Birmingham Hip Resurfacing at 20 years

Abstract

AimsThe Birmingham Hip Resurfacing (BHR) arthroplasty has been used as a surgical treatment of coxarthrosis since 1997. We present 20-year results of 234 consecutive BHRs performed in our unit.MethodsBetween 1999 and 2001, there were 217 patients: 142 males (65.4%), mean age 52 years (18 to 68) who had 234 implants (17 bilateral). They had patient-reported outcome measures collected, imaging (radiograph and ultrasound), and serum metal ion assessment. Survivorship analysis was performed using Kaplan-Meier estimates. Revision for any cause was considered as an endpoint for the analysis.ResultsMean follow-up was 20.9 years (19.3 to 22.4). Registry data revealed that 19 hips (8.1%) had been revised and 26 patients (12%) had died from causes unrelated to the BHR. Among the remaining 189 hips, 61% were available for clinical follow-up at 20 years (n = 115) and 70% of patients had biochemical follow-up (n = 132). The cumulative implant survival rate at 20 years for male patients was 96.5% (95% confidence interval (CI) 93.5 to 99.6), and for female patients 87% (95% CI 79.7 to 94.9). The difference was statistically significant (p = 0.029). The mean Oxford Hip Score, Hip disability and Osteoarthritis Outcome Score, and Forgotten Joint Score were 45 (29 to 48), 89 (43 to 100), and 84 (19 to 100), respectively. The mean scores for each of the five domains of the EuroQol five-dimension three-level questionnaire were 1.2, 1.0, 1.2, 1.3, and 1.1, and mean overall score 82.6 (50 to 100). Ultrasound showed no pseudotumour. Mean cobalt and chromium levels were 32.1 nmol/l (1 to 374) and 45.5 nmol/l (9 to 408), respectively.ConclusionThis study shows that BHRs provide excellent survivorship and functional outcomes in young male patients. At 20 years, soft-tissue imaging and serum metal ion studies suggest that a metal-on-metal resurfacing implant can be well tolerated in a group of young patients.Cite this article: Bone Joint J 2023;105-B(9):946–952.

Birmingham Hip Resurfacing at 25 years

“…In a 2013 paper by Matharu et al, 24 the authors reported 100% survival in a highly selected group of male patients aged under 50 years with the diagnosis restricted to OA and excluding infections. More recently, Dhawan et al 25 studied a larger sample size of 234 BHR hips with OA. The cumulative implant survival rate at 20 years was 91.5% (95% CI 87.6 to 95.6), and female sex and smaller head size (< 48 mm) were found to be negative prognostic factors.…”

“…The cumulative implant survival rate at 20 years was 91.5% (95% CI 87.6 to 95.6), and female sex and smaller head size (< 48 mm) were found to be negative prognostic factors. 25…”

“…Nonetheless, the survival for males undergoing a BHR reported in this series exceeds the survival of several other THAs reported in the literature. 25,28-37 Petheram et al 28 studied the Exeter femoral stem (Stryker, UK) in 382 patients for more than 20 years. The authors reported an 11% revision rate (42 hips) and overall hip survival of 82.9% at 22.8 years, which is notably comparable with the whole cohort reported here.…”