Types of hip surgery: which one do you need?

This guide is for people with hip pain who are trying to understand which operation a surgeon might suggest and why. It describes each type of hip surgery, who it typically suits, and how recovery compares, using figures from the American Academy of Orthopaedic Surgeons, Canadian and provincial health sources, joint registries, and peer-reviewed studies. Your surgeon decides which procedure, if any, fits your hip.

What are the main types of hip surgery?

Hip operations fall into two families. Joint-preserving surgery, such as arthroscopy and osteotomy, repairs or realigns your own joint and is usually offered to younger people whose cartilage is still mostly intact. Joint-replacing surgery, such as total hip replacement and resurfacing, removes worn surfaces and replaces them with an implant, and is usually offered once arthritis is advanced. Revision and fracture surgery deal with a failed implant or a broken bone.

Total hip replacement

Total hip replacement, or total hip arthroplasty, removes the worn ball and socket and replaces them with a metal stem and ball, a metal socket, and a polyethylene or ceramic liner. The AAOS says the operation takes 1 to 2 hours, that patients go home the same day or after at least one night, and that most light daily activities return within 3 to 6 weeks. Serious complications such as joint infection occur in less than 2% of patients.

It is the most common hip operation in Canada by a wide margin. The Canadian Joint Replacement Registry counted more than 62,000 hip replacements in 2018–2019. Modern implants last: a 2026 Lancet analysis of eight national registries found 93.6% of hip replacements with modern bearings still in place at 20 years.

Pathway’s surgeons perform direct anterior hip replacement, which reaches the joint through the front of the hip between muscles. Dr. Sebastian Rodriguez-Elizalde, who directs the Humber Hip and Knee Fellowship and has performed more than 5,000 combined robotic knee and hip replacements, consults in Toronto and Montreal. Pathway’s hip replacement procedure page and its guide to hip replacement recovery time cover the details.

Hip resurfacing

Resurfacing is a variant of replacement that keeps the femoral head. The AAOS describes it this way: the head is trimmed and capped with a smooth metal covering, and the socket is lined with a metal shell. Because less thigh bone is removed, a later conversion to a total hip replacement can be easier.

The candidate profile is narrow. The AAOS says resurfacing generally suits patients younger than 60 with larger frames, often men, and strong, healthy bone. Older, female, or smaller-framed patients, and anyone with weaker bone, face a higher risk of fracturing the femoral neck under the cap. The metal-on-metal bearing can also release metal ions, which is why the procedure is performed less often than it once was. The operation takes 1.5 to 3 hours, patients usually go home in 1 to 4 days, and most resume daily activities by about 6 weeks.

The evidence is mixed. A 2024 meta-analysis of eight randomized trials found similar revision, infection, and loosening rates to total hip replacement at a mean of 7.7 years, with fewer dislocations after resurfacing. An Australian registry study of men under 65, however, found the most widely used resurfacing implant had a higher all-cause revision rate at 17 years than the three best-performing conventional hip replacements. Pathway’s guide to hip resurfacing versus hip replacement weighs the trade-offs.

Hip arthroscopy for FAI and labral tears

Hip arthroscopy is keyhole surgery. The surgeon places the leg in traction to open the joint, inserts a small camera through a buttonhole-sized incision, and works through one or two more small portals. The AAOS lists the conditions it treats: femoroacetabular impingement, labral tears, loose bodies, synovitis, snapping hip, and some tendon problems around the hip. It is usually considered after rest, physiotherapy, and injections have failed, and for a generally healthy person it is day surgery.

FAI is the most common reason. Extra bone on the femoral head (cam), the socket rim (pincer), or both grinds against the labrum and cartilage during movement. Arthroscopy lets the surgeon repair the labrum, trim the socket rim, and shave the bump on the femoral head. The AAOS notes that damage already done cannot always be reversed, which is one reason surgeons prefer to treat FAI before arthritis develops.

Outcomes in the right patient are good. A meta-analysis of 1,981 hips, mean age 30, found 87.7% of patients returned to sport, a complication rate of 1.7%, and a 5.5% rate of further surgery, including later conversion to hip replacement. A Canadian meta-analysis of 6,962 hip arthroscopies put the overall complication rate at 4.0%, with major complications at 0.3%.

At Pathway, Dr. Thierry Pauyo performs hip arthroscopy in Montreal. He is Head Team Physician for the Montreal Canadiens, completed fellowships at Boston Children’s Hospital (Harvard) and the University of Pittsburgh Medical Center, and is an Assistant Professor at McGill. Pathway’s hip arthroscopy procedure page describes the technique.

Periacetabular osteotomy

Periacetabular osteotomy, or PAO, is a hip-preservation operation for dysplasia, where the socket is too shallow to cover the femoral head. The surgeon cuts the pelvis around the socket, rotates the socket into a better position, and fixes it with screws. It is a larger operation than arthroscopy and is reserved for young adults before arthritis takes hold.

A 2022 meta-analysis of 3,655 hips found about 76% of hips had avoided conversion to hip replacement at 10 years and about 37% at 20 years, with the ideal patient under 40 and with little or no arthritis on X-ray. The complication rate was 23.5%, mostly minor. If your imaging shows dysplasia, ask whether a hip-preservation surgeon should assess you.

Revision hip replacement

A revision replaces some or all of an existing hip implant. The AAOS lists the usual reasons: wear and loosening, bone loss around the implant (osteolysis), infection, repeated dislocation, a fracture around the implant, or a reaction to metal debris. Younger, more active patients carry the highest long-term risk of wear.

Revision is a longer, more complex operation than a first replacement. The surgeon removes the old components and any cement, rebuilds lost bone with grafts or metal augments, and fits longer stems or cups with extra screws. The AAOS says surgery usually takes several hours, patients most likely stay in hospital for several days, and recovery is slower than after a primary replacement. CIHI counted almost 10,000 hip and knee revisions in Canada in 2018–2019, nearly 30% of them for infection, with an average hospital stay of 9 days. Pathway’s guide to how long a hip replacement lasts explains how often revision is needed.

Hip fracture surgery

A hip fracture is a break in the upper thigh bone, usually at the femoral neck or just below it. The AAOS says most hip fractures occur in older adults whose bones have weakened with osteoporosis, typically after a fall at home. Younger people break a hip after high-energy injuries such as a fall from height or a vehicle crash.

The operation depends on the fracture. A femoral neck fracture that has not shifted can be fixed in place with screws. A displaced femoral neck fracture in an older adult is usually treated with a partial hip replacement (hemiarthroplasty) or, in selected active patients, a total hip replacement. Fractures between or below the trochanters are fixed with a sliding hip screw or a rod inside the bone (an intramedullary nail). The AAOS recommends surgery within 24 to 48 hours of admission to lower the risk of complications, and most patients are out of bed with a physiotherapist the day after surgery.

Hip fracture surgery is emergency care delivered through the public hospital system. Pathway’s surgeons perform elective hip surgery; if you or a family member has had a fall and cannot bear weight, go to the nearest emergency department.

How does recovery compare across hip surgeries?

The replacement, resurfacing, revision, and fracture figures come from the AAOS pages cited above. The arthroscopy figures combine the AAOS, Alberta Health Services’ guide to recovering at home after hip arthroscopy, a meta-analysis of return to play (mean 7.4 months, 84.6% of athletes), and a meta-analysis of return to work (mean 115 days, with people in light jobs returning sooner than those in strenuous ones). Individual plans vary with what was repaired and how you heal.

How do I know which hip surgery I need?

Three things decide it. First, the diagnosis: arthritis points toward replacement, while a labral tear or impingement in a hip with good cartilage points toward arthroscopy. Second, the state of the cartilage on X-ray and MRI: preservation surgery works best before arthritis is established, and replacement works best once it is. Third, your age, bone quality, activity, and goals, which shape the choice between resurfacing and replacement and the timing of surgery.

A surgeon who performs the operation in question is the person to ask. Pathway routes your case by sub-specialty: hip arthroscopy and preservation cases go to Dr. Pauyo, and arthritis and replacement cases go to Dr. Rodriguez-Elizalde and Pathway’s other arthroplasty surgeons. Consultations take place within 1–4 business days, no referral required, with surgery typically 2–4 weeks after consultation and quote approval at Pathway’s partner surgical centres in Toronto and Montreal.

Quick answers

What is the most common type of hip surgery?

Total hip replacement. The Canadian Joint Replacement Registry counted more than 62,000 hip replacements in 2018 to 2019, up about 20% over five years. Hip arthroscopy is the most common operation for younger people with labral tears or impingement.

What is the difference between hip arthroscopy and hip replacement?

Arthroscopy is keyhole surgery that repairs your own joint, usually a labral tear or impingement, in people whose cartilage is still healthy. Replacement removes the worn ball and socket and fits an implant once arthritis is advanced. Arthroscopy is day surgery with crutches for weeks; replacement means a short hospital stay and light daily activities within 3 to 6 weeks.

Is hip resurfacing better than hip replacement?

For most people, no. Resurfacing keeps more bone and may lower dislocation risk, but it suits a narrow group, mostly men under 60 with strong bone, and an Australian registry found a higher long-term revision rate than the best conventional hip replacements. Your surgeon weighs your age, sex, bone quality, and goals.

What is the least invasive hip surgery?

Hip arthroscopy. It uses two or three small incisions, is usually done as day surgery, and has a reported major complication rate of about 0.3%. It treats labral tears, impingement, and loose bodies, but it cannot treat established arthritis.

Which hip surgery has the fastest recovery?

For everyday activities, total hip replacement and arthroscopy are closer than people expect: most people are back to light daily activities within about 6 weeks after either. Sport takes longer after arthroscopy, with a mean return of about 7 months in pooled studies. Revision and osteotomy have the longest recoveries.

Questions to ask your surgeon

• What exactly is damaged in my hip, and does my cartilage still look healthy on imaging?
• Which operation do you recommend, and which alternatives did you consider?
• Is there a joint-preserving option for my hip, or has the arthritis gone too far for that?
• If I choose arthroscopy or osteotomy now, how likely is it that I will still need a replacement later?
• How many of this specific operation do you perform each year?
• What is the hospital stay, the time on crutches, and the realistic return to my work and sport?
• What happens if I wait?

If a replacement is likely, Pathway’s plain-English guide to hip replacement wait times in Canada covers timing in the public system and the private route.

References

1. American Academy of Orthopaedic Surgeons (OrthoInfo). Total Hip Replacement. Accessed October 20, 2026.
2. American Academy of Orthopaedic Surgeons (OrthoInfo). Hip Resurfacing. Accessed October 20, 2026.
3. American Academy of Orthopaedic Surgeons (OrthoInfo). Hip Arthroscopy and Femoroacetabular Impingement. Accessed October 20, 2026.
4. American Academy of Orthopaedic Surgeons (OrthoInfo). Revision Total Hip Replacement. Accessed October 20, 2026.
5. American Academy of Orthopaedic Surgeons (OrthoInfo). Hip Fractures. Accessed October 20, 2026.
6. Alberta Health Services. Hip Arthroscopy: What to Expect at Home. MyHealth.Alberta.ca; current as of July 31, 2024. Accessed October 20, 2026.
7. Canadian Institute for Health Information. Hip and Knee Replacements in Canada: CJRR Annual Report. Accessed October 20, 2026.
8. Pentland V, Thompson Z, Dayimu A, et al. Survivorship of modern total hip replacement to 30 years: systematic review, meta-analysis, and extrapolation of global joint registry data. Lancet. 2026;407(10531):855–866.
9. Za P, Casciaro C, Papalia GF, et al. Hip resurfacing versus total hip arthroplasty: a systematic review and meta-analysis of randomized clinical trials. Int Orthop. 2024;48(10):2589–2601.
10. Stoney J, Graves SE, de Steiger RN, et al. Is the survivorship of Birmingham Hip Resurfacing better than selected conventional hip arthroplasties in men younger than 65 years of age? A study from the Australian Orthopaedic Association National Joint Replacement Registry. Clin Orthop Relat Res. 2020;478(11):2625–2636.
11. Minkara AA, Westermann RW, Rosneck J, Lynch TS. Systematic review and meta-analysis of outcomes after hip arthroscopy in femoroacetabular impingement. Am J Sports Med. 2019;47(2):488–500.
12. Kowalczuk M, Bhandari M, Farrokhyar F, et al. Complications following hip arthroscopy: a systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc. 2013;21(7):1669–1675.
13. O’Connor M, Minkara AA, Westermann RW, et al. Return to play after hip arthroscopy: a systematic review and meta-analysis. Am J Sports Med. 2018;46(11):2780–2788.
14. Blaeser AM, Mojica ES, Mannino BJ, Youm T. Return to work after primary hip arthroscopy: a systematic review and meta-analysis. Am J Sports Med. 2023;51(5):1340–1346.
15. Tan JHI, Tan SHS, Rajoo MS, et al. Hip survivorship following the Bernese periacetabular osteotomy for the treatment of acetabular dysplasia: a systematic review and meta-analysis. Orthop Traumatol Surg Res. 2022;108(4):103283.

Health information notice: This article provides general information about types of hip surgery and cannot replace individual medical advice. Your surgeon decides which procedure, if any, is right for your hip, based on your imaging, your health, and your goals.