Which procedure is likely right for you

Three variables tend to decide which operation makes most sense: your age, the quality of your bone, and how physically active you plan to be once you have recovered.

If you are under 60 to 65, have good bone density, and want to return to high-impact sport or a demanding physical lifestyle, hip resurfacing is worth a serious conversation with your surgeon. The procedure preserves the femoral head rather than removing it, which keeps your options open for the future and produces a joint with markedly lower dislocation risk.

If you are older, have osteoporosis or reduced bone quality, or are a woman of childbearing age, total hip replacement (THR) is almost certainly the more appropriate route. THR has a longer evidence base, suits a far wider range of patients, and is not constrained by the bone-stock requirements that govern resurfacing.

A third option — SPAIRE, a muscle-sparing variant of total hip replacement — suits patients who are not suitable for resurfacing but want to minimise soft-tissue disruption and support a faster early recovery.

None of these procedures is right for everyone. Individual anatomy, overall health, and personal goals all feed into the decision, and a specialist assessment is needed to weigh them properly. Lincolnshire Hip offers access to all three options through a single clinical pathway, with consultations available locally in Sleaford and Grantham.

What each operation actually involves

Structurally, the three operations differ in a single key question: how much of your own bone does the surgeon keep?

Hip resurfacing

The femoral head (the ball at the top of your thigh bone) is trimmed and shaped, then capped with a close-fitting metal component. The acetabulum (the socket in your pelvis) is lined with a matching metal cup. Nothing is removed from the femoral shaft below, and the femoral neck — the column of bone connecting the ball to the rest of the thigh bone — is left entirely intact. Because the cap closely matches the natural femoral head, the resulting bearing diameter is approximately 44–56 mm, similar to the original joint.

Standard total hip replacement

Here, the surgeon removes the femoral head and neck entirely and inserts a metal stem down the femoral shaft (the central canal of the thigh bone), anchoring an artificial ball on top. The socket is resurfaced in the same way as in resurfacing surgery. The new ball is smaller than the natural femoral head.

SPAIRE (muscle-sparing total hip replacement)

SPAIRE follows the same bone-removal steps as standard THR but uses a surgical approach that carefully preserves the muscles and tendons surrounding the hip joint, rather than cutting through them. The difference is in soft-tissue handling, not in what happens to the bone.

| | Femoral head | Femoral neck | Soft tissue | Bearing size | |---|---|---|---|---| | Resurfacing | Capped | Preserved | Standard approach | ~44–56 mm | | THR | Removed | Removed | Standard approach | Smaller | | SPAIRE THR | Removed | Removed | Muscle-sparing | Smaller |

All three operations address the same underlying problem — loss of cartilage in the hip joint — but they reach the solution by different anatomical routes.

The patient profile that suits hip resurfacing

The classic resurfacing profile is a patient under 60 to 65 years old with strong, healthy bone stock, a primary hip osteoarthritis diagnosis, and a clear intention to return to demanding physical activity — including competitive or high-impact sport — after surgery. Larger bone size is also relevant: historically, the procedure has been better suited to patients with a broader femoral head, which gives the surgeon more working bone to shape and cap.

Who is typically excluded

Two contraindications carry particular clinical weight.

• Poor bone density or osteoporosis. If you have been told your bone density is low, or if osteoporosis has been identified on a scan, resurfacing is generally not appropriate — the trimmed femoral head needs to be strong enough to support the metal cap over the long term.
• Women of childbearing age. The bearing surface in hip resurfacing is metal-on-metal. Although ion release levels are generally low, clinical guidance advises against resurfacing in women who may become pregnant, as a precaution around theoretical fetal exposure.

Historically, women have also shown lower implant survivorship in resurfacing overall — 8-year survival rates of around 89.6% in earlier cohorts. A high-volume retrospective study found that refined surgical technique improved that figure to 97.7%, significantly closing the gap with male patients. This does not remove the need for individual assessment, but it does mean women should not assume resurfacing is automatically ruled out without a detailed discussion.

The age question — and what 2025 evidence changes

The under-65 guideline is well established, but a 2025 study of 395 patients aged 65 and over found no difference in 10-year (98.6%) or 16-year (98.2%) implant survivorship compared with younger patients — results that exceed NICE benchmarks for total hip replacement. A separate propensity-matched study the same year found that carefully selected resurfacing patients over 65 reported higher function scores and lower pain at one year than matched THR patients.

Those findings do not mean resurfacing is the right choice for every active older patient. They do mean that age alone should not close the conversation before a specialist has assessed bone quality, anatomy, and physical goals.

When total hip replacement is the right route

THR remains more appropriate for patients with advanced or diffuse hip osteoarthritis (Tönnis grade 3), poor bone quality, significant deformity, or anatomy that makes femoral head preservation impractical. UK cost-effectiveness analysis confirms THR holds the advantage in these presentations.

What the long-term evidence shows on outcomes

The dislocation advantage is the most clearly quantified difference between the two operations in current evidence. A 2025 network meta-analysis drawing on 72 studies and nearly 794,000 patients found that standard total hip replacement carried a dislocation rate 13.45 times higher than hip resurfacing — a difference the authors attributed to the larger bearing diameter used in resurfacing, which closely matches the natural femoral head. The same analysis found no significant difference in overall complication rates or functional outcomes between the two approaches at short-to-medium term follow-up.

On implant survivorship, a large single-surgeon series of 6,114 metal-on-metal hip resurfacing cases reported 19-year Kaplan-Meier survivorship of 97.5% overall — the authors describe it as among the best long-term survivorship data published for any hip arthroplasty. Results of this kind compare favourably with leading total hip replacement registry benchmarks, though surgeon volume and refined technique are widely acknowledged as material factors; access to a high-volume centre matters when weighing the options.

From a UK health-economic standpoint, resurfacing has been calculated at £17,451 per quality-adjusted life year (QALY) gained in the first year — below the standard £20,000 willingness-to-pay threshold applied by NICE — supporting its use for appropriately selected patients. Where selection criteria are not met, particularly in advanced-grade (Tönnis grade 3) disease, total hip replacement remains more cost-effective by the same analysis.

Total hip replacement carries a longer overall track record across all age groups and continues to be the appropriate choice for the majority of patients presenting with hip osteoarthritis. The survivorship and dislocation data for resurfacing are genuinely strong, but they apply to carefully selected cases rather than the general hip replacement population.

Accessing hip surgery through Lincolnshire Hip

For patients in Lincolnshire weighing up the options covered in this article, the Lincolnshire Hip Clinic offers access to all three procedures — hip resurfacing, total hip replacement, and SPAIRE — through a single coordinated private pathway. The service sits within the MSK Doctors group and holds clinics at MSK House in Sleaford and The Keep in Grantham, meaning most patients in the county have a local consultation point within reasonable reach.

The pathway is structured around the practical realities of accessing specialist hip surgery outside London. Initial assessment, pre-operative imaging, and follow-up appointments take place in Lincolnshire; surgery itself is performed at Weymouth Street Hospital in London, with patients returning home for post-operative recovery and physiotherapy locally. The all-inclusive cost is £17,800, covering consultation, the procedure, and unlimited post-operative physiotherapy — with no itemised billing for individual components.

Professor Paul Lee leads the clinical pathway and carries expertise across resurfacing, standard THR, and the SPAIRE muscle-sparing technique. At the initial consultation he assesses which of the three options — if any — is appropriate given a patient's bone quality, anatomy, and activity goals. No GP referral is needed to book an initial hip assessment.

Questions worth raising at your consultation

Arriving at a first consultation with a few prepared questions tends to produce a more useful conversation than waiting to be told what to do.

• Am I a candidate for hip resurfacing — and if not, which factor rules it out: my age, my bone quality, or something else?
• What are your own revision and complication rates for the procedure you are recommending?
• If resurfacing is not appropriate for me, is a SPAIRE muscle-sparing approach worth considering alongside standard hip replacement?
• What activity level is realistic at 12 months, and does that change meaningfully between the options?
• If I ever need revision surgery in the future, how does each procedure affect what that involves?

None of these require a decision on the day. For younger or more active patients in particular, that last question — which procedure keeps the most surgical options open if anything changes down the line — tends to be the one that shapes the direction of the consultation most clearly. Bringing it early is rarely a wrong move.

1. [1] Uncemented hip resurfacing in patients over 65: 16-year outcomes from a large, single-surgeon series. (2025). https://doi.org/10.1007/s12306-025-00929-2 https://doi.org/10.1007/s12306-025-00929-2
2. [2] Total Hip Arthroplasty vs Hip Resurfacing in Patients Over 65: A Propensity Score–Matched Comparison. (2025). https://doi.org/10.1016/j.artd.2025.101721 https://doi.org/10.1016/j.artd.2025.101721
3. [3] Hip resurfacing arthroplasty reduces dislocation and infection rates without differences in clinical outcomes compared to short and standard stems: A Network Meta-Analysis. (2025). https://doi.org/10.1016/j.otsr.2025.104239 https://doi.org/10.1016/j.otsr.2025.104239
4. [4] Outcomes of metal-on-metal hip resurfacing arthroplasty: a single-surgeon series of 6114 cases with 2–19 year follow-up. (2025). https://doi.org/10.1186/s13018-025-06076-5 https://doi.org/10.1186/s13018-025-06076-5
5. [5] Interventions for Improving Hip Resurfacing Outcomes in Women: A High-Volume, Retrospective Study. (2017). https://doi.org/10.1016/j.arth.2017.06.003 https://doi.org/10.1016/j.arth.2017.06.003