What is Birmingham Hip Resurfacing?

Birmingham Hip Resurfacing (BHR) is a hip replacement designed specially for young and active people with arthritis of their hips.It differs from a ‘conventional’ Total Hip Replacement (THR) in three main ways:

  1. The metal-on-metal bearing usesvery hard high carbide cobaltchrome alloy to reduce weardebris (Debris is considered tobe a major cause of looseningand failure of joint replacements).
  2. BHR has the same dimensionsas the normal hip, makingdislocation rare – thus allowing more normal activitiessuch as squatting and getting into confined spacessuch as sports cars and aircraft.
  3. Because BHR is a ‘resurfacing’ less of the normal boneis removed, potentially making revision to a THR easier if required.

Who can benefit from a BHR?

Young people with arthritis of their hips.Arthritis is inflammation of the hip due to disease or injury. Usually it becomes painful, especially with activity, such as walking, and at night.

A common problem in Asiansis avascular necrosis (AVN), a condition where there is loss of blood supply to the bone causing collapse and arthritis. Other problems are infection, injury,slipped upper femoral epiphysis and where hips do not form properly, as in a congenital dislocation of the hip.

Shouldn’t I wait as long as possible before having a hip operation?

In the past young people were advised to put hipreplacement off for as long as possible because it was likely they would wear out the artificial hips after around 20 years, thus requiring a second (or ‘revision’) hip replacement, which is usually more difficult than the first and usually does not last as long.Because we believe the BHR will last indefinitely we now advise most people under 60 and active people under 65 to consider a BHR when they have hip pain that is unpleasant and not controlled by simple drugs.

Is there anyone who should not have BHR?

Only those with significant osteoporosis should not have BHR.

Can I return to sport?

Many patients have returned to sport at all levels includingreturning to judo and marathon running – and so far theyare doing well.

My hip is badly damaged.Can I still have a BHR?

Even if you have lost the top [headand neck] of your thigh bone you may still be able to enjoy theadvantages of the large diametermetal on metal bearing by havinga ‘hybrid BHR’ – where a metalstem is placed into the thigh bone,much like a conventional THR, witha modifi ed BHR ball, and standardBHR socket.e with significant osteoporosis should not haveOnly those with significant osteoporosis should not haveBHR.

What does the BHR involve?

Under a general anaesthetic a cut is made in the side ofthe leg, the strips from your muscles around the hip are carefully cut to expose the hip joint, which is dislocated.The arthritic joint and a thin layer of bone are removed and replaced with a metal ‘ball and socket’. The muscles and skin are stitched up. The operation takes about one hour.You can walk with crutches the next day, and can usually go home after five to six days.

Are there other types of hip resurfacing?

There are currently 3 main designs.There are differences in the type of metal used and the way they are made.Not all ‘hip resurfacings’ are the same and none have the published follow up of the BHR.

What are the results so far?

The cohort of 5500 patients independently followed upby Professor James Richardson in Oswestry, UK, has averified revision rate of 0.76% at over 6 years. To put this in perspective, the best results of THR in patients under 55 years of age from the Swedish National Total Hip Replacement Register (which follows all hip replacementsin Sweden) show a 10% failure rate at 8 years. Dr. McMinn published excellent results up to 10 years [JBJS BrVol.86-B, No.2, March 2004]

What are the risks?

The general risks are the same as for a THR:

  • infection (less than 0.5%);
  • a clot in the leg known as a deep venousthrombosis [1-2%];
  • a pulmonary embolus [less than 0.1%];general anaesthetic
  • or medical problems [about 1%depending on one’s age and general health].

The specific risk of BHR is of a fracture in the thigh bone below the BHR [less than 1%]. The risk of dislocation is very low [about 0.1%].There is an increase in metal ions in the blood after a metalon metal hip replacement. So far no problems have been identified as a result.

When can I return to work?

Executive office work – about 3 weeks.Manual work – about 3 months.

What follow up is needed?

Ideally you would have an x-ray 6-8 weeks after theoperation and then once a year.

When can I fly?

Ideally you should wait for six weeks to reduce the risk. BHR surgical package is available at a predeterminedprice.

Articles on this website are informative only and not intended to be a substitute for professional medical advice, diagnosis or treatment. They should not be relied upon for specific medical advice.