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Love for sports can take a toll on aging bodies, with deteriorating joints leading to painful osteoarthritis, especially in the hip. For hardcore athletes and weekend warriors, a total hip replacement often limits participation in high impact or intense physical activities.

However, a surgical procedure called Birmingham hip resurfacing — an appealing alternative to total hip replacement for people in their 30s, 40s or 50s — is much more likely to allow patients to remain highly active, even many years after the procedure, according to long-term data from Washington University School of Medicine in St. Louis.

The research was published recently in The Journal of Bone and Joint Surgery.

Birmingham hip resurfacing, named after the city in the United Kingdom where it was first performed, often is preferred by young, very active patients over total hip replacements, because it has a proven track record of returning patients to highly competitive levels of athletic activity. , the Charles F. and Joanne Knight Professor of Orthopaedic Surgery at WashU Medicine, analyzed long-term outcomes for 224 patients ages 35 to 59 who had hip resurfacing at Barnes-Jewish Hospital from 2006 to 2013. Both the number of patients and their rate of participation — 93% of those contacted — are extraordinarily high for a single-institution study of this type.

“Compared with a total hip replacement, three times as many patients who had hip resurfacing successfully returned, 5 to 10 years later, to running and cutting sports — those requiring rapid turns and shifts, such as basketball and tennis,” said Barrack. “Remarkably, almost all are still active — an average of 14 years after surgery.”

Barrack is one of the country’s foremost experts in hip resurfacing and was the first surgeon to perform the Birmingham hip resurfacing procedure in the U.S., in 2006. Despite the extra precision demanded by the procedure, the surgery also had a comparably low complication rate to standard hip replacement, with only 4% of patients requiring follow-up surgery on their joint for any reason at 15 years or beyond, which is a rate that is as or good as or better than published results for any standard hip replacement.

Validating success

Total hip replacement implants a ball and socket mechanism anchored in the pelvis in place of the original hip joint, a process that requires the femoral head (the top end of the thigh bone) to be removed in order to attach the bone to the device. In contrast, hip resurfacing retains the form and function of the original joint. The top of the femur is retained but reshaped to fit a metal-alloy cap that is the same size as the original femoral head and that forms a joint with a metal socket attached to the pelvis. Because the procedure retains much more of the femoral bone, the surgery better preserves normal weight distribution at the hip and the likelihood of retaining very high activity levels.

The hip resurfacing procedure is typically recommended to middle-aged men rather than women because the smallest cap is slightly less than 2 inches across, which is too large to fit on the femurs of most female patients. The procedure is highly technical and demanding of a surgeon’s skills because, if not well aligned, the implanted joint components can create friction with each other that can increase the level of metal ions in the blood.

Barrack has observed dramatic examples of the procedure’s success. His first patient from 2006, for instance, was a youth soccer coach who went on from his surgery to win gold at several track and field events in the Senior Olympics (for athletes 50 and over) and continued in competitive sports for over a decade.

To get a more-complete look at patients’ outcomes, Barrack’s team collected medical histories for all the participants, as well as questionnaires about their current level of physical activity, to compare against the information they reported about themselves at the time of their original surgery.

Approximately 60% of hip resurfacing patients rated themselves as highly active — a 9 or 10 on the 10-point scale — five to 10 years after their operation, compared to 20% of hip replacement patients.

The study also demonstrated that the surgery has a good track record in the long term: fewer than 4% of the patients who had their hips resurfaced required follow-up procedures for any reason, including for metal ion levels, pain or joint component wear, even 15 years after the procedure. This is as good or better than any hip replacement.

“We accomplished something that very few centers do, in that we were able to do follow-up with 93% of our patients, from an average of 14 years out from their surgeries up to 18 years,” explained Barrack, crediting his team’s dedication to ensuring that his patients are well cared for and followed over time.

Skating around the pain

Jason Cutter, 50, a recent patient of Barrack’s who had his left hip resurfaced in 2024, said he wishes he had had the procedure five years ago.

An active athlete and outdoorsman who remodels houses as a sideline to his career in sales, Cutter said that he’d been feeling discomfort and pain in his hips for years, but attributed his aches to age, insufficient stretching, and strain from the heavy tool belts he wore while on work sites.

Realizing these changes were limiting the activities he could do, Cutter reached out to the people he knew with expertise in joint pain: the former professional hockey players who he skates with in a recreational league. They urged him to contact Barrack’s office.

Three months after the resurfacing procedure, he was cleared to get back on the ice. “I’m squatting, I’m doing all my leg exercises. I’m stretching — I feel fantastic,” said Cutter.

Zuke WA, Hannon CP, Kromka J, Granger C, Clohisy JC, Barrack RL. Long-term results of the Birmingham hip resurfacing implant in the United States: An updated analysis of a single institution’s experience. The Journal of Bone and Joint Surgery. Feb. 5, 2025. DOI: .

is a global leader in academic medicine, including biomedical research, patient care and educational programs with 2,900 faculty. Its National Institutes of Health (NIH) research funding portfolio is the second largest among U.S. medical schools and has grown 56% in the last seven years. Together with institutional investment, WashU Medicine commits well over $1 billion annually to basic and clinical research innovation and training. Its faculty practice is consistently within the top five in the country, with more than 1,900 faculty physicians practicing at 130 locations and who are also the medical staffs of and hospitals of . WashU Medicine has a storied history in MD/PhD training, recently dedicated $100 million to scholarships and curriculum renewal for its medical students, and is home to top-notch training programs in every medical subspecialty as well as physical therapy, occupational therapy, and audiology and communications sciences.