Hip Resurfacing

The ideal candidate is a young (under 55-65), active male with good bone quality (DEXA T-score greater than -2.5), large femoral head (greater than 48mm), adequate renal function (GFR 60 or greater), and arthritis limited to the hip joint surfaces. Patients with osteoporosis, small femoral heads, femoral head cysts greater than 1cm, short femoral necks, renal disease, or metal allergy are not candidates. Males show 96.5% survival at 20 years versus 87% for females, which is why most surgeons preferentially recommend resurfacing for male patients.

Resurfacing preserves more bone, has virtually zero dislocation risk (versus 1-3% for THR), requires NO post-operative motion restrictions, allows higher activity levels, and provides more natural proprioception. In patients under 55, resurfacing shows a significant mortality benefit (1.6% versus 8.9% all-cause mortality). However, it has narrower patient selection criteria, metal ion monitoring requirements, and is not suitable for women, osteoporotic patients, or those with renal impairment. If resurfacing fails, conversion to THR is straightforward since bone stock is preserved.

Metal-on-metal hip resurfacing releases small amounts of cobalt and chromium ions into the bloodstream. Per MHRA 2017 guidance, blood levels are monitored at 1 year, 7 years, then every 3 years. The critical threshold is 7 micrograms per liter—levels above this trigger cross-sectional imaging (MARS MRI) to check for adverse tissue reactions. Most well-positioned BHR implants maintain ion levels well below 2 micrograms per liter. With proper patient selection and surgical technique, ARMD rates are 1-2%. Ceramic hip resurfacing (H1) received MHRA approval in 2025, potentially eliminating metal ion concerns for future patients.

Hip resurfacing allows higher activity levels than traditional THR with NO motion restrictions post-operatively. 85-93% of patients return to pre-operative sporting activities including running, cycling, hiking, skiing, tennis, and recreational sports. The larger head size provides virtually zero dislocation risk during athletic activities. However, during the first 14 weeks (femoral neck fracture risk window), impact activities should be avoided. Long-term, moderation of repetitive high-impact loading is advised to preserve the implant.

If resurfacing fails (loosening, adverse metal reaction, or femoral neck fracture), revision to a standard total hip replacement is performed. Because resurfacing preserves the femoral canal and more bone stock, the revision is straightforward and outcomes are equivalent to primary THR. Published data confirms no disadvantage to the 'resurfacing first, THR if needed later' strategy. This bone-preserving aspect is the primary rationale for choosing resurfacing in younger patients who face the prospect of multiple revisions over their lifetime.

Generally, hip resurfacing is not recommended for most women. Female patients show significantly lower 20-year survival (87% versus 96.5% for males), likely due to smaller femoral head sizes, higher rates of osteopenia/osteoporosis, and different hip biomechanics. Women of childbearing age have an absolute contraindication due to potential metal ion teratogenicity. Select postmenopausal women with large femoral heads (greater than 46mm), excellent bone density, and no metal sensitivity may be considered on a case-by-case basis, but THR remains the standard recommendation for female patients.

A minimum stay of 2-3 weeks post-surgery is recommended, comprising 3-5 days hospitalized followed by 10-14 days nearby for wound checks, suture removal, and initial physical therapy. Extended stays provide direct access to the surgical team for any early complications. Most patients are walking independently before departure, and telemedicine follow-up is available for continued coordination with the Thai surgical team and metal ion monitoring protocols.

Confirmed availability includes Vejthani Hospital (CCPC-accredited joint center, 5,500+ minimally invasive joint surgeries), MedPark Hospital (BHR explicitly listed, ROSA robotic surgery, Dr. Siripong hip specialist), and Piyavate Hospital (Dr. Thanadet BHR-trained surgeon, computer navigation). Bangkok Hospital is likely available with advanced navigation equipment. Costs range from $10,000-$18,000 depending on implant choice and complexity; confirm final pricing directly with the hospital. Verification of surgeon experience with resurfacing technique specifically is recommended.