Hip Arthritis: Resurfacing vs. Replacement

QUESTION: Is there a benefit to hip resurfacing instead of hip replacement in surgery for painful hip arthritis?

ANSWER: Theoretically, resurfacing the worn out ball-and-socket joint of the arthritic hip with metal shells seems like a good "conservative" idea, avoiding throwing away the ball (femoral head) as done in a hip replacement, possibly withstanding running and jumping sports better over time. But early experience with resurfacing in the '80s was disastrous, and recent designs, despite newer materials, are as yet unproven over the long term. What is clear so far is that current resurfacing hip surgery has a higher incidence of complications including hip fracture, loosening of the cemented shell on the femur bone, and metal ion wear particles spread to the entire body via the bloodstream with unknown future consequences. The operation requires a larger incision, more muscle and tendon dissection, likely greater blood loss (increasing the chance of a need for blood transfusions), and a longer period of rehabilitation. Minimal incision, muscle sparing, uncemented total hip replacement with state-of-the-art bearing surface materials remains the gold-standard treatment for painful, disabling hip arthritis for the vast majority of patients.