Last reviewed and updated: September 2026

For patients with advanced hip arthritis, total hip replacement is the most widely performed surgical solution. However, for some active patients with appropriate bone quality and anatomy, hip resurfacing may provide a bone-preserving alternative.

The two procedures are designed to relieve pain and restore function, but they differ in how much natural femoral bone is preserved, the type of implant used, patient-selection criteria, certain surgical risks and the evidence supporting long-term outcomes.

Today, hip resurfacing can include both traditional metal hip resurfacing and newer ceramic hip resurfacing. The most appropriate option depends on the individual patient rather than on one procedure being universally better than another.

What Is Hip Resurfacing?

Hip resurfacing is a bone-preserving form of hip arthroplasty.

Instead of removing the entire femoral head and neck, the surgeon reshapes the femoral head and covers it with a cap. The damaged socket is also resurfaced with an acetabular component.

The femoral head and much of the upper femur are therefore retained.

The Hospital for Special Surgery describes preservation of femoral bone as one of the principal differences between resurfacing and conventional total hip replacement.

This preservation of bone can be particularly relevant in younger patients who may require another hip operation later in life.

What Is Total Hip Replacement?

In a total hip replacement, also called total hip arthroplasty, the damaged femoral head and neck are removed.

A stem is placed inside the femur, a prosthetic ball is attached to the stem and an artificial socket replaces the damaged acetabular surface.

Modern total hip replacement can use combinations of materials including ceramic, metal and highly wear-resistant polyethylene.

Total hip replacement remains the established standard surgical treatment for many patients with advanced hip arthritis and can provide excellent pain relief and functional improvement across a broad range of patient ages and anatomies.

Hip Resurfacing vs Total Hip Replacement: Quick Comparison

What Are the Potential Advantages of Hip Resurfacing?

Preservation of Femoral Bone

The primary structural advantage of hip resurfacing is that the femoral head and neck are preserved rather than removed.

For a younger patient who may eventually require another procedure later in life, maintaining more natural bone can be an important consideration.

Larger Femoral Head Size

Resurfacing retains a femoral head size that is closer to the patient's natural anatomy.

This contributes to joint stability and is one reason resurfacing has historically demonstrated a low dislocation rate.

A 2024 systematic review and meta-analysis of randomized clinical trials comparing hip resurfacing with total hip arthroplasty found no statistically significant differences in revision, infection, aseptic loosening or several functional outcomes, while the resurfacing group had a statistically lower dislocation rate.

See the 2024 systematic review in International Orthopaedics.

Activity Goals

Hip resurfacing is often considered by patients who want to maintain a high level of physical activity.

Some comparative studies have reported higher postoperative activity levels among selected resurfacing patients.

However, this does not mean that every patient with a resurfaced hip should automatically return to running or other high-impact activities.

Return-to-sport recommendations should consider:

• bone healing;
• implant position;
• muscle strength;
• balance and movement mechanics;
• the specific sport;
• the patient's individual risk profile.

What Are the Potential Disadvantages or Risks of Hip Resurfacing?

Hip resurfacing has many of the general surgical risks associated with total hip arthroplasty, including infection, blood clots, nerve injury and the possible need for revision surgery.

It also has considerations specific to the resurfacing technique.

Femoral Neck Fracture

Because the femoral neck remains in place after resurfacing, fracture of this preserved bone is a recognized complication.

This is one reason bone quality and implant positioning are particularly important.

Bone Quality

Patients with significant osteoporosis or other conditions that compromise the femoral head or neck may not be good resurfacing candidates.

Metal Ion Exposure With Metal-on-Metal Resurfacing

Traditional metal hip resurfacing uses cobalt-chromium bearing surfaces.

These implants can release measurable cobalt and chromium ions, and a small subset of patients can develop adverse local tissue reactions.

Careful patient selection, implant positioning and appropriate postoperative monitoring remain important when metal resurfacing is used.

More Limited Candidate Pool

Hip resurfacing is not simply a substitute for total hip replacement in every patient.

Anatomy, bone density, femoral-head condition, diagnosis and other medical factors may make total hip replacement a more appropriate choice.

Who May Be a Candidate for Hip Resurfacing?

Candidacy should be determined individually rather than by age alone.

Factors that may support consideration of hip resurfacing include:

• advanced hip arthritis causing significant pain or functional limitation;
• good femoral bone quality;
• anatomy suitable for resurfacing;
• a desire to preserve femoral bone;
• an active lifestyle;
• realistic postoperative expectations;
• absence of medical or anatomical contraindications.

Traditional metal hip resurfacing has historically produced its most predictable outcomes in carefully selected younger, active men with larger femoral head sizes and good bone quality.

Newer ceramic resurfacing may potentially broaden the population considered for resurfacing, but patients still require careful anatomical and clinical assessment.

Who May Be Better Suited to Total Hip Replacement?

Total hip replacement may be preferable when resurfacing is not appropriate because of factors such as:

• poor bone quality or significant osteoporosis;
• substantial femoral-head damage or deformity;
• anatomy that does not allow reliable resurfacing;
• certain diagnoses affecting the femoral head or neck;
• medical factors that make resurfacing less suitable;
• patient goals that do not provide a meaningful reason to favour a bone-preserving procedure.

Total hip replacement should not be viewed simply as an option for “older or low-demand” patients.

Many younger and highly active patients also achieve excellent results with modern total hip replacement.

Metal Hip Resurfacing vs Ceramic Hip Resurfacing

The principle of preserving the femoral head is similar with both procedures, but the bearing materials are different.

What Does the Current Evidence Say About Ceramic Hip Resurfacing?

Ceramic hip resurfacing is newer than both traditional metal resurfacing and total hip replacement, so its long-term evidence should not be described in the same way.

Read the five-year ceramic hip resurfacing study on PubMed.

You can also read our detailed explanation of the latest five-year ceramic hip resurfacing results.

For more information on the regulatory change, see Ceramic Hip Resurfacing Is Now Licensed in Canada: What This Means for Patients.

How Do Functional Outcomes Compare?

Both procedures can produce substantial pain relief and functional improvement in appropriately selected patients.

A 2024 meta-analysis of eight randomized trials involving 844 patients found no statistically significant difference between hip resurfacing and total hip replacement in several outcomes, including revision rate, infection, aseptic loosening, UCLA activity score and WOMAC score.

The analysis did find a lower dislocation rate in the resurfacing group.

A newer systematic review published in 2026 similarly found that many functional, revision and survivorship outcomes were broadly comparable between resurfacing and total hip arthroplasty, although the underlying studies involved different implants and patient populations.

These findings reinforce an important point:

patient selection is more useful than declaring one operation universally superior.

Can You Return to Sports After Hip Resurfacing?

Return to sport is one of the main reasons active patients ask about hip resurfacing.

Many appropriately selected resurfacing patients return to high levels of activity after recovery.

In a prospective international study of ceramic hip resurfacing, patient activity scores improved significantly and 45% of patients reported returning to high-impact activity at two-year follow-up.

See the international ceramic hip resurfacing study published in The Journal of Arthroplasty.

However, return to high-impact exercise should always be individualized.

The ability to return to running, skiing, tennis, cycling, weight training or other sports depends on the patient's healing, bone quality, strength, implant position and specific activity demands.

Can You Be Active After Total Hip Replacement?

Yes.

Modern total hip replacement is not limited to sedentary patients.

Many people return to walking, hiking, cycling, golf, swimming, strength training and other recreational activities after surgery.

Recommendations regarding repetitive high-impact activities vary according to the implant, patient characteristics and surgeon.

Patients should therefore discuss the specific activities they hope to resume rather than assuming that total hip replacement automatically prevents an active lifestyle.

Is Recovery Faster With Hip Resurfacing or Total Hip Replacement?

Recovery can be similar in many respects because both procedures require surgical exposure of the hip and rehabilitation of the surrounding muscles.

Neither operation should be chosen solely because of an assumption that one always has a faster recovery.

Recovery depends on:

• the patient's preoperative condition;
• surgical technique;
• bone quality;
• muscle strength;
• medical health;
• rehabilitation;
• the patient's activity goals.

With resurfacing, additional caution may be required during the early healing period because the femoral neck has been preserved and is subject to fracture risk.

Which Procedure Has a Lower Risk of Dislocation?

Hip resurfacing generally has a low dislocation risk because it retains a large femoral head diameter.

The 2024 randomized-trial meta-analysis found a statistically lower dislocation rate with hip resurfacing compared with total hip arthroplasty.

Modern total hip replacement has also become increasingly stable through improvements in surgical technique, implant positioning and implant design.

Dislocation is therefore only one factor to consider when selecting a procedure.

What Happens if Hip Resurfacing Needs Revision?

One potential advantage of resurfacing is preservation of the femoral head, neck and femoral canal during the original surgery.

If the femoral resurfacing component later requires revision, conversion to a stemmed total hip replacement may be possible.

However, revision surgery should not automatically be described as “easy.”

Its complexity depends on:

• the reason for failure;
• bone quality;
• whether the acetabular component also needs revision;
• infection;
• bone loss;
• soft-tissue condition.

The benefit is that resurfacing generally preserves more femoral bone before any revision is required.

Which Procedure Lasts Longer?

There is no single longevity number that applies to every resurfacing or total hip implant.

Implant survival depends on:

• implant design;
• patient selection;
• surgical technique;
• component positioning;
• age and activity;
• bone quality;
• reason for surgery.

Modern total hip replacement has extensive long-term evidence spanning decades.

Certain metal hip resurfacing systems also have substantial long-term follow-up in carefully selected patients.

Ceramic hip resurfacing is newer. Current published research reports encouraging outcomes through five years, but longer follow-up is necessary before its long-term durability can be compared with technologies that have been followed for decades.

Is Hip Resurfacing Better Than Total Hip Replacement?

Not universally.

The more useful question is:

Which operation is better suited to this individual patient?

For one patient, preserving the femoral head may provide a meaningful benefit.

For another, total hip replacement may offer a more predictable option because of bone quality, anatomy, diagnosis or other factors.

A treatment decision should consider:

• age;
• bone density;
• femoral-head anatomy;
• severity and cause of arthritis;
• activity level;
• sports goals;
• medical history;
• implant-related risks;
• long-term expectations.

Why Having Access to More Than One Option Matters

One advantage of a comprehensive hip practice is that the treatment recommendation does not have to be built around a single procedure.

Dr. John Antoniou performs:

• metal hip resurfacing;
• ceramic hip resurfacing;
• total hip replacement.

This allows the consultation to focus on which treatment best matches the patient's anatomy, bone quality, medical history and goals rather than trying to make every patient fit one surgical technique.

Frequently Asked Questions

What is the main difference between hip resurfacing and total hip replacement?

Hip resurfacing preserves the patient's femoral head and neck, while total hip replacement removes them and replaces the upper femur with a stemmed implant.

Is hip resurfacing only for young men?

No, but patient selection is important.

Traditional metal hip resurfacing has historically had its most predictable outcomes in younger men with larger femoral anatomy and good bone quality.

Recent ceramic resurfacing research has reported encouraging five-year outcomes in both men and women and across different implant sizes. However, candidacy still depends on bone quality, anatomy, diagnosis and other individual factors.

Can women have hip resurfacing?

Potentially, yes.

Women historically had higher revision rates with some metal-on-metal resurfacing systems, partly associated with smaller component sizes and other factors.

Published ceramic-on-ceramic resurfacing data has reported encouraging outcomes in women, but every patient still requires individual assessment.

Is ceramic hip resurfacing available in Canada?

Yes.

The ceramic resurfacing device used by Dr. Antoniou is now a Health Canada-licensed medical device under Licence #115850. Individual Special Access authorization is no longer required for this licensed device.

Is ceramic hip resurfacing experimental?

Ceramic hip resurfacing is a newer technology than traditional metal resurfacing or total hip replacement.

The device used by Dr. Antoniou is licensed for sale in Canada, and peer-reviewed clinical studies have now reported outcomes through five years.

However, longer-term follow-up remains important because the technology does not yet have the decades of data available for older implant systems.

Does ceramic hip resurfacing release metal ions?

Ceramic-on-ceramic resurfacing avoids the metal-on-metal bearing surface associated with cobalt and chromium ion release in traditional metal resurfacing.

Can I run after hip resurfacing?

Some patients return to running and other high-impact activities after hip resurfacing.

Whether this is appropriate depends on healing, bone quality, implant position, strength and the patient's individual risk profile. Return to high-impact exercise should be discussed with the surgeon.

Can I still be active after total hip replacement?

Yes. Many total hip replacement patients return to a high level of recreational activity. Recommendations for specific high-impact sports vary and should be individualized.

Does hip resurfacing have a lower dislocation risk?

Generally, yes. The larger effective femoral head used in resurfacing provides substantial stability, and randomized-trial meta-analysis has reported a lower dislocation rate compared with total hip replacement.

Is revision easier after hip resurfacing?

Resurfacing preserves more femoral bone, which can be advantageous if conversion to total hip replacement is later required. However, the actual complexity of revision surgery depends on the reason for failure and the condition of the bone, socket and soft tissues.

How long does ceramic hip resurfacing last?

It is too early to provide a decades-long longevity estimate.

A 2025 international multicentre study reported 98% survivorship at five years. Longer-term follow-up is required to establish durability over 10, 15 or 20 years.

How do I know which procedure is right for me?

The decision requires review of your medical history, symptoms, X-rays or other imaging, bone quality, anatomy, activity level and long-term goals.

A consultation can determine whether ceramic hip resurfacing, metal hip resurfacing or total hip replacement is the most appropriate option.