Femoral neck fracture is one of the most common complications of hip resurfacing and considered by some to be related to reduced blood flow as a consequence of the surgical approach. We measured oxygen concentration during hip resurfacing through the trochanteric flip approach (n = 15 patients) and compared this approach with previous data for the posterior and anterolateral approaches. With the trochanteric flip the average femoral oxygenation decreased during the procedure to approximately 50% of that at the start, however it recovered to starting level by the end of the procedure. Preservation of oxygenation with the trochanteric flip was similar to that observed with the anterolateral approach, but with less variation during the procedure. Both of these approaches were superior in terms of oxygenation preservation to the posterior approach which resulted in a dramatic reduction in oxygenation.