Hip arthritis under 55 is rarely simple wear and tear. In most younger patients the joint was never quite the right shape to begin with: a subtle childhood problem, an impingement, a shallow socket or an old injury has been quietly overloading the cartilage for years. By the time the pain arrives, the surface has worn through while the bone underneath is usually still strong.
That last point matters, because it is the reason resurfacing exists. The operation was developed in Birmingham in the 1990s precisely for active adults in their thirties, forties and fifties whose hips were failing earlier than expected. The common causes of early hip arthritis are set out below; most of them leave a hip that can be resurfaced, and a few do not.
Femoroacetabular impingement is an extra bump of bone on the femoral head or the socket rim that pinches the cartilage with every deep bend. Common in people who played sport hard when young, it is a frequent cause of hip arthritis in men in their forties. The head and socket are usually well formed, which makes these hips good candidates for resurfacing.
A socket that is too shallow concentrates load on a small area of cartilage. Mild dysplasia is often compatible with resurfacing; substantial dysplasia, where the socket is very shallow or the head has migrated, usually favours a stemmed replacement because the socket needs rebuilding.
Perthes disease and slipped capital femoral epiphysis (SUFE) can leave the femoral head misshapen. The decision depends on how much deformity remains: a mildly flattened head can often be resurfaced, while marked residual deformity or a large leg-length difference tends to push the choice towards replacement.
Fractures and dislocations of the hip, inflammatory arthritis, and loss of blood supply to the femoral head (avascular necrosis) all cause arthritis in younger adults. Each is judged on the imaging: what matters is whether enough good bone remains in the head to support a cap.
Worth knowing Joint-preserving operations such as arthroscopy and osteotomy are for hips where the cartilage is still largely intact. This page is about the hip where the cartilage has already gone and the question has become which implant, not whether.
Because a hip implant put in young has to work harder, for longer, in a stronger and more active body. A total hip replacement at 70 will usually outlast its owner. The same operation at 45 is likely to be revised at least once, and the UK data on this are stark: a man who has a total hip replacement in his early fifties faces close to a one-in-three lifetime chance of revision surgery.
The figures come from a 2017 analysis of more than 63,000 hip replacements recorded in UK primary-care and hospital records over twenty years, published in The Lancet. For patients over 70 the lifetime risk of revision was around five per cent. For men aged 50 to 54 it was nearly 30 per cent, and for women of the same age around 15 per cent. Among patients under 60 who did need revision, it came on average less than five years after the first operation.
Every revision is a bigger operation than the one before it: more bone is lost, the implants get longer, and the results get less predictable. So the question for a younger patient is not only "which operation suits me now" but "which operation leaves me in the best position if I need another one at 65". That is the question resurfacing answers.
Resurfacing reshapes and caps the femoral head instead of cutting it off. The neck and the upper femur are untouched, the ball stays its natural size, and the joint keeps its own mechanics. For a younger patient that delivers three things a replacement cannot: bone in reserve, a joint that feels like a hip, and a much easier first revision if one is ever needed.
A resurfacing that eventually wears is revised to a standard total hip replacement, using the bone that was preserved at the first operation. Put simply, the patient's first "replacement" happens at 65 rather than 45, from near-normal anatomy. A worn total hip replacement is revised to a longer, more complex revision implant with less bone to fix it to. The comparison with total hip replacement sets this out step by step.
Because the femoral head is kept at its native size, typically 44 to 56 mm across, the resurfaced hip is far harder to dislocate than a replacement with a small artificial head. Dislocation is one of the commoner early complications of a total hip replacement, and one of the things young, active patients most want to avoid. The large bearing also tolerates deep flexion, squatting and awkward positions: the movements of sport, physical work and parenting.
Most surgeons advise against regular impact sport on a total hip replacement because of wear and loosening concerns. Resurfacing patients are routinely cleared for running, cycling, skiing, climbing and racquet sports once the bone has matured around the cap. The activity question is covered in its own section below.
Takeaway Resurfacing is not a smaller operation than replacement. It is a different strategy: spend the bone as late as possible, and keep the joint's own mechanics for as long as they will last.
Most younger adults with hip arthritis are candidates, because they usually have the two things the operation depends on: strong bone and a femoral head that is still reasonably well shaped. Age itself is never the problem at this end of the range. What is assessed is the state of the hip, and the full assessment is set out on the candidacy page.
The femoral head must have enough good bone to support the cap, without large cysts or areas of dead bone, and the socket must be well enough formed to take the matching cup. Younger patients rarely have a problem with bone density; where there is any doubt, a DEXA scan settles it before a decision is made.
In the metal-on-metal era, smaller femoral heads were the main reason younger patients, particularly women, were turned away. Ceramic hip resurfacing has changed that: the ReCerf implant is made in sizes down to 40 mm, so hips that would once have gone straight to a replacement can now be resurfaced. For younger women there is a dedicated page on hip resurfacing for women, including the questions about pregnancy and metal ions that used to close the conversation.
Plans to have children, a physically demanding job, a sport you are not prepared to give up: none of these rules resurfacing out. Several of them are reasons to prefer it. They do shape which implant is chosen, and the bearing decision is the substance of the consultation.
Takeaway At this age the question is rarely "am I suitable" but "which implant, and how soon".
Almost everything they did before the hip failed. Patients walk on the day of surgery, are usually off crutches within four to six weeks, and return to desk work within six to twelve weeks. Impact sport is cleared individually from around four to six months, once the bone has matured around the implant. The large, native-sized bearing is what makes that range of activity possible.
The practice's patients include distance runners, an Ironman triathlete, skiers, climbers and mountain bikers, alongside plenty of people whose ambition is simply to garden, walk the dog and carry a child up the stairs without thinking about it. What they share is a hip that is not the limiting factor. The week-by-week picture is set out in the recovery guide, and the sporting timeline in the article on running after hip resurfacing.
One honest caveat. The freedom to run does not mean every patient should run a marathon. Impact is phased back in, and the first six months are the period when the preserved femoral neck is protected most carefully. After that, the hip is treated as a hip.
When the femoral head cannot be trusted to carry a cap, or the socket needs rebuilding. Resurfacing only works on good bone, and a small number of younger patients do not have it. In those hips a total hip replacement is not a compromise; it is the safer operation, and modern implants give excellent results in young patients provided the surgeon and patient plan for the long term.
Large cysts, advanced avascular necrosis with collapse, or major deformity from earlier disease can leave too little reliable bone to resurface onto.
A very shallow or migrated socket needs reconstruction that a resurfacing cup cannot provide.
Resurfacing keeps the native neck, so it offers little scope to correct leg length. A stemmed replacement can.
Uncommon in younger adults, but long-term steroid use, inflammatory arthritis and some medical conditions can thin the bone enough to raise the risk of femoral neck fracture.
Where the decision is finely balanced, an experienced resurfacing surgeon is the person to make it, because the judgement is in reading the imaging and knowing how a particular head will behave under a cap. That experience is one of the things worth weighing when choosing a hip resurfacing surgeon.
Most younger patients find out within one consultation whether resurfacing is the right operation for them, and which implant it would be. A recent X-ray is all that is needed to start.
Book a ConsultationThe same as for any patient. Self-pay hip resurfacing with Mr Hussain is offered as a fixed-price, all-inclusive package for a single hip: £12,250 for an Adept metal-on-metal resurfacing and £13,450 for a ceramic ReCerf resurfacing, covering surgeon, anaesthetist, implant, theatre, hospital stay, in-patient physiotherapy and routine follow-up. The initial consultation is £250.
Younger patients are often insured through work, and hip resurfacing is covered by the major UK insurers subject to preauthorisation. The fees page sets out the packages in full and the insurance guide explains the authorisation process. Prices apply to treatment at Royal Orthopaedic Hospital private care (The Woodlands Suite); packages at Priory Hospital Edgbaston and The Harborne Hospital are quoted individually.
For a patient in their forties the more useful comparison is not the price of one operation but the cost of two: a resurfacing now, revised to a straightforward replacement decades later, against a replacement now and a complex revision in between. Framed that way, keeping the bone is usually the economical choice as well as the clinical one.
No. Hip resurfacing was designed for exactly this group: active adults whose hips have failed early. Published series include patients operated in their twenties and thirties with good long-term function. What decides suitability at 35 is not the number but the state of the femoral head, the quality of the bone and the shape of the hip, all of which are assessed on imaging before any recommendation is made.
It may, but no implant put in at 40 can be promised for 50 years, and the honest way to plan is to assume a further operation may one day be needed. The advantage of resurfacing is what happens then: because the femoral head and neck are kept, a resurfacing that eventually wears is revised to a standard total hip replacement from near-normal bone, rather than to a more complex revision replacement.
Often, yes. Arthritis from femoroacetabular impingement usually leaves a well-formed head and socket that resurface well. Mild dysplasia and mild residual deformity from childhood conditions can also be suitable. Substantial dysplasia, severely deformed heads or a large leg-length difference favour a stemmed replacement instead, so the answer depends on the imaging rather than the diagnosis alone.
Not necessarily. Waiting makes sense while symptoms are manageable, but resurfacing depends on the femoral head keeping enough good bone to cap. As arthritis advances the head can develop cysts, flatten and lose bone, and a hip that would have resurfaced well at 45 can become a replacement-only hip by 50. The right time is decided by the state of the joint, not by reaching a particular age.
No. Physically demanding work is one of the stronger arguments for resurfacing in a younger patient, because the large native-sized bearing tolerates heavy loading and awkward positions better than a small-headed replacement, and the risk of dislocation is markedly lower. Most patients return to desk work within six to twelve weeks; heavier manual work is phased back in as the bone around the implant matures.
Yes, if you are under about 60 and reasonably active. Hip resurfacing is performed by a small number of UK surgeons, so a recommendation for total hip replacement often simply means resurfacing was not on the table where you were seen, not that it was considered and ruled out. The only way to know is to have the X-ray read by a surgeon who does both operations. Enough good bone in the femoral head, and a socket that does not need rebuilding, usually means resurfacing is possible; if it is not, you will be told so plainly, and a replacement remains a good operation. A second opinion needs nothing more than a recent X-ray.
If you are under 60 with hip arthritis, the state of your femoral head today decides what is possible. Mr Hussain will review your imaging, tell you plainly whether resurfacing is right for your hip, and which implant he would use.
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