if the femoral head or implant is not properly aligned during surgery.

Long-Term Outlook (Prognosis)

• Pain relief: Most patients experience significant pain relief and improved function.

• Longevity: Hip resurfacing implants generally last 15-20 years, but the possibility of future revision surgery is greater in younger, more active patients.

• Functional recovery: Patients typically return to a range of low-impact activities, but high-impact sports should be avoided to prolong the implant’s lifespan.

Intraoperative image showing instruments used in total hip replacement.

Out-of-Pocket Cost

Medicare

CPT Code 27130 – Hip Resurfacing (Total Hip Arthroplasty via Anterior or Posterior Approach): $303.45

Medicare Part B typically covers 80% of the approved cost for this procedure once your annual deductible has been met, leaving you responsible for the remaining 20%. Supplemental Insurance plans such as Medigap, AARP, or Blue Cross Blue Shield generally cover that remaining 20%, minimizing or eliminating out-of-pocket expenses for Medicare-approved surgeries. These plans work in coordination with Medicare to fill the coverage gap and reduce patient costs.

If you have Secondary Insurance, such as TRICARE, an Employer-Based Plan, or Veterans Health Administration coverage, it serves as a secondary payer. These plans typically cover any remaining coinsurance or small deductibles, which usually range between $100 and $300, depending on your plan and provider network.

Workers’ Compensation

If your hip resurfacing surgery is required due to a work-related injury or degenerative condition caused by your job, Workers’ Compensation will cover all medical expenses, including surgery, rehabilitation, and follow-up care. You will not have any out-of-pocket expenses, as the employer’s insurance carrier directly covers all approved treatments.

No-Fault Insurance

If your hip resurfacing is needed due to an automobile accident, No-Fault Insurance will typically cover the full cost of treatment, including surgery and postoperative care. The only potential out-of-pocket cost may be a small deductible or co-payment depending on your insurance policy.

Example

Rachel Mitchell required hip resurfacing surgery (CPT 27130) due to hip arthritis. Her estimated Medicare out-of-pocket cost was $303.45. Since Rachel had supplemental insurance through Blue Cross Blue Shield, her remaining balance was fully covered, leaving her with no out-of-pocket expenses for the procedure.

Frequently Asked Questions (FAQ)

Q. How long does recovery take?

A. Full recovery typically takes 3-6 months, but patients may be able to return to non-impact activities sooner.

Q. Will I be able to walk right away?

A. Yes, most patients are able to walk with crutches immediately after surgery, bearing weight on the hip.

Q. Can I return to sports?

A. Low-impact activities like swimming, biking, and walking are encouraged, but high-impact activities should be avoided.

Summary and Takeaway

Hip resurfacing is a viable option for younger, active patients with hip arthritis who want to preserve their bone structure. It offers faster recovery and fewer complications compared to total hip replacement, making it an excellent choice for those seeking joint preservation.

Clinical Insight & Recent Findings

When considering hip replacement options, patients aged 65 or older have the choice between total hip arthroplasty (THA) and hip resurfacing arthroplasty (HRA). A recent study comparing these two procedures found that HRA led to superior functional outcomes, with better mobility and reduced pain at the one- and two-year follow-ups.

Patients undergoing HRA also demonstrated greater activity levels as measured by the Lower Extremity Activity Scale (LEAS). However, the study emphasized the importance of careful patient selection, as older patients with conditions like osteoporosis or renal insufficiency may face greater risks with HRA.

While HRA provided favorable results in this study, the decision should always be based on individual health assessments and surgical considerations. (“Study on outcomes of total hip replacement vs hip resurfacing for patients over 65 – see PubMed.“)

Who Performs This Surgery? (Specialists and Team Involved)

Orthopedic surgeons specializing in hip replacements perform this surgery. The surgical team may include anesthesiologists, surgical assistants, and physical therapists.

When to See a Specialist?

If you are experiencing persistent hip pain and have not found relief through conservative treatments, consult an orthopedic specialist to discuss your surgical options.

When to Go to the Emergency Room?

Seek immediate medical attention if you experience sudden, severe hip pain or signs of infection (e.g., fever, redness, swelling) after surgery.

What Recovery Really Looks Like?

The recovery process involves limited weight-bearing, physical therapy, and follow-up visits to ensure proper healing. Most patients regain substantial mobility and function within a few months.

What Happens If You Delay Surgery?

Delaying hip resurfacing can lead to further joint degeneration, increased pain, and decreased function, potentially requiring a more invasive procedure later.

How to Prevent Recurrence or Failure?

Maintaining a healthy weight, avoiding high-impact activities, and following your surgeon’s post-surgery instructions can help ensure the long-term success of the implant.

Nutrition and Bone or Joint Health

Adequate intake of calcium and vitamin D is important for bone health. Avoid smoking and excessive alcohol consumption to support healing.

Activity and Lifestyle Modifications

Post-surgery, engage in low-impact activities like swimming or cycling, and avoid activities that put excessive strain on the hip joint, such as heavy lifting or running.

Do you have more questions?