The operation does potentially offer some advantages over total hip replacement in a small number of patients. These are generally males under 55 with higher activity levels. It may also be a reasonable option if you are slightly older but have good bone quality and would be very active. The operation isn’t suitable for women as the failure rate is significantly higher.

The time in hospital and the recovery time are similar to total hip replacement.

The National Joint Registry has an online tool that can estimate the benefit you may gain after surgery, the risk of revision and the risk of death, which you may find helpful. To access this, please click here. This will give you figures for total hip replacement rather than hip resurfacing but is accurate enough to give useful information. I can discuss any differences with you at your consultation.

The risk profile compared to total hip replacement is a little different. It can be broken down into those risks that are the same, those that are less common than in total hip replacement, and those that are more common.

Risks that are the same

Infection 1%

Blood clots 2% in the leg and 0.5% in the lung

These occur at the same rate as described on the total hip replacement page.

Risks that are less common

Dislocation: Around 0.1% compared to just under 1%

Leg length difference. Probably 0.5% compared to 1%

Risks that are more common

Damage to nerves and vessels (0.1%)

Femoral neck fracture: This can occur in 6 per 1000 cases and may be due to an interruption of the blood supply to the area. It also seems to be related to surgeon experience. To my knowledge I have had three cases but the last of these was over 15 years ago. It doesn’t guarantee that it won’t happen again, but it does I think make it less likely. Should it happen a revision procedure to a total hip replacement would be needed.

Adverse reaction to metal debris: All joint replacements generate particulate debris. A hip resurfacing is a metal on metal construction which will generate cobalt and chromium particles. These can cause damage to the surrounding tissues, such that revision surgery is required in 1-2% of patients. I use the Birmingham Hip Resurfacing which has a 13A* rating by ODEP the organisation that determines the quality of hip and knee implants in the UK. This is one of the highest ratings possible.

 Metal on metal hip resurfacing is not to be confused with metal on metal total hip replacements, which were discontinued in the UK in 2010.

Blood Transfusion (less than 5%): Blood transfusion is uncommon after joint replacement, and in my hands the rate runs at less than 5%. We take steps to optimise your blood count before surgery, as the risk of transfusion is higher in those patients with low haemoglobin levels. A few patients with some chronic conditions  (e.g. kidney disease or rheumatoid arthritis) can’t have their blood count normalised and that would be discussed with you before your surgery.

If you don’t want to receive blood, that wish would be respected and documented when you consent for the surgery.

Mortality after hip resurfacing surgery: Patients often ask about the risk of death after a big operation. This is often very difficult to be precise about, but the NCEPOD in the UK had a tool that uses age and general health to give an estimate. The general health is described using something called the ASA score. ASA1 is fit and healthy, ASA2 means you have some other condition e.g. diabetes, but it is well controlled, ASA3 means your general health has a greater effect on your quality of life e.g. COPD limiting your mobility or angina and ASA4 means your health is very poor. It would not be possible to perform surgery at Fulwood Hall if you fall into the ASA4 category. The estimate of your ASA status wouldn’t be finalised until you have your pre-op assessment.

The table below gives an estimated mortality at 30 days for patients undergoing total hip replacement. The risk profile will be the same for hip resurfacing, but patients undergoing this operation are younger and fitter, so only the two highlighted boxes apply.