Hip resurfacing is rarely a snap decision, but a few questions will tell you whether a proper assessment is worth your time. If most of these land as yes, the answer is almost certainly that it is.
The sections that follow explain what sits behind each of those questions and where the genuine boundaries lie.
Hip resurfacing was developed in the 1990s for active adults in their thirties, forties and fifties whose hips were failing earlier than expected. The centre of gravity is still there today, but the edges have moved. Patients under sixty-five with osteoarthritis remain the classic profile. Patients in their late sixties and seventies are increasingly considered where the bone is good and where the patient genuinely wants to keep an active life, because the long-term registry data in this group has been reassuring.
The sex question is bound up with the bearing rather than with eligibility in itself. In the metal-on-metal era, women had worse outcomes from resurfacing, mainly because smaller native head sizes drove higher wear and a greater rate of adverse reaction to metal debris. Today the question is which bearing suits a particular woman, not whether resurfacing is on the table at all. The dedicated page on hip resurfacing for women covers this in detail.
Takeaway Age is a guide, not a cut-off. Sex shapes the bearing, not the eligibility.
Resurfacing leaves the native femoral head and neck in place. The implant is supported by the patient's own bone, and the long-term result depends on that bone being good enough to carry the load. Patients with significant osteoporosis are not suitable for resurfacing, because the supporting bone is too weak to hold the cap reliably and the risk of femoral neck fracture rises.
Cystic changes in the femoral head, large areas of dead bone from avascular necrosis, or marked bone destruction from inflammatory arthritis are all important warning signs. Where bone quality is uncertain, a DEXA scan and a careful imaging review settle the question before any commitment is made. Most patients clear this assessment without difficulty.
Takeaway Good bone is non-negotiable. We image and assess before we decide.
The shape of your hip determines what is possible. A native femoral head of reasonable size, a well-formed socket and an absence of significant deformity make for a straightforward resurfacing. Substantial dysplasia, severely cystic heads, residual deformity from a childhood slipped capital femoral epiphysis, or a large pre-existing leg-length discrepancy all complicate the picture and may push the decision towards a stemmed replacement instead.
Head size used to decide the question outright. In the metal-on-metal era, small native heads ruled patients out because of the wear penalty that came with smaller bearings. The arrival of ceramic-on-ceramic resurfacing has reopened the operation for patients who would previously have been told no. Many of those patients are women; some are simply men with smaller frames.
Takeaway Anatomy decides the conversation. The H1 implant has widened the door.
Hip resurfacing is an operation for people who want to keep moving on their own anatomy. The patients who benefit most are those who want to walk briskly without thinking about it, cycle, hike, play golf or racquet sports, garden without paying for it the next day, and travel without their hip dominating the trip.
Some patients want more, including running, skiing, mountain biking and martial arts. Resurfacing supports those goals better than a stemmed replacement, because the joint feels closer to native and the large bearing diameter forgives more in extreme positions. If your goal is mostly comfortable daily life without impact sport, a standard hip replacement is also an excellent answer and may be the simpler choice. The honest test is what you want the operation to give back to you.
Takeaway Resurfacing is built around active lives. Match the implant to the life you want.
Surgery has its own demands, and patients need to be fit enough for the anaesthetic and the early recovery. A small number of specific conditions matter more for resurfacing than for total hip replacement.
Moderate or worse kidney impairment rules out metal-on-metal bearings, because the body cannot clear cobalt and chromium ions efficiently. Known significant metal allergy similarly rules out metal-on-metal, though neither problem affects the ceramic implants. Active joint or systemic infection needs treating and clearing before surgery is considered. Pregnancy and current child-bearing intention rule out metal-on-metal in this practice, in line with MHRA guidance; ceramic bearings remove that constraint.
Most patients clear this section without difficulty. The point of raising it is honesty about where the boundaries sit, so that patients who do have a relevant condition know to discuss it openly at consultation.
Takeaway General health shapes which bearing is safe. For most patients, more than one implant option remains on the table.
For most candidates today, the question has shifted from "can I have hip resurfacing" to "which implant suits me best". The choice depends on the same factors that decide eligibility: head size, sex, bone quality, lifestyle, and the patient's own feelings about metal versus ceramic.
The Adept metal-on-metal cap remains the right answer for active men with larger native heads and good bone, where decades of registry data confirm long-term success. The ReCerf ceramic-on-ceramic implant has become the default modern choice for most candidates, men and women alike, and is the bearing under most active discussion in current literature. The H1 ceramic-on-ceramic implant, developed at Imperial College London, is a newer ceramic option in the field.
Takeaway Three implants, one decision. Choosing the right one is the substance of the consultation.
The six dimensions interact. Few patients arrive perfect on all of them; most candidates are strong on four or five and have a complicating factor or two. The work of the consultation is to weigh them together honestly and recommend whether resurfacing is the right operation, and if so, which bearing.
Most patients who come in with active hip arthritis and a question about resurfacing leave with a clear answer. Either it is yes, and here is the implant we would use, or it is no, and here is why a standard hip replacement is the better operation for you. Both answers are useful, and either is preferable to uncertainty.
A small number of situations rule out resurfacing entirely, regardless of which implant is being considered.
Many patients worry that they fall into one of these categories and turn out not to. That is the most important reason to seek a formal assessment rather than to assume.
The assessment is straightforward. An initial consultation covers your history, the pattern of your pain, your activity goals, and any relevant medical background. A clinical examination of the hip follows. Weight-bearing AP and lateral hip radiographs are reviewed, with a CT scan where templating or anatomy makes that useful. A DEXA scan is arranged where there is any question about bone density. Blood tests cover general fitness for anaesthesia.
The conversation that follows is frank. You will be told whether hip resurfacing is the right operation for you, and if so, which bearing fits. A second opinion is welcomed, not discouraged — and our guide to choosing a hip resurfacing surgeon sets out the questions worth asking whoever you see. Most patients reach a clear decision in one consultation; some prefer a second visit to think it through.
Not necessarily. Age is one of the six factors, but it is not the deciding one. Patients in their late sixties and seventies are considered where the bone is good and the patient is genuinely active. The honest answer comes from the imaging and the conversation, not from a birthday.
Often, yes. The clinical picture for hip resurfacing has changed materially with the arrival of the H1 and ReCerf ceramic implants. Patients who were correctly told no in the metal-on-metal era may have a different answer today. A second opinion is welcomed.
Yes, and many do. The ceramic implants have reopened the operation for women who were previously advised against it. The dedicated page on hip resurfacing for women covers this in detail.
Bilateral hip arthritis is common in resurfacing candidates. Both hips can be resurfaced. The usual approach is to treat one side first, recover, and treat the second side a few months later. In selected patients a single-sitting bilateral resurfacing is possible, and this is discussed individually.
For most well-selected patients, yes. Running is realistic, usually from around six months, with a graduated build. The larger bearing diameter and the preserved native anatomy support a return to impact that a standard hip replacement does not encourage in the same way.
Resurfacing leaves the upper femur intact. If revision ever becomes necessary, the operation converts to a straightforward standard hip replacement with the stem set into a femur that has never been opened. That option, kept in reserve, is one of the structural advantages of the operation.
The most useful next step is a private consultation with imaging review. You will be told plainly whether hip resurfacing is the right operation for you, which bearing would suit, and what realistic recovery looks like.
Book a Consultation