Hip Resurfacing vs. Total Hip Replacement: Which Is Right...

Orthopedic Surgery · 3 · September 15, 2025

A 42-year-old marathon runner with hip arthritis faces a dilemma: total hip replacement eliminates the pain but most surgeons recommend limiting impact activities. Hip resurfacing — a metal cap placed over the femoral head rather than replacing it — preserves bone stock and allows return to high-impact sports. The Birmingham Hip Resurfacing (BHR), designed by Derek McMinn in the UK, now has 27-year follow-up data.

How Resurfacing Differs from Replacement

In total hip replacement, the femoral head is removed and a stem is inserted down the femoral canal. In resurfacing, the femoral head is shaped and capped with a metal component. The acetabulum receives a standard metal cup. This preserves femoral bone stock, making future revision to a total hip straightforward. The trade-off: resurfacing uses a metal-on-metal bearing, which requires monitoring for metal ion levels.

The Evidence: 27 Years of BHR Data

The Birmingham Hip Resurfacing Registry — the world's largest single-design hip resurfacing database — reports 94% survivorship at 20 years in men and 88% in women (women have smaller femoral heads, which increases metal-on-metal wear). The Australian Joint Replacement Registry confirms that in men under 55, BHR outperforms total hip replacement with 96% survivorship at 15 years.

Who Should Consider Resurfacing

Ideal candidate: Male, under 55, large femoral head (48mm+), desires return to high-impact sports, no renal impairment, no metal allergy.

Not recommended: Female patients (smaller femoral heads = higher wear), cystic bone changes, osteoporosis, renal impairment, known metal hypersensitivity.

In India, hip resurfacing at Kokilaben Mumbai costs $6,000–$8,000. In the UK, where the BHR was designed, it costs £8,000–£12,000 at McMinn Centre Birmingham.

Cost Comparison

| Country | Cost Range (Hip Resurfacing)

| United States | $30,000–$50,000

| India | $6,000–$8,000

| Turkey | $8,000–$12,000

| Mexico | $12,000–$18,000

Key Takeaways

- BHR shows 94% survivorship at 20 years in men — outperforming total hip replacement in the under-55 age group.

- Hip resurfacing preserves femoral bone stock, making future revision straightforward if needed.

- Best for men under 55 with large femoral heads who want to return to high-impact sports.

Compare real-time pricing using our global cost calculator.