In the past, most patients were encouraged to put off total hip replacement surgery as long as possible until they were in severe pain and very limited in their activity levels. That's because the results of total hip replacement in younger patients are poor. They simply return to higher activity levels than older patients.
Birmingham Hip Resurfacing preserves as much bone in the femoral head as possible, making it a more natural and anatomical replacement of the hip than conventional replacement.
Part of mainstream European orthopedics for more than 15 years, hip resurfacing is now available right here in the Rocky Mountain West, making it unnecessary for patients to travel overseas for the procedure.
Hip resurfacing is not for everyone. We have endeavored to put a wide variety of informational material on this page and elsewhere on this website to help you assess this procedure. Most of all we encourage you to meet with your orthopedic surgeon.
FDA - U.S. Food and Drug Administration: The United States Food and Drug Administration granted approval for the Birmingham Hip Resurfacing procedure in June, 2006. This is one of several types of hip replacement procedures that uses a metal-on-metal implant. The FDA mandate is to continue to follow and study all drugs and procedures even after approval. In that context the FDA has released new information based on its studies of these types of implants over the past several years. We encourage you to review the website they have developed around this information.
Birmingham Hip Resurfacing Operation: This video is a full and graphic presentation of a Birmingham Hip Resurfacing procedure. For those evaluating this procedure as compared to conventional hip replacement, it may provide useful information in your decision making process. However, the graphic nature of the video may not be suitable for everyone.
Virtual Hip Resurfacing: What better way to understand hip resurfacing surgery than to perform one yourself? This site offers a virtual hip resurfacing procedure that puts you in the role of the surgeon. It is educational and even fun.
SurfaceHippy: A hip resurfacing patient support group, SurfaceHippy is a forum for sharing information and experiences among patients who have had hip resurfacing surgery. Anyone interested in learning about the procedure is welcome to participate.
Surface Hippy Info: This website is created by surface hippies for the global community of surface hippies to collect and share: a comprehensive knowledgebase on Hip Resurfacing; scientific and anecdotal statistics; and personal stories to help people return to happy and productive lives, and to pay it forward to future generations.
ActiveJoints.com: A website with additional information about hip replacement and hip replacement surgery.
Hip Replacement or Hip Resurfacing: A Book of Choices
Listed below is a selection of studies assembled by Smith&Nephew that illustrate the safety and effectiveness of the BHR Hip.
2009 Australian Registry
Table HT 46. Australian Orthopaedic Association National Joint Replacement Registry Annual Report. Adelaide: AOA; 2009.
2009 Australian Registry's results for 8,427 BHR hips shows the BHR Hip's survivorship at 8 years (95%) is better than all other resurfacing implants' survivorship after just their 5th year.
The Australian Registry accounts for greater than 98 percent of all procedures performed in that country, and pre-dates the introduction of BHR, so it is a nearly complete record of the device in a single market.
2008 Australian Registry
Table HT 46. Australian Orthopaedic Association National Joint Replacement Registry Annual Report. Adelaide: AOA; 2008.
The 2008 Australian Registry tracked 6,773 BHR Hips and shows it had the highest survivorship among all resurfacing devices, and resurfacing devices were shown to outperform total hip replacement for men under age 55, as well as ages 55-64.
Great Britain's Oswestry Outcomes Centre's patient registryRobinson E, Richardson JB, Khan M. MINIMUM 10 YEAR OUTCOME OF BIRMINGHAM HIP RESURFACING (BHR), A REVIEW OF 518 CASES FROM AN INTERNATIONAL REGISTER. Oswestry outcome centre, Oswestry, UK.
The Oswestry Outcomes Centre's patient registry shows the BHR Hip's 10-year survivorship of 95.4%, with 98.6% of patients rating their opinion of the experience as "pleased" or "extremely pleased." This registry includes 569 BHR hips implanted by 21 different surgeons in 17 countries.
Journal for Bone and Joint Surgery
Langton DJ, Jameson SS, Joyce TJ, Hallab NJ, Natu S, Nargol AVF. Early failure of metal-on-metal bearings in hip resurfacing and large-diameter total hip replacement, A CONSEQUENCE OF EXCESS WEAR. J Bone Joint Surg Br. 2010; 92-B: 38-46
This peer-reviewed article from the January 2010 edition of the Journal for Bone and Joint Surgery discusses the success of the BHR Hip relative to another device. In this study, 155 consecutive BHR Hip patients were tracked, and the author found that none were revised due to metal wear debris. In the same study, the author also tracked 505 metal on metal implants from a different manufacturer and found revision rates of 5.9% and 11.4%, respectively, for two of this company's implant designs.
American Academy of Orthopaedic Surgeons 2010 Annual Meeting
Beaule PE, Smith FC, Powell JN et al. A Survey on the Incidence of Pseudotumours with MOM Hip Resurfacings in Canadian Academic Centres. Podium presentation #665. Proceedings of the American Academy of Orthopaedic Surgeons Annual Meeting, New Orleans LA. 2010
This multi-site study, performed by orthopaedic surgeons practicing at nine Canadian academic centers, showed that three years after surgery, 99.91% of their 3,400 hip resurfacing patients experienced no implant failure due to metal wear debris. The BHR Hip was the most used resurfacing device in this study.
Journal of Engineering in Medicine
Visuri TI, Pukkala E, Pulkkinen P, Paavolainen P. Cancer incidence and causes of death among total hip replacement patients: a review based on Nordic cohorts with a special emphasis on metal-on-metal bearings 2005. Proc. IMechE Vol. 220 Part H: J; 399-407.
As Derek McMinn said at the May 6, 2010, press conference, the composition of the metal used in the BHR Hip has a long track record of safety. This paper notes that over a 28-year period, there is no increased incidence of cancer among patients who received a particular metal-on-metal hip (known as McKee-Farrar) when compared to the general population. The metal used to make the BHR Hip is based on this McKee-Farrar component. This data comes from patient registries in Sweden, Norway, Finland and Denmark.
American Academy of Orthopaedic Surgeons 2010 Annual Meeting
Graves S, De Steiger R, Davidson D, Ryan P, Miller L, Stanford T, Tomkins A. Resurfacing Hip Replacement: Outcomes at 8 years - An analysis of 12,093 primary procedures. m presentation # 669. Proceedings of the American Academy of Orthopaedic Surgeons Annual Meeting, New Orleans LA. 2010
This study, presented at the 2010 annual meeting of the American Academy of Orthopaedic Surgeons, reinforces what Dr. Edwin Su spoke about at the March 6, 2010, press conference. That is, the success of a hip resurfacing procedure depends on patient and implant selection.
Journal for Bone and Joint Surgery (British edition)
Heilpern GNA, Shah NN, Fordyce MJF. Birmingham hip resurfacing arthroplasty: A SERIES OF 110 CONSECUTIVE HIPS WITH A MINIMUM FIVEYEAR CLINICAL AND RADIOLOGICAL FOLLOW-UP. J Bone Joint Surg Br. 2008;90-B(9):1137-1142.
This study tracked the performance of 110 BHR Hips over a 5-year span. Excerpts from the author's conclusions include: "Survivorship compares well with similar studies using conventional hip replacements, and concerns regarding high rates of early complications and failures are not borne out... Our results, which include the surgeon's learning experience with the BHR, show a 96.3% survival at five years and do not differ greatly from the results achieved by the surgeon-inventors group. This gives us confidence to continue using this implant."
Acta Orthopaedica Belgica
Malviya Ajay, Holland James P. Pseudotumours associated with metal-on-metal hip resurfacing: 10-year Newcastle experience. Acta Orthopaedica Belgica. August 2009, 75 (4) p477-83.
In a 10-year study published last year in Acta Orthopaedica Belgica, the official journal of the Belgian Society of Orthopaedics and Traumatology, a single-surgeon series of BHR Hip patients resulted in 2 adverse tissue reactions in 670 procedures (0.18%). In the report, the authors note: "In our experience the risk of pseudotumours is low (0.15%) and can be fully explained. In selected cases the bearing surface can be retained."