The results of primary Birmingham hip resurfacings at a mean of five years

Abstract

We report an independent prospective review of the first 230 Birmingham hip resurfacings in 212 patients at a mean follow-up of five years (4 to 6). Two patients, one with a loose acetabular component and the other with suspected avascular necrosis of the femoral head, underwent revision. There were two deaths from unrelated causes and one patient was lost to follow-up. The survivorship with the worst-case scenario was 97.8% (95% confidence interval 95.8 to 99.5). The mean Harris hip score improved significantly (paired t-test, p < 0.05) from 62.54 (8 to 92) pre-operatively to 97.7 (61 to 100) at a mean of three years (2.1 to 4.3), then deteriorated slightly to a mean of 95.2 (47 to 100) at a mean of five years. The mean flexion improved from 91.5 degrees (25 degrees to 140 degrees) to 110.4 degrees (80 degrees to 145 degrees) at a mean of three years with no further improvement at five years (111.2 degrees; 70 degrees to 160 degrees). On radiological review at five years, one patient had a progressive lucent line around the acetabular component and six had progressive lucent lines around the femoral component. A total of 18 femoral components (8%) had migrated into varus and those with lucent lines present migrated a mean of 3.8 degrees (1.02 degrees to 6.54 degrees) more than the rest. Superolateral notching of the femoral neck and reactive sclerosis at the tip of the peg of the femoral component were associated with the presence of lucent lines (chi-squared test, p < 0.05), but not with migration of the femoral component, and are of unknown significance. Our results with the Birmingham hip resurfacing continue to be satisfactory at a mean follow-up of five years.

Frequent Femoral Neck Osteolysis With Birmingham Mid-head Resection Resurfacing Arthroplasty in Young Patients

“…These functional results are comparable to the BMHR results of the implant developers at 3.5 years followup [35]. They are also comparable to the mid-term functional and survivorship results of various currently used, traditional hip resurfacing systems [3,8,25,41,49] and far better than the mid-term survivorship and functional results of conventional MoM THA [9,31,32,47]. So, despite the fact that the BMHR is technically considered a stemmed LHMoM implant, its design, fixation (neck-fixed), and loading-bearing concepts [35,36] appear to produce a clinical performance that is better than the notorious traditional stemmed LHMoM THAs and comparable to traditional resurfacing arthroplasties at mid-term.…”

“…Patients' median OHS (using the 48-point OHS) improved from 26 (range, [16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35] preoperatively to 46 (range, [35][36][37][38][39][40][41][42][43][44][45][46][47][48], and UCLA score improved from 5 (range, 2-8) to 8 (range, 4-10) at latest review (paired t-test p \ 0.001 for both). There was no difference in median [35][36][37][38][39][40][41][42][43][44][45][46][47][48] or in the median postoperative UCLA scores between males (8; range, 5-10) and females (8; range, 4-10) (Mann-Whitney U p = 0.293 and p = 0.115, respectively).…”

MRI Predicts ALVAL and Tissue Damage in Metal-on-Metal Hip Arthroplasty

“…The current generation of metal-on-metal (MOM) cobaltchromium-molybdenum bearings in hip arthroplasty have shown overall survivorship rates at 5 and 10 years of 98% and 94% [3,4,13,18,31] respectively. However, reports have emerged describing the presence of periprosthetic soft tissue lesions, which have been described interchangeably as adverse local tissue reactions (ALTR) [1], adverse reactions to metal debris (ARMD) [17], aseptic lymphocytic vasculitis-associated lesions (ALVAL) [33], metallosis [23], and pseudotumors [24].…”

Intraoperative Radiographs for Placing Acetabular Components in Hip Resurfacing Arthroplasty

“…The use of hip resurfacing arthroplasty (HRA) has been resurgent with the development of modern designs of metal-on-metal bearings since the late 1990s [2,4,7,8,11,15,21,28]. Recent studies reported revision rates of 1% to 5% at an average of 5 to 7 years in young and active patients after HRA [2,15,21,28].…”

“…Recent studies reported revision rates of 1% to 5% at an average of 5 to 7 years in young and active patients after HRA [2,15,21,28]. Even though femoral neck fracture and femoral loosening were formerly reported as the most common failure modes in these studies [2,4,21], revision related to the acetabular component is being recognized more frequently in recent reports [8,11].…”