Birmingham Hip Resurfacing was developed in 1997. It offers an alternative to total hip replacement surgery and is particularly suitable for active male patients. Twenty-five years after it was first introduced, we explore the pros and cons of this type of surgery and consider the latest research findings from a team at The Royal Orthopaedic Hospital in Birmingham.
What is Birmingham Hip Resurfacing?
Birmingham Hip Resurfacing (BHR) is a surgical treatment for severe hip pain due to osteoarthritis. It entails replacing the surface of the femoral head (the ‘ball’ part of the ball and socket joint) and the acetabulum (the ‘socket’ part) but keeping the bone of the femur – including the femoral neck – intact.
BHR surgery has a number of key benefits. It can reduce the risk of dislocation compared to a total hip replacement, as the natural size and shape of the patient’s own hip joint is preserved. Some patients say the hip feels more ‘normal’ after surgery compared to a prosthetic hip implant. BHR involves less bone resection than total hip replacement surgery and this can result in faster post-operative recovery. Patients undergoing BHR are more likely to return to sporting activities, which makes this a particularly suitable approach for younger, more active patients. However, BHR is not generally recommended for female patients or those with smaller hips, as the hip needs to measure 50mm or more. Below this, there is a higher risk of developing complications.
Who is it suitable for?
The procedure is normally offered to active males who are experiencing moderate to severe symptoms associated with osteoarthritis. This is a degenerative disease that causes the smooth cartilage in the hip joint to become rough and the lining of the joint to thicken. The bone may become more dense and can develop bony spurs called osteophytes which prevent the bones from moving against each other smoothly. As the condition develops, the bones may start to rub and grate together. Osteoarthritis causes worsening pain, stiffness and loss of normal function in the hip joint.
How does it differ from conventional hip replacement surgery?
Conventional total hip replacement surgery involves removing the damaged hip joint and replacing it with a prosthetic implant. By contrast, with Birmingham Hip Resurfacing, the natural bone remains intact but the ball and socket – the moving surfaces of the joint – are resurfaced in metal.
The latest research findings
A team at The Royal Orthopaedic Hospital in Birmingham carried out a research study, publishing its findings in The Bone and Joint Journal in June 2024. A surgeon at the hospital had previously reported findings relating to 130 patients who had received surgery (144 procedures in total). The aim of this was to show how many of the patients had experienced a failure of the procedure and required revision surgery. Findings were reported at five and 10 years, with three and 10 failures respectively.
The research team at The Royal Orthopaedic Hospital went back to the original cohort of patients to report on outcomes 25 years on. All patients had undergone surgery between August 1997 and May 1998. The average age of those having surgery was 52.1 years and the cohort included 37 female patients (28.5%).
The researchers found that 83.5% of BHR implants had survived. The number at risk of failure 25 years on was 79. Male patients saw a survival rate of their implants of 89.5%, compared to a survival rate for female patients of 66.9%. Ten additional failures occurred in the period of 10 to 25 years. These involved an adverse reaction to metal debris in four patients, a periprosthetic femoral head fracture in five patients and aseptic loosening in one patient. During the 25-year study, 29 patients had died. Patient survival 25 years on was 75.10%.
Researchers concluded that the Birmingham Hip Resurfacing procedure offers a durable alternative to total hip replacement. It is particularly suitable to younger male patients who want to maintain an active lifestyle. The results compare favourably with the best results for total hip replacement surgery.
If you have moderate to severe hip osteoarthritis and are keen to maintain an active lifestyle following hip replacement surgery, contact us to discuss the possibility of undergoing Birmingham Hip Resurfacing surgery. We also offer total and partial hip replacements.
