Results of Birmingham hip resurfacing at 12 to 15 years

Abstract

We report a 12- to 15-year implant survival assessment of a prospective single-surgeon series of Birmingham Hip Resurfacings (BHRs). The earliest 1000 consecutive BHRs including 288 women (335 hips) and 598 men (665 hips) of all ages and diagnoses with no exclusions were prospectively followed-up with postal questionnaires, of whom the first 402 BHRs (350 patients) also had clinical and radiological review. Mean follow-up was 13.7 years (12.3 to 15.3). In total, 59 patients (68 hips) died 0.7 to 12.6 years following surgery from unrelated causes. There were 38 revisions, 0.1 to 13.9 years (median 8.7) following operation, including 17 femoral failures (1.7%) and seven each of infections, soft-tissue reactions and other causes. With revision for any reason as the end-point Kaplan-Meier survival analysis showed 97.4% (95% confidence interval (CI) 96.9 to 97.9) and 95.8% (95% CI 95.1 to 96.5) survival at ten and 15 years, respectively. Radiological assessment showed 11 (3.5%) femoral and 13 (4.1%) acetabular radiolucencies which were not deemed failures and one radiological femoral failure (0.3%). Our study shows that the performance of the BHR continues to be good at 12- to 15-year follow-up. Men have better implant survival (98.0%; 95% CI 97.4 to 98.6) at 15 years than women (91.5%; 95% CI 89.8 to 93.2), and women < 60 years (90.5%; 95% CI 88.3 to 92.7) fare worse than others. Hip dysplasia and osteonecrosis are risk factors for failure. Patients under 50 years with osteoarthritis fare best (99.4%; 95% CI 98.8 to 100 survival at 15 years), with no failures in men in this group.

Follow-Up of Metal-on-Metal Hip Arthroplasty Patients Is Currently Not Evidence Based or Cost Effective

“…The Birmingham Hip Resurfacing (BHR) is the most frequently implanted HR device worldwide [22]. The BHR has established 10-15 year outcomes when implanted by designing [14,23] and independent surgeons [12,13,24], and is also supported by registry data [9,25]. Therefore, for proven HR implants, such as the BHR, closer follow-up is recommended in those with ARMD risk factors [26][27][28], whilst less regular follow-up is required for patients with established devices but without these risk factors.…”

Are There Long-term Benefits to Cementing the Metaphyseal Stem in Hip Resurfacing?

“…Metal-on-metal hip resurfacing has been considered an effective way to treat young and active patients with endstage osteoarthritis since the 1990s [9,13,14,30,31]. However, aseptic failure of the femoral component (component loosening or femoral neck fracture) has been reported as one of the main modes of failure, particularly in the early reports [3,12,19,21,23,25].…”

Subsurface characterisation of wear on mechanically polished and electro-polished biomedical grade CoCrMo

“…In addition, Bozic et al [8] compared the clinical effectiveness and cost-effectiveness of MoM hip resurfacing to THR and concluded that MoM hip resurfacing could be clinically advantageous and cost-effective in younger men and women. Daniel et al [9] reported a 12-to 15-year implant survival assessment of a prospective single-surgeon series of Birmingham Hip Resurfacing (BHR) and showed that the performance of the BHR is good at 12-to 15-year follow up, especially for male patients under 50 years. Matharu et al [10] reported the long-term survival and functional outcome of the BHR in patients aged o50 years at operation and stated that the BHR provides excellent survival and functional results in men into the second decade, with good results achieved in appropriately selected women.…”