Hip Resurfacing vs Hip Replacement: Know The Difference

Although many are aware of joint replacement surgery, fewer know about hip resurfacing (as an alternative treatment option) and when it's appropriate to use it. Because hip resurfacing is less invasive than total hip replacement (THR), it is classified as a joint-preserving procedure; however, not all patients will qualify for resurfacing after being advised to undergo THR. Primarily, it is recommended for a small, select number of patients based on their age, activity level, and bone quality.

This article will discuss the key differences in the processes and outcomes of resurfacing and THR, and provide a basic understanding of the pros and cons of each procedure.

Who is the Best Candidate for Hip Resurfacing?

Not everyone is an appropriate candidate for hip resurfacing; men generally achieve better results than women, according to several studies.

• The most favourable candidates for hip resurfacing rather than total hip replacement are those with osteoarthritis of the hip, rather than those with avascular necrosis.
• Candidates for hip resurfacing typically include younger, active people with good-quality bones who desire to continue enjoying an active lifestyle.
• These individuals are expected to benefit from the advantages of hip resurfacing (e.g., greater joint stability and a greater opportunity to participate in recreational activities).
• The choice between hip resurfacing (which replaces the ball of the hip joint) and total hip replacement surgery should be determined through discussion with an orthopedic surgeon after assessing the patient's age, bone health, activity level, and health status to decide which procedure is best for that patient.

Procedural Similarities and Differences

The processes of both resurfacing and THR are similar, as both are intended to relieve pain and restore mobility in patients with degenerative conditions of the hip joint.

Hip resurfacing preserves bone structure better than total hip replacement, potentially making revisions easier later on. The placement of a metal cap over the femoral head creates an artificial ball that closely resembles the normal shape of the joint and may decrease the likelihood of dislocating the new joint while promoting a more normal walking pattern. However, there are also risks to hip resurfacing.

Some risks include fracture of the femoral neck during the procedure, and some patients may be sensitive to metal debris from the metal-on-metal components of the resurfaced hip. Finally, because the procedure requires reshaping the femoral head, larger incisions are often necessary.

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Advantages and Disadvantages of Hip Resurfacing Compared to Hip Replacement

Revision surgeries are often much easier with hip resurfacing than with total hip replacements as the femur remains intact with hip resurfacing, whereas total hip replacements remove the femoral head, leading to a loss of bone and consequently a greater degree of complexity due to a limited amount of bone available for new implants.

Femoral Neck Fracture Risk

Resurfacing the femoral head (top part of the thigh bone) leads to a higher rate of fracture risk at the femoral neck (the thin part of the thigh bone), so if you fracture your femur, your surgeon may convert the surgery into a total hip replacement. Although there is still a risk of fracture with a total hip replacement, this risk does not correlate directly with the procedure.

Size of Incision

Hip resurfacing typically involves more bone preservation; however, because the femoral head (top part of the thigh bone) must be reshaped before placing the metal cap, a surgeon may need a slightly larger incision to perform the procedure. Hip resurfacing can be technically difficult; therefore, not all orthopedic surgeons will routinely perform hip resurfacing.

Implant Type

Total hip replacement allows for a wide variety of implant materials, including combinations of metal, ceramic, and polyethene. Hip resurfacing generally uses metal-on-metal implants; however, ongoing studies are developing ceramic implants for hip resurfacing.

Implant Longevity

For well-selected patients, particularly younger and more active patients, hip resurfacing can provide a longer-lasting implant than total hip replacement, as younger patients are more likely than older patients to outlive the expected lifespan of a traditional hip implant.

Return to Daily Activities

Hip resurfacing procedures usually allow for return to an active lifestyle; some patients are able to play competitive sports (eg, running, skiing) after hip resurfacing. However, total hip replacement may limit participation in some high-impact sports.

Lower Risk of Dislocation and Leg Length Discrepancy

Due to the use of larger femoral head components in hip resurfacing surgery, the risk of hip dislocation is reduced compared to total hip replacement. Also, because the femoral head and part of the femur are preserved, there is a greater likelihood of having equal leg lengths after hip resurfacing than after total hip replacement, where there may be a slight risk of having unequal leg lengths.

Conclusion

Hip resurfacing and total hip replacements are good surgical procedures to assist people with significant joint problems achieve greater mobility by having less pain. Both procedures serve the same purpose but have different applications. Surgeons will approach them differently (e.g., by preserving bone) and use different types of implants. Hip resurfacing preserves more available bone than total replacements.

Therefore, hip resurfacing may better meet the needs of more active, younger people than total hip replacement types. Regardless of which option is chosen, each potential patient must have a thorough consultation with their orthopedic surgeon before making a final decision on which to undergo.