If you're weighing total hip replacement against hip resurfacing, the right answer depends on your age, sex, anatomy, and how active you want to stay. Both work — but they don't work equally well for everyone. Our LAOSS hip surgeons walk you through what each procedure actually does, who it's best for, and the trade-offs nobody mentions in the brochure.
Two procedures, very different best-fit patients.
Both procedures treat the same problem: a hip joint worn out by arthritis, dysplasia, or post-traumatic damage. They get there differently.
Total hip replacement (THR / THA) removes the worn-out head and neck of your femur and replaces them with a metal stem topped by a ceramic or metal ball. The arthritic socket is resurfaced with a metal cup lined with polyethylene or ceramic. It's the standard of care for hip osteoarthritis, and outcomes are excellent across virtually every age group and activity level. Modern THR can be done through an anterior, posterior, or lateral approach, and many LAOSS patients go home the same day.
Hip resurfacing preserves your femoral head and neck. Instead of removing bone, the surgeon caps the femoral head with a metal sphere and pairs it with a metal acetabular cup. Because more native bone stays in place, the femoral head ends up close to its normal size — which means a more stable joint with lower dislocation risk and often a more natural feel for active patients.
The catch: resurfacing is a metal-on-metal bearing. Since the early 2010s, FDA scrutiny and registry data have narrowed who's a good candidate — primarily because metal ions can be released into surrounding tissue and bloodstream, and women and smaller patients have shown higher complication rates. Today, resurfacing is best suited to men under 60 with large native femoral heads, normal bone density, and no metal sensitivity. Everyone else does better with THR.
This surgery replaces your damaged hip joint with implants that move like the ball and socket of a healthy hip. A total hip replacement can restore your hip function and reduce your pain.
Animations licensed from ViewMedica · Swarm Interactive
The hip is a ball-and-socket joint. The 'ball' is the femoral head, the 'socket' is the acetabulum. THR replaces both sides of the joint with a stemmed metal implant and a polyethylene-lined cup. Resurfacing keeps the femoral head and neck intact, capping the ball with a metal sphere and resurfacing the socket with a metal cup. How much native bone is preserved is the biggest anatomical difference between the two operations.
Deciding between THR and resurfacing isn't a coin flip — it's a series of specific questions our hip surgeons answer at your evaluation.
The exam: Where exactly is the pain? Groin and lateral hip pain pointing toward intra-articular disease, or buttock pain that might be lumbar in origin? How much internal rotation is left? Is the leg shortened? Is there a meaningful Trendelenburg gait?
Imaging: Weight-bearing AP and lateral X-rays show the joint space, the femoral head shape, the acetabular coverage, and any cysts or bone loss. For resurfacing candidacy specifically, we measure femoral head size, look for cysts in the head and neck, and assess overall bone quality. Patients with large head cysts or poor bone density aren't resurfacing candidates.
Patient profile: Age, sex, activity goals, and any metal sensitivity history all factor in. We'll order metal ion baseline testing in some cases. We talk through what "return to activity" actually means for you — there's a difference between wanting to walk pain-free and wanting to keep running marathons at 55.
Most LAOSS patients leave their first evaluation with imaging in hand, a clear diagnosis, and a written plan that names both options when both are reasonable.
Both paths start with the same conservative-care foundation. Where they diverge is the surgical decision — and that decision depends much more on who you are than on which procedure sounds better.
A narrow profile, but a good fit when it applies. We screen carefully — not every active patient is a resurfacing candidate.
The default for the vast majority of hip arthritis patients — and the right call in many situations where resurfacing once seemed appealing.
The biggest anatomical difference between THR and resurfacing — and the trade-off you weigh against everything else.
Resurfacing keeps your femoral head and neck. The surgeon caps the ball with a metal sphere instead of removing it. For a 50-year-old who may need another procedure decades from now, that conserved bone matters.
THR removes the femoral head and neck and replaces them with a stemmed implant. You give up bone, but you gain universality — THR works for almost any patient anatomy, age, or activity level.
Day-to-day recovery is similar. Where the procedures differ is the ceiling of activity you can push toward at the end of rehab.
Most LAOSS THR patients walk the day of surgery, drop the walker within 2-3 weeks, and return to normal life inside 6-12 weeks. Same-day discharge is possible for many.
Early recovery looks similar to THR. Where it diverges is what we let you do at the 6-month mark and beyond — resurfacing patients can usually push back to higher-impact sport.
Both implants are designed to last decades. But registry data and patient profile drive different real-world outcomes.
Modern THR implants — highly cross-linked polyethylene on ceramic or metal heads — show 90%+ survivorship at 15-20 years in registry data.
When properly indicated (right patient, right implant, experienced surgeon), modern resurfacing shows comparable survivorship at 10-15 years. Outside ideal candidacy, results drop sharply.
Hip implants of both kinds are revisable. The key is catching the problem early — which is why LAOSS surgeons want you in for surveillance even when you feel fine.
Hip arthroplasty is one of the most volume-sensitive procedures in orthopedics. Surgeon volume predicts outcome more reliably than implant brand or surgical approach.
We do both procedures — but we recommend resurfacing only when the patient truly fits the profile. The default is THR because THR is the right answer for most people.
If most of the items in either column match your situation, an evaluation with a hip specialist is the next step. Many patients qualify for THR but not resurfacing — that's the norm, not the exception.
A narrow but real group of patients does very well with resurfacing — typically younger, larger-framed, active men.
Most hip arthritis patients fall here — and THR isn't a compromise, it's the gold standard for nearly all comers.
Whether you choose THR or resurfacing, the first 8 weeks look similar. The differences show up around the 4-6 month mark when we clear higher-impact activity.
Most patients are walking with assistance the day of surgery. The first two weeks focus on pain control, wound healing, and restoring basic motion.
Structured PT rebuilds gait, strength, and confidence. Most patients are walking unaided by 4-6 weeks and back to desk work within the same window.
Once function is restored, the focus shifts to long-term activity goals — and that's where THR and resurfacing diverge.
Both procedures carry standard surgical risk plus a small set of risks specific to the bearing surface and the approach. We talk through all of these at your evaluation — informed consent is a conversation, not a form.
Every hip arthroplasty carries the same baseline risks. We screen, prepare, and monitor for these on every patient.
Resurfacing carries risks that THR does not — these are the reasons FDA indications have narrowed and the reasons patient selection matters so much.
Dr. David Barba and Dr. Erik Dworsky are LAOSS's hip & knee surgeons — they perform both total hip replacement and, in carefully selected patients, hip resurfacing. Dr. Sevag Bastian handles sports-related hip pathology, including labral tears and femoroacetabular impingement that can feed into the surgical decision later.
We don't push every younger patient toward resurfacing because it sounds appealing — and we don't default every patient over 60 to THR without thinking. The right answer comes from a real evaluation with the right imaging in hand. Most patients leave their first LAOSS visit with both options named, the trade-offs explained, and a clear recommendation grounded in their specific anatomy and goals.
Highly recommend Dr. Dworsky for hip replacement. Patient, thorough, and the recovery has been ahead of schedule. So glad I came here.
Book a visit with a LAOSS hip surgeon at any of our eight Los Angeles–area offices. Bring your imaging if you have it — we'll tell you which procedure actually fits, and which doesn't.
