At Palmetto Bone and Joint, we are dedicated to providing patients with the most accurate, evidence-based guidance when it comes to joint health. If you’ve been told you need hip surgery, you may have heard about hip resurfacing as a less invasive, bone-preserving alternative to total hip replacement. While this may sound appealing, the reality is that hip resurfacing often introduces more risks than benefits, especially when compared to modern surgical approaches like anterior total hip replacement.

In this article, we’ll explain why hip resurfacing is frequently the wrong choice, what complications you should be aware of, and why anterior total hip replacement remains the gold standard in hip surgery.

What Is Hip Resurfacing?

Hip resurfacing is a procedure in which the damaged surface of the femoral head (the ball of the hip joint) is reshaped and covered with a metal cap. The socket (acetabulum) is also replaced with a metal cup. Unlike total hip replacement, the femoral head and neck are not removed.

The idea behind hip resurfacing is that it preserves more bone and may offer increased range of motion, particularly for younger, more active patients. However, this procedure comes with a set of unique and significant complications that make it unsuitable for the vast majority of patients.

The Hidden Risks of Hip Resurfacing

1. Femoral Neck Stress Fractures

One of the most serious complications after hip resurfacing is a femoral neck stress fracture. These fractures occur just below the metal cap placed on the femoral head and are particularly devastating because they almost always require conversion to a total hip replacement. This revision is far more complex and less predictable than a primary hip replacement.

• Incidence: Occurs in approximately 1% to 4% of resurfacing patients.
• Risk Factors: Higher risk in women, patients with smaller femoral heads, and those with lower bone density.
• Consequences: Results in pain, loss of mobility, and an urgent need for more invasive surgery.

2. Extensive Muscle Damage from Surgical Approach

Hip resurfacing is typically performed using posterior or lateral approaches, which involve cutting through or detaching major muscles like the gluteus maximus and the external rotators. This can lead to:

• Increased post-operative pain
• Prolonged rehabilitation
• Weakened joint stability
• Higher risk of dislocation

Despite claims that hip resurfacing enables higher activity levels post-surgery, the muscle damage incurred during the procedure often hinders early recovery and physical performance.

3. Metal-on-Metal Complications

Hip resurfacing relies on metal-on-metal (MoM) components. This design was once considered innovative but has since been largely abandoned in total hip replacements due to serious complications:

• Metal ion release (cobalt, chromium) into the bloodstream
• Adverse local tissue reactions (inflammation, pseudotumors)
• Systemic toxicity affecting organs like the thyroid and heart
• Increased revision rates, especially in women

Many of these issues stem from the wear and corrosion of metal components, which can cause long-term health problems.

The Evidence: Higher Revision Rates with Hip Resurfacing

National joint registries in the U.S., UK, and Australia consistently show that hip resurfacing has a significantly higher failure rate than total hip replacement:

• Revision rates are nearly double those of total hip replacement.
• Women face up to a threefold increased risk of revision.
• Smaller implants correlate with higher failure rates.

These numbers are not just statistics; they represent real patients needing additional surgeries, facing longer recoveries, and enduring more pain.

The Superior Alternative: Anterior Total Hip Replacement

At Palmetto Bone and Joint, we advocate for anterior total hip replacement as the superior option for most patients requiring hip surgery. This advanced technique addresses all the shortcomings of hip resurfacing.

What Is Anterior Hip Replacement?

Anterior hip replacement involves accessing the hip joint through a small incision at the front of the hip. This muscle-sparing approach avoids cutting major muscles and allows the surgeon to work between natural planes of tissue.

Advantages of Anterior Hip Replacement

1. No Risk of Femoral Neck Fracture
   The entire femoral head and neck are replaced, eliminating the possibility of stress fractures.
2. Minimal Muscle Damage
   Unlike the posterior approach used in resurfacing, the anterior method preserves major muscle groups, leading to:
   • Less pain
   • Faster mobility
   • Quicker return to daily activities
3. Faster Recovery
   Most patients:
   • Walk the same day as surgery
   • Go home within 24 hours
   • Resume driving and basic activities in 2–3 weeks
4. Lower Risk of Dislocation
   Preserving the posterior capsule and muscles maintains natural joint stability.
5. No Metal-on-Metal Bearings
   Modern implants use ceramic or highly cross-linked polyethylene, eliminating the risk of metal ion exposure.
6. Long-Term Durability
   Today’s implants last 30 years or more, even in active patients.
7. Easier Revision (if ever needed)
   Should revision ever be required, a primary total hip is far simpler to revise than a failed hip resurfacing.

Final Thoughts: Choose Proven Over Promised

While hip resurfacing is often marketed as a lifestyle-enhancing, bone-saving solution, the truth is it brings significant risks:

• Higher complication and revision rates
• Potential for toxic metal exposure
• Increased pain and recovery from muscle trauma
• Risk of catastrophic femoral neck fractures

Anterior total hip replacement not only avoids these complications but offers superior outcomes, faster recovery, and long-term durability.

At Palmetto Bone and Joint, we believe in treatments backed by science, outcomes, and patient safety. If you’re considering hip surgery, don’t be swayed by trends or outdated techniques. Let us guide you toward a procedure that truly works—and keeps you moving for decades to come.

Ready to take the next step?

Schedule a consultation with our expert hip surgeons and learn how anterior hip replacement can restore your mobility, eliminate your pain, and get you back to the life you love—safely and confidently.