Survival and functional outcome of the Birmingham Hip Resurfacing system in patients aged 65 and older at up to ten years of follow-up

Abstract

Purpose Limited evidence exists regarding the outcomes of hip resurfacing in elderly patients. The primary study aims were to determine the survival and functional outcome following Birmingham Hip Resurfacing (BHR) in patients ≥65 years at up to ten years of follow-up. Secondary aims were to explore factors affecting survival and functional outcome. Methods Between 1997 and 2012, data were prospectively collected on 180 BHR (162 patients; mean age 69.2 years; 62 % male) implanted by one designing surgeon. Mean follow-up was six (range one to 14.4) years with no loss to follow-up. Outcomes of interest were implant survival, functional outcome [Oxford Hip Score (OHS)] and radiological evidence of implant failure. Results Three hips were revised, giving an overall cumulative survival of 96.4 % [95 % confidence interval (CI) 90.3-100] at ten years. Survival of 111 male BHR was 98.9 % (95 % CI 94.8-100) at ten years (one revision) compared with 91.9 % (95 % CI 77.0-100) in 69 female BHR (two revisions). Survival was affected by age (p=0.014) and femoral head size (p=0.024) but not by gender (p=0.079). Median pre-operative OHS was 50.0 % [interquartile range (IQR) 37.5-68.8], improving to 4.4 % (IQR 0-10.4) postoperatively. Men had significantly better postoperative OHSs compared with women (median male OHS 2.1 % versus 6.3 % female OHS; p=0.021). Conclusions Good survival and functional outcomes were achieved with the BHR at ten years in men and women ≥65 years. Despite registry findings to the contrary, age alone should not be a contraindication for hip resurfacing in centres with expertise in this procedure.

The future role of metal-on-metal hip resurfacing

“…On occasions experienced surgeons may also wish to consider older patients for HR provided they are active and meet all other proposed indications. This is because chronological age was not originally cited as an absolute contraindication to HR [41], with good medium-term to long-term outcomes reported by experienced surgeons in patients aged over 60 years [27,57]. In addition, although there have been some case reports of adverse outcomes in patients receiving staged bilateral MoM HRs [58,59], medium to long-term outcome studies for the BHR suggest bilateral implantation in suitable candidates is safe [26,27,30,60].…”

Current Expert Views on Metal-on-Metal Hip Resurfacing Arthroplasty. Consensus of the 6th Advanced Hip Resurfacing Course, Ghent, Belgium, May 2014

“…At the previous consensus meeting in 2012 there was no agreement with regard to the necessity of performing a DEXA scan in all females older than 55 years (39.4% were advocates, 42.3% found that unnecessary but would assess the bone quality on x-rays and in relation with the patient's general health and activity level and 18.3% would perform DEXA scans in cases of doubt). However, it was advocated in 2012 and in 2014 to primarily consider the physiological age of the patient based on activity level and bone quality at the hip which is confirmed by studies showing no significant difference between THA and HRA especially in older men (17-18-19). With our ageing population remaining more active and healthy for a longer period of time, the physiological age is the most stringent argument in the decision whether or not to perform a hip resurfacing.…”

A Comparative Cohort Study With a 20-Year Age Gap: Hip Resurfacing in Patients Aged ≤35 Years and Patients Aged ≥55 Years

“…Qualitative studies show that older adults have high expectations concerning physical health and level of activity. Recent studies have demonstrated low rates of revision and improved patient-reported outcome measures (PROMs) in older patients who underwent HRA [ 42 , 43 ].…”