Hip resurfacing keeps your own femoral head and caps it with metal instead of cutting it off. A decade and a half of registry data has narrowed who it suits. The people who still do well are mostly men under about 65 with large hips and healthy bone. Women and anyone needing a small component have had much higher failure rates, and one major brand is now contraindicated in women.
If you are younger, active and reading about resurfacing because you want to keep running or lifting, this guide sets out what the registries show, what monitoring you sign up for, and why surgeon volume matters even more for resurfacing abroad than for a standard total hip.
What hip resurfacing is, and how it differs from a total hip
In a total hip replacement, the surgeon removes the femoral head and neck and puts a stem down the thigh bone with a new ball on top. In resurfacing, the femoral head is trimmed and covered with a metal cap, and the socket is lined with a metal shell1. The neck and most of the head stay.
That has two consequences. First, the bearing is metal-on-metal, so resurfacing carries the metal ion and tissue reaction concerns that ended metal-on-metal total hips. Second, because the femoral neck is kept, a small percentage of patients later break it, which usually means converting to a total hip. That fracture cannot happen after a total hip, because the neck is removed1.
Day-to-day recovery is similar. The American Academy of Orthopaedic Surgeons describes most patients going home one to four days after surgery and resuming normal daily activities by about six weeks1.
Hip resurfacing
- Keeps femoral head and neck
- Metal-on-metal bearing
- Risk of femoral neck fracture
- Metal ion monitoring often advised
- Best results in larger men with good bone
Total hip replacement
- Removes head and neck, uses a stem
- Usually metal or ceramic on cross-linked plastic
- No neck to fracture
- Standard follow-up visits and X-rays
- Used across ages, sexes and body sizes
Who is still a candidate: the registry profile
The patient education site of the American Academy of Orthopaedic Surgeons describes good candidates as generally under 60, larger-framed (often but not always male) and with strong, healthy bone. Older, female or smaller-framed patients and those with weaker bone face higher complication risk, especially neck fracture1.
The registries put numbers on that. An Australian registry analysis of 12,093 resurfacings done from 1999 to 2008 found an 8-year cumulative revision rate of 5.3%, against 4.0% for conventional total hips4. Risk rose with older age, a diagnosis of hip dysplasia, certain implant designs and femoral heads under 50 mm. In patients under 55 with osteoarthritis and heads of 50 mm or larger, 7-year revision was 3.0%4.
Australia's regulator published Australian registry figures for the most widely used device, the Birmingham Hip Resurfacing (BHR). As of January 2016, men under 65 with heads of 50 mm or more had revision rates of 2.0% at 5 years and 3.7% at 10 years. Women had 7.1% and 14.2%. Patients with heads of 48 mm or smaller had 6.5% and 13.1%5.
Compare those with England's NICE benchmark, which recommends hip prostheses only if they have a revision rate of 5% or less at 10 years8. The best-suited men clear that bar. Women and small-head patients, on these figures, do not come close.
A 2025 analysis of 17-year Australian registry data on a newer resurfacing design found cumulative revision of 5.7% for that device, 7.0% for the BHR, and 3.9% for the best-performing conventional total hips. In men under 65 the three groups were not significantly different (4.9%, 6.7% and 3.8%)6. Only 13 women had the newer device, too few to analyze, and fracture was the leading early reason for revision, with metal-related problems appearing after about eight years6.
Why women and small components do worse
The Australian data suggest that head size explains much of the gap. In the 12,093-hip analysis, women had higher revision rates than men, but the difference largely disappeared once the researchers adjusted for femoral head size4. That points to component size, not sex itself, as the main driver, and smaller components failed more often.
Regulators acted on that. In June 2015 the maker of the BHR withdrew femoral heads of 46 mm and smaller and their matching cups, and said the system should no longer be used in women. A 48 mm head is reserved for cases where a 50 mm head was planned and the surgeon measures 48 mm during the operation5. The UK regulator issued the same instructions in a medical device alert7.
The FDA lists resurfacing devices with femoral heads of 44 mm or smaller, and women, among the groups at higher risk of problems with metal-on-metal implants. It says resurfacing is not generally recommended for people with kidney problems, known metal allergy, weakened immune systems, high-dose corticosteroid use, or for women of childbearing age3. The FDA also notes there is no widely accepted test before surgery that predicts who will react to metal3.
Ask which device they plan to use, what head size they expect, and how they reconcile that with the BHR contraindication in women. A surgeon may have a reasoned answer for a different device, but you should hear it, in writing, before paying a deposit.
FDA status in the United States
The FDA lists two metal-on-metal hip resurfacing systems approved through its premarket approval process: the Cormet Hip Resurfacing System from Corin and the Birmingham Hip Resurfacing System from Smith & Nephew. By contrast, it states that no metal-on-metal total hip systems have approved applications and that they are not currently legally marketed2. The FDA page notes its content was current as of March 2019, so ask your surgeon for the current labeling of any device they propose.
If you are having surgery outside the US or Canada, the device on offer may be one that is not approved at home. That does not automatically make it worse, but it does mean your home surgeon may have no experience with it, and US or Canadian registry data on it may not exist.
Metal ion monitoring: what you sign up for
Resurfacing is not a one-and-done operation. Because metal particles can cause a reaction in the tissue around the hip, many surgeons follow resurfacing patients for life. Agencies differ on how intensively.
- UK regulator (for BHR patients who are female, have heads of 46 mm or smaller, or have symptoms): review every year for the life of the implant, with imaging by MARS MRI or ultrasound. A whole-blood cobalt or chromium level above 7 parts per billion suggests potential for a soft tissue reaction, and a result above that is repeated three months later. Imaging carries more weight than blood levels alone7.
- FDA (any metal-on-metal hip that appears to work well): a physical exam and X-rays every one to two years, with no evidence supporting extra tests in patients without symptoms. Surgeons may increase follow-up based on the implant, blood results or imaging3.
Practically, that means finding a surgeon at home who will order and interpret metal ion tests and specialized MRI, and budgeting for them. Ask your home insurer or provincial plan before surgery whether that follow-up will be covered. Report new pain, swelling, numbness, noises from the hip or changes in walking promptly3.
Availability and surgeon volume abroad
Resurfacing has become a niche operation. A 2019 review of the learning curve cited UK registry figures showing resurfacing fell from 8% of hip procedures in 2011 to 0.6% in 20179. Fewer cases means fewer surgeons with recent, high-volume experience, at home and abroad.
Experience matters. The same review reports that a learning curve of about 50 cases is commonly described. In one multi-surgeon series, major complications fell from 5.6% in each surgeon's first 25 cases to 1.6% in the next 25, and in a single-surgeon series, femoral neck fracture risk was about eight times higher in the first 69 cases9. The authors cite an Australian registry suggestion that hospitals doing fewer than 25 resurfacings a year should preferably not offer it, and give their own opinion that surgeons should do at least 25 a year9.
- How many resurfacings did you personally do last year, and in total?
- Which device, and is it approved by the FDA or Health Canada?
- What head size do you expect for me, based on my X-rays?
- What is your own revision rate, and how do you know it (registry, personal database)?
- What follow-up do you recommend, and can my surgeon at home do it?
- If the resurfacing fails, what does conversion to a total hip involve?
- Will I leave with implant stickers and the operative note?
We could not find reliable public price data for hip resurfacing in Colombia, so we are not quoting a range. Get a written quote that names the device and states what follow-up is included. A standard total hip is far more common and easier to compare across clinics; you can request a quote for either. Keep your implant records using our implant record passport, which matters doubly for a metal-on-metal device.
Decision table: resurfacing or total hip
| Your situation | What the evidence suggests |
|---|---|
| Man under 65, osteoarthritis, expected head 50 mm or larger, good bone | Resurfacing results in registries are close to total hips; a reasonable option with an experienced surgeon |
| Woman of any age | BHR is contraindicated; FDA advises against resurfacing in women of childbearing age; total hip is the usual choice |
| Expected head 48 mm or smaller | Registry revision rates far above the NICE benchmark; total hip favored |
| Hip dysplasia | Linked to higher resurfacing revision in Australian data; discuss carefully |
| Kidney disease, metal allergy, weakened immune system, high-dose steroids | FDA says resurfacing is not generally recommended |
| Over about 65, or weaker bone | Higher neck fracture and revision risk; total hip favored |
| Cannot commit to long-term follow-up at home | A metal-on-metal device needs monitoring; a total hip with a non-metal bearing is simpler |
If you are under 50 and weighing either option, our guide to joint replacement under 50 covers how age changes the calculation, and sports after joint replacement covers what activity levels surgeons usually allow. For a decision this specialized, a second opinion from a surgeon who does both operations is worth getting; our second opinion builder helps you prepare one.