Marc Darrow MD,JD

Many times a patient will come into our office with a stack of MRIs, a post-surgical report, and a promise that they were told that they could resume their running after a hip resurfacing procedure. Unfortunately for them, the surgery did not meet their expectations. Recently published research in the American Journal of Sports Medicine, says “Running is possible after hip resurfacing, and runners can even return to some level of competition, but this short follow-up series of hip resurfacing in athletes should be interpreted with caution regarding implant survival.”(1)

A study from 2019 (2) presented a more optimistic outlook. Here the researchers suggested: “Patients undergoing hip resurfacing improved their preoperative gait pattern of a significant limp to a symmetrical gait at high speeds and on inclines, almost indistinguishable from normal controls. Hip resurfacing with an approved device offers substantial functional gains, almost indistinguishable from healthy controls.”

Lessen Your Expectations as to What Sports You Can Play and at What Level

Now why suggest that patients limit their expectations as to what sports they can participate in when the above study suggests that hip resurfacing can get the athlete back to a level of play nearly indistinguishable from people who did not have hip problems? It is not me, it is surgeins who are saying this:

In the Journal of Bone and Joint Surgery,(3) surgeons warn: “High levels of sporting activities can be detrimental to the long-term success of hip resurfacing devices, independently from other risk factors. Patients seeking hip resurfacing are usually young and should limit their involvement in sports to levels that the implant construct will be able to tolerate.”

A 2021 study (4) sought to predict who would have complication after the hip resurfacing procedure. Specifically they wrote: “Hip resurfacing is used to treat degenerative diseases in the later stages. After surgery, there is a risk of endoprosthesis loosening and low-energy fracture during daily physical activity.”

A December 2020 (5) study suggested “the hip resurfacing may provide a functional benefit in sports and recreation and greater satisfaction in patients who meet the current criteria for hip resurfacing. Because these benefits may be small, pre-operative counseling should focus on balancing the possible functional benefits against the longer-term risks associated with metal-on-metal bearings.”

What is the Difference Between Hip Resurfacing and Hip Replacement?

Hip resurfacing is not hip replacement. In hip resurfacing the head of the femur is capped (after being trimmed) with a smooth metal covering. The damaged bone and cartilage within the socket is removed and replaced with a metal cup, similar to that in a total hip replacement.

In total hip replacement, not only is the head of the femur replaced, but also the socket in the pelvis (acetabulum). One of the main selling points for hip resurfacing is that it leaves more bone so a hip replacement can be performed later.

I see hip resurfacing as one hip surgery setting up another. Surgery in my opinion should always be the last option.

Is Hip Resurfacing Really a Less Invasive Technique?

According to surgeons, hip resurfacing is more difficult to perform and requires a larger incision than typical hip replacement. This increases the risk of complications. For an athlete or a worker whose profession is physically demanding, or any other patient, this can mean unexpected down time and costs.

Does Hip Resurfacing Keep a Younger Patient Active?

Another main selling feature for hip resurfacing as opposed to hip replacement is that studies have shown that it allows the patient to remain more active. However, it is for a limited amount of time. Hip resurfacing has an unknown life span. Thereafter, hip replacement is often necessary. There can be more issues in relation to the soft tissue needed to stabilize the hip:

Doctors in the medical journal Radiographics suggest: “Surgical management for hip disorders should preserve the soft tissue constraints in the hip when possible to maintain normal hip biomechanics.”(6)

This is exactly why we see so many patients after hip surgery. It is too often that the soft tissue that holds the tendons to the bone, or the ligaments that hold the bones to the bones, are compromised. Strengthened ligaments and tendons help hold the hip joint in its proper place, causing less grinding and less bone-on-bone. Restored collagen can help rebuild the cartilage between the pelvis and thighbone, cushioning and relieving the bone-on-bone condition. This is when a consultation for Stem Cell Therapy and Platelet-Rich Plasma Therapy should be considered—and hopefully prior to rather than after surgery: once a prosthesis has been implanted, it is too late to regenerate tissue.

The non-surgical options PRP and Stem Cell Therapy

  • PRP treatments involve collecting a small amount of your blood and spinning it in a centrifuge to separate the platelets from the red cells. The collected platelets are then injected into toe joints to stimulate healing and regeneration.
  • Stem cell therapy involves the use of bone marrow derived stem cells. These stem cells are also injected into to the joint to stimulate healing and regeneration.

The determination of which treatment is used is made during the initial consultation and physical examination of the hip. Afterwards we discuss with the patient the realistic healing options that these treatment can offer them.

Do you have questions? Ask Dr. Darrow

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Stem cell and PRP injections for musculoskeletal conditions are not FDA approved. We do not treat disease. We do not offer IV treatments. There are no guarantees that this treatment will help you. Prior to our treatment, seek advice from your medical physician. Neither Dr. Darrow, nor any associate, offer medical advice from this transmission. This information is offered for educational purposes only. The transmission of this information does not create a physician-patient relationship between you and Dr. Darrow or any associate. We do not guarantee the accuracy, completeness, usefulness or adequacy of any resource, information, product, or process available from this transmission. We cannot be responsible for the receipt of your email since spam filters and servers often block their receipt. If you have a medical issue, please call our office. If you have a medical emergency, please call 911.

1 Fouilleron N, Wavreille G, Endjah N, et al. Running activity after hip resurfacing arthroplasty: a prospective study. Am J Sports Med. 2012 Apr;40(4):889-94. doi: 10.1177/0363546511434564. Epub 2012 Feb 1.
2 Wiik AV, Lambkin R, Cobb JP. Gait after Birmingham Hip Resurfacing: an age-matched controlled prospective study. The bone & joint journal. 2019 Nov;101(11):1423-30.
3 Le Duff MJ, Amstutz HC. The relationship of sporting activity and implant survivorship after hip resurfacing. J Bone Joint Surg Am. 2012 May 16;94(10):911-8.
4 Eremina GM, Smolin AY. Risk assessment of resurfacing implant loosening and femur fracture under low-energy impacts taking into account degenerative changes in bone tissues. Computer simulation. Computer Methods and Programs in Biomedicine.:105929.
5 McLawhorn AS, Buller LT, Blevins JL, Lee YY, Su EP. What Are the Benefits of Hip Resurfacing in Appropriate Patients? A Retrospective, Propensity Score-Matched Analysis. HSS Journal®. 2019 Dec 4:1-1.
6 Smith MV, Costic RS, Allaire R, Schilling PL, Sekiya JK. A biomechanical analysis of the soft tissue and osseous constraints of the hip joint. Knee Surg Sports Traumatol Arthrosc. 2012 Oct 30.

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