Hip Resurfacing Vs. Total Hip Replacement, What’s the difference?

A painful hip can be excruciating. It can stop you from doing activities you enjoy. Walking, running, sitting, driving, playing sports, working, and even sleeping can become agonizing.

While they can both help relieve hip pain, there is a difference between hip resurfacing and hip replacement surgery.

IBJI recently chatted with Dr. Ritesh Shah, a board-certified orthopedic surgeon with fellowship training in joint preservation, resurfacing, and reconstruction. Read on as Dr. Shah explains the difference between hip resurfacing and hip replacement to reduce your hip pain. (His responses—below—have been edited and condensed for space.)

Hip Pain Can Keep You From Living a Full Life

A painful hip can be excruciating. It can stop you from doing activities you enjoy. Walking, running, sitting, driving, playing sports, working, and even sleeping can become agonizing.

Eventually, hip pain can affect your psyche. You might start declining invitations from friends or family to go places because of the long walk required or lack of places to sit. You might limit playing with your kids because of the pain. You might even stop exercising because of the hip pain.

Suddenly, you find yourself in a vicious cycle—more stiffness, pain, limitations, and even weight gain. You don’t have to live with this. There are options to make the hip pain disappear to regain your activity level and quality of life.

Types of Hip Treatment

Several forms of treatment can be used to relieve hip pain. Dr. Shah gives the following examples, “For some patients with a hip labrum tear, a hip arthroscopy with a labrum repair will have them return to their activity. For others, a hip injection under X-ray is enough. For others, a total hip replacement surgery is required. Finally, hip resurfacing may be an option for those who are extremely active and wish to return to being extremely active.”

“If you suffer from hip pain, have advanced osteoarthritis in your hip, are extremely active, and wish to return to being extremely active, hip resurfacing may be the right surgical option,” says Dr. Shah.

What Is a Hip Replacement?

“A total hip replacement is when I remove a femoral head (the ball of the hip joint) and then implant a femoral stem into the thigh with a new smaller ceramic femoral head, and implant a metallic shell with a liner into the acetabulum (the socket of the hip joint),” says Dr. Shah.

What Is Hip Resurfacing?

“With a hip resurfacing, I do not cut the femoral head off,” explains Dr. Shah, “Instead, I shape the femoral head to make it spherical and pegged. Then, instead of a femoral stem in the thigh, I place a metal cap with a short peg on the retained femoral head and implant a metallic shell into the socket.”

“While the socket side of the surgery is not too different, the femur side is drastically different. This means less bone loss from the femur and a more anatomic and normally-sized femoral head.”

The Difference Between Hip Resurfacing and Hip Replacement

Dr. Shah says the main difference between hip resurfacing and hip replacement is the activity level after surgery. “From an activity standpoint, patients who get hip resurfacing can safely have a higher activity level. Most patients that get hip resurfacing are extremely active, including running, high-level racquet sports, skiing, and martial arts, and may have high-demand occupations like firefighters, police officers, and construction.”

“Also, hip resurfacing offers a lower chance of dislocation because the femoral cap is larger and more anatomic,” adds Dr. Shah. “Hip resurfacing is a technically-demanding surgery with a small margin for error that only a few hip surgeons in the Chicagoland area perform. For this reason, most surgeons that perform hip resurfacing also perform total hip replacements.”

“Most surgeons that perform total hip replacements do not perform hip resurfacing. There is additional certification required to be authorized to perform a hip resurfacing. However, not all patients with hip arthritis need or should get a hip resurfacing,” says Dr. Shah.

Why Not Perform Hip Resurfacing on Every Patient?

There are several reasons why you should have one surgery over the other. Every patient is different, meaning what works for one person may not suit another.

“You should not have a hip resurfacing if you have a metal allergy or sensitivity, kidney problems, weaker bones, smaller bones, abnormal anatomy, significant leg length difference, or are not highly active. In these cases, a total hip replacement may be a better option for you.”

Dr. Shah shares more about the difference between hip resurfacing and hip replacement surgery: “Both hip resurfacing and total hip replacement can be performed safely as an outpatient procedure and have similar recovery times. While there are many types of hip replacement products, the Birmingham hip resurfacing is the only product approved for a hip resurfacing procedure. It has a good track record worldwide.”

Ritesh Shah, MD, FAAOS

Ritesh Shah, MD, FAAOSFellowship Trained Orthopedic Surgeon

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