Aims. Metal-on-metal hip resurfacing (MoM-HR) has seen decreased usage due to safety and longevity concerns. Joint registries have highlighted the risks in females, smaller hips, and hip dysplasia. This study aimed to identify if reported risk factors are linked to revision in a long-term follow-up of MoM-HR performed by a non-designer surgeon. Methods. A retrospective review of consecutive MoM hip arthroplasties (MoM-HRAs) using Birmingham Hip Resurfacing was conducted. Data on procedure side, indication, implant sizes and orientation, highest blood cobalt and chromium ion concentrations, and all-cause revision were collected from local and UK National Joint Registry records. Results. A total of 243 hips (205 patients (163 male, 80 female; mean age at surgery 55.3 years (range 25.7 to 75.3)) with MoM-HRA performed between April 2003 and October 2020 were included. Mean follow-up was 11.2 years (range 0.3 to 17.8). Osteoarthritis was the most common indication (93.8%), and 13 hips (5.3%; 7M:6F) showed dysplasia (lateral centre-edge angle < 25°). Acetabular cups were implanted at a median of 45.4° abduction (interquartile range 41.9° - 48.3°) and stems neutral or valgus to the native neck-shaft angle. In all, 11 hips (4.5%; one male, ten females) in ten patients underwent revision surgery at a mean of 7.4 years (range 2.8 to 14.2), giving a cumulative survival rate of 94.8% (95% confidence interval (CI) 91.6% to 98.0%) at ten years, and 93.4% (95% CI 89.3% to 97.6%) at 17 years. For aseptic revision, male survivorship was 100% at 17 years, and 89.6% (95% CI 83.1% to 96.7%) at ten and 17 years for females. Increased metal ion levels were implicated in 50% of female revisions, with the remaining being revised for unexplained pain or avascular necrosis. Conclusion. The Birmingham MoM-HR showed 100% survivorship in males, exceeding the National Institute for Health and Care Excellence ‘5% at ten years’ threshold. Female sex and small component sizes are independent risk factors. Dysplasia alone is not a contraindication to resurfacing. Cite this article: Bone Jt Open 2023;4(11):853–858

Reports of improved functional outcome of Metal on Metal Hip Resurfacing Arthroplasty (mHRA) to Total Hip Replacement needs to be balanced with concerns of metal ion release. By removing cobalt-chrome, cHRA reduces these risks. To the author's knowledge, there is no data available on functional outcomes of cHRA, therefore the aim of the study was to compare the function between cHRA patients and mHRA patients.

24 patients received a unilateral cHRA (H1, Embody) and was compared to 24 age and gender matched patients with a unilateral mHRA (BHR, Smith and Nephew). All patients completed the Oxford Hip Score (OHS)[T2] and underwent gait analysis on an instrumented treadmill before and at a mean of 74wks (+/− 10) for mHRA and 53wks (+/− 2) for cHRA post op. Walking trials started at 4km/h and increased in 0.5km/h increments until a top walking speed (TWS) was achieved. Vertical ground reaction forces (GRF) were recorded along with the symmetry index (SI). Spatiotemporal measures of gait were also recorded. Vertical GRF were captured for the entire normalised stance phase using statistical parametric mapping (SPM; CI = 95%).

The gain in OHS was similar: H1 (25-46), BHR(27-47). TWS increased by 19% with H1 (6.02 – 8.0km/hr), and 20% with BHR (6.02 – 7.37km/hr). SPM of the entire gait cycle illustrated the restoration of symmetry in both groups with no difference in GRF across the stance phase between groups at 5km/hr pre-op and post-op. At faster speeds (6.5km/hr), H1 patients had a mid-support GRF slightly closer to normal compared to BHR. Both groups increased step length similar from pre to post op (H1:0.76 – 0.85cm, BHR:0.77-0.86cm).

In this study, subjective and objective functional outcome measures suggest that short term functional outcomes of ceramic resurfacing is not inferior to metal resurfacing.

When the Birmingham Hip Resurfacing (BHR) metal-on-metal implant system was approved by the United States Food and Drug Administration in 2006, a multicenter, prospective, post-approval study (PAS) was required. This study uses data from the PAS to investigate metal level and glomerular filtration rate (GFR) trends over the first decade in vivo. Between October 2006 and March 2011, 290 primary BHR procedures were performed among 262 patients at 5 sites. Whole blood samples were sent to a single specialized laboratory to determine GFR, cobalt (Co) and chromium (Cr) levels. The population for this study consists of 117 unrevised unilateral patients with a mean age at surgery of 51.3±6.5 years who had pre-operative, 1-year, 4-year, 5-year and 10-year laboratory data. The mean follow-up for these patients that included 36 females was 10.1±0.2 years. Median metal levels at 1-year increased relative to pre-operative values for Co (by a factor of 9.7 from 0.13 to 1.26 ppb, p<0.001) and Cr (by a factor of 2.5 from 0. 60 to 1.50 ppb, p<0.001). Metal levels subsequently remained relatively constant over time with a median 10-year value of 1.12 ppb for Co and 1.29 ppb for Cr. Based on 585 blood samples from all 117 patients, there was no relationship between GFR and Co (. →. =−0.06, p=0.14) or Cr (. →. =0.05, p=0.27) levels. However, lower pre-operative GFR values were associated with larger increases in Co at 1-year relative to the pre-operative level (. →. =−0.26, p=0.005). There was no relationship between pre-operative GFR values and changes in Cr at 1 year (. →. =−0.13, p=0.15). Through the first decade in vivo, elevated whole blood metal levels for unilateral BHR patients do not appear to adversely affect GFR. However, patients with lower pre-operative GFR values tend to have larger increases in their Co level at 1-year

Femoral neck fracture is a recognised complication of Birmingham Hip Resurfacing. But stress fracture is uncommon. Femoral neck stress fractures are one of the most difficult problems to diagnose. The pain associated with a femoral neck stress fracture often is localized poorly and may be referred to the thigh or back. We present a young fit gentleman who underwent Birmingham Hip resurfacing for Osteoarthritis Hip. He underwent Birmingham Hip Resurfacing Right side with satisfactory post-operative x-rays and progress. He presented for the Left side Birmingham Hip Resurfacing. X-rays revealed a stress fracture through the femoral neck. Patient was asymptomatic and refused any surgical intervention. Patient successfully underwent Birmingham Hip Resurfacing Left side. The Right stress fracture neck of femur healed in varus without any further complications. The patient is asymptomatic after 30 months of diagnosis. We conclude that expectant treatment has role in asymptomatic stress fracture following Birmingham Hip resurfacing

In 1997 the Birmingham Hip Resurfacing was introduced to address the needs of young active patients. Alternative designs were introduced to try and improve wear performance. The aim of this study was a comparative cohort study of two types of metal-on-metal bearing to determine the mechanism of failure at 15 years. The study reviewed 91 Brimingham Hip Resurfacings (BHR) (Smith and Nephew) and 715 DUROM hip resurfacing (Zimmer) procedures in prior to 2009. Failure was defined as revision of either component for any reason. Kaplan-Meyer survivorship analysis performed. Routine follow-up with serum metal ion levels and radiographs. Mean follow-up was 17.9 years (range 15.2 – 25.1). The mean age at operation was 51.6 years (SD 8.6, range 20.7 to 70.2), including 299 women (37.1%). The Birmingham resurfacing demonstrated 92.3% survivorship at 15 years (SE 2.8, 95% CI 3.9 – 7.8) and 90.0% at latest follow-up (SE 3.5, 95% CI 4.9 to 9.4). By comparison, the DUROM survivorship at 15 years was 89.1% at 15 years (SE 1.2, 95% CI 2.0 to 2.5) and 87.4% (SE 1.3, 95% CI 2.5 to 2.3) at latest follow-up. There was no statistically significant difference in survivorship between groups (p= 0.32). Survival in male patients was 92.7% compared to 80.0% in females. The reported failures occurred from Adverse Reaction to Metal Debris (32 patients), periprosthetic femoral neck fracture (6) and aseptic loosening (41), PJI (12) and undiagnosed pain (6). The mean cobalt and chromium levels at last follow-up were 33.4 nmol/L and 36.5 nmol/L respectively. This study demonstrates two differently designed metal-on-metal hip resurfacing provided a durable alternative to total hip replacement, particularly in younger male patients with osteoarthritis. Differences in design did determine the reason for revision with acetabular fixation being one of the principal failure mechanisms for the DUROM compared to elevated ion levels

Purpose. Elevated blood metal ions are associated with the early failure of the Hip Resurfacing Arthroplasty. The aim of this study was to analyse our prospective database of Hip Resurfacing Arthroplasty patients, to independently review the outliers with elevated blood metal ions and to determine whether a screening program would be of value at our institution. Method. In 2004 a ten year prospective longitudinal study was set up to evaluate the clinical effectiveness and safety of Metal on Metal Hip Resurfacings in young, active adults with degenerative hip disease. Six hundred and four patients have enrolled in this multi-surgeon prospective study with strict inclusion criteria for Hip Resurfacing Arthroplasty. All have received the same implant design. All have completed validated functional outcome questionnaires at baseline, three and six months, then annually. A sub-cohort of 196 patients underwent whole blood chromium and cobalt analysis at the same time periods. Metal on metal bearings have a running in period of a minimum of six months before a steady state wear pattern is attained. We chose five parts per billion for Cobalt or Chromium as our threshold value. This value corresponds to the workplace exposure limit in the United Kingdom to Cobalt in whole blood. Therefore patients with ion levels greater than five parts per billion after six months were recalled for independent review, including further metal ion analysis. Results. Twenty two patients were recalled. Twenty one patients (32 Hip Resurfacing Arthroplasties) were reviewed. At latest review 11 patients (15 Hip Resurfacing Arthroplasties; eight females) had levels greater than five parts per billion. Mean follow up was 59.8 months (47–78). Mean age at surgery was 48.7 years (37–55). Median femoral component size was 50 millimetres (42–54). Mean acetabular anteversion was 18.3 degrees (−5.2 43.0). Mean acetabular inclination was 46.1 degrees (33.1–57.1). Mean cobalt and chromium levels were 8.82 parts per billion (3.49 18.42) and 9.15 parts per billion (3.79 24.33). Patients with ion levels greater than five parts per billion were associated with inferior functional scores (p= 0.018), inferior hip flexion (p=0.01) and mal-positioned acetabular components (p=0.023). All symptomatic patients were female. Conclusion. It is reassuring that the majority do not have elevated metal ions (185/196; 94.4%). That said, blood metal ion screening of Hip Resurfacing Arthroplasties aids in the early detection of problematic cases. Comprehensive clinical review should follow as patient safety is paramount. The early detection of problematic cases is advantageous to the surgeon and patient. Revision surgery for an established pseudotumour has been found to be technically challenging, often with a poor outcome

Introduction: Hip Resurfacing has always been an attractive concept for the treatment of hip arthritis in young patients. Excellent early and medium-term results have been reported with the Birmingham Hip Resurfacing (BHR) device in single and multi-surgeon all-diagnoses and OA series. In the present report we present the results of BHR in inflammatory arthritis. Methods: This is a single-surgeon consecutive series. There were 15 consecutive hips (12 patients) including 2 women (2 hips) with ankylosing spondylitis (AS) operated at a mean age of 41.7 years (range 29.5 to 54.3 years). Fortytwo hips (31 patients) with seronegative or rheumatoid (RA) arthritis treated with a BHR at a mean age of 40 (13 to 64) years and a follow-up of 2 to 9 (mean 5.9) years were also studied. One patient died 5 years later. Revision for any reason was the end-point and unrevised patients were assessed with Oxford hip scores and reviewed clinico-radiologically with AP and lateral radiographs. Results: In the RA group there was one failure from femoral neck fracture two months after operation giving a failure rate of 2.4%. There were no failures in this cohort at a follow-up of 1.8 to 8.8 (mean 4.9) years. As a combined group the failure rate of BHRs in inflammatory arthritis is 1.75% and the cumulative survivorship at 9 years is 98.2% (figure). Discussion: The good results of Birmingham Hip Resurfacing in inflammatory arthritis in this relatively young cohort of patients make this a viable treatment option for these patients. Selection of patients with a reason-able bone quality and adherence to precise operative technique are vital to the success of this procedure

We report experience of 207 consecutive metal on metal hip resurfacings in 179 patients, implanted by one surgeon since January 2002. The mean age at operation was 56 years (35 – 78 years) and follow-up ranged from 12 to 84 months (mean 39 months). The gender mix was 2:1 M: F. The Birmingham Hip Resurfacing was implanted in the first 155 cases with a switch to Finsbury Adept Hip Resurfacing for the remaining 52 cases. Data was obtained on all but one patient. There were four unrelated deaths (1.9%). No primary infections and no femoral neck fractures were encountered. One secondary infection at five years was salvaged by surgery and antibiotic treatment (0.5%). One male suffered a pertrochanteric fracture as a result of significant violence 15 months after operation (0.5%). Dislocation in five cases was the commonest complication encountered (2.4%). One of these cases developed recurrent dislocation and underwent early revision to a constrained total hip replacement (0.5%). This was the only failure in the series and no further revisions are pending. Our survivorship results compare very favourably with outcomes reported from centres of excellence and far exceed the survivorship estimates published by the National Joint Registry

A concern of metal on metal hip resurfacing arthroplasty is long term exposure to Cobalt (Co) and Chromium (CR) wear debris from the bearing. This study compares whole blood metal ion levels from patients drawn at one-year following Birmingham Hip Resurfacing (BHR) to levels taken at a minimum 10-year follow-up. A retrospective chart review was conducted to identify all patients who underwent a BHR for osteoarthritis with a minimum 10-year follow-up. Whole blood metal ion levels were drawn at final follow-up in June 2019. These results were compared to values from patients with one-year metal ion levels. Of the 211 patients who received a BHR, 71 patients (54 males and 17 females) had long term metal ion levels assessed (mean follow-up 12.7 +/− 1.4 years). The mean Co and Cr levels for patients with unilateral BHRs (43 males and 13 females) were 3.12 ± 6.31 ug/L and 2.62 ± 2.69 ug/L, respectively, and 2.78 ± 1.02 ug/L and 1.83 ± 0.65 ug/L for patients with bilateral BHRs (11 males and 4 females). Thirty-five patients (27 male and 8 female) had metal-ion levels tested at one-year postoperatively. The mean changes in Co and Cr levels were 2.29 ug/l (p = 0.0919) and 0.57 (p = 0.1612), respectively, at one year compared to long-term. These changes were not statistically significant. This study reveals that whole blood metal ion levels do not change significantly when comparing one-year and ten-year Co and Cr levels. These ion levels appear to reach a steady state at one year. Our results also suggest that regular metal-ion testing as per current Medicines and Healthcare products Regulatory Agency (MHRA) guidelines may be impractical for asymptomatic patients. Metal-ion levels, in and of themselves, may in fact possess little utility in determining the risk of failure and should be paired with radiographic and clinical findings to determine the need for revision

We previously reported the five to ten-year results of the Birmingham Hip Resurfacing (BHR) implant. The purpose of this study was to evaluate the survivorship, radiographic results, and clinical outcomes of the BHR at long-term follow-up. We retrospectively reviewed 250 patients from the original cohort of 324 BHRs performed from 2006 to 2013 who met contemporary BHR indications. Of these, 4 patients died and 4 withdrew. From the 242 patients, 224 patients (93%) were available for analysis. Modified Harris hip score (mHHS) and University of California, Los Angeles (UCLA) scores were collected and compared to a matched total hip arthroplasty (THA) cohort. Mean follow-up was 14 years. Survivorship free of aseptic revision was 97.4% and survivorship free of any revision was 96.0% at 15 years. Revisions included 3 periprosthetic joint infections, 2 for elevated metal ions and symptomatic pseudotumor, 2 for aseptic femoral loosening, and 1 for unexplained pain. The mean mHHS was 93 in BHR patients at final follow-up, similar to the THA cohort (p=0.44). The UCLA score was significantly higher for BHR patients (p=0.02), however there were equal proportions of patients who remained highly active (UCLA 9 or 10) in both groups, 60.5% and 52.2% (p=0.45) for BHR and THA respectively. Metal ion levels at long term follow-up were low (mean serum cobalt 1.8±1.5 ppb and mean serum chromium 2.2±2.0 ppb). BHR demonstrated excellent survivorship in males less than 60 years of age at time of surgery. Clinical outcomes and activity levels were similar to THA patients. Failures related to the metal-on-metal bearing were rare and metal levels were low at long-term follow-up. Level of evidence: III. Keywords: survivorship; hip arthroplasty; activity; metal-on-metal. Surface Replacement Arthroplasty demonstrates low revision rates and similar activity level compared to total hip arthroplasty at long-term follow-up

We present a consecutive case cohort of the first 100 Birmingham Hip Resurfacing (BHR)'s in 90 patients with a minimum follow up of 20 years. All procedures were performed by a single surgeon having commenced the study in 1998. The original cohort included 68 males with 75 hips (7 bilateral) and 22 females with 25 hips (3 bilateral). The mean age at index procedure was 52. Patients were recalled to review in clinic as per Medicines and Healthcare products Regulatory Agency guidelines with x-rays, metal ions and Harris Hip Scores recorded. After a minimum of 20 year follow-up review the known overall revision rate is 11%. 11 have died and 7 have been lost to review. In males the known revision rate is 4/75 (5%), 3 of which were due to early fractures and 1 revision for infection at 5 years. The known revision rate in females is 7/25 (28%) of which 6 were due to adverse reactions to metal debris; 3 at 7–8 yrs, 1 at 15 yrs, 2 at 18 years, and 1 at 2 months for avascular necrosis. The mean 20 year metal ions results were cobalt 36.6 nmol/l (range 7.4–232.1) and chromium 32.1 nmol/l (range 6–120.8). The mean Harris hip score was 88.5 (range 38.6–99.8). This case series with 20 years follow-up demonstrates excellent long term survival of the BHRs further to registry BHR data and similar to THR for same age recipients. Applying today's strict criteria for patient selection would likely improve survival rate further. BHR has not demonstrated the catastrophic revision rates associated with some metal-on-metal resurfacing and remains a safe option for those who meet the criteria

The 22 year survivorship of metal on metal hip resurfacing arthroplasty (RSA) is reported to be 94.3% with expert surgeons, in males with head sizes greater than 48mm. The 2023 National Joint Registry (NJR) report estimates survivorship of all RSA at 19 years to be 85%. This estimate includes all designs, head sizes and females. Our aim was to estimate the survivorship of RSA currently available for implantation (males only, head size >48mm, MatOrtho Adept or Smith and Nephew Birmingham Hip Resurfacing (BHR)) in those under 55 years, performed by all surgeons, compared to conventional THR. We performed a retrospective analysis of the NJR. We included all males under 55 years who had undergone BHR or Adept RSA with head size greater than 48mm. Propensity score matching was used to produce two comparable groups of patients for RSA or conventional THR. We matched in a 3:1 ratio (THR:RSA) using sex, ASA, BMI group, age at primary procedure, surgeon volume, diagnosis and surgeon grade as covariates. The primary analysis was survivorship at 18 years. Time-to-revision was assessed using Kaplan-Meier curves. Cox's proportional hazard models were used to investigate between group differences. 4839 RSA were available for analysis. After matching the RSA and THR groups were well balanced in terms of covariates. Survivorship at 18 years was 93.7% (95% CI 89.9,96.2) in the RSA group and 93.9% (90.5,96.0) in the THR group. Despite these similar estimates the adjusted hazard ratio was 1.40 (95% CI 1.18, 1.67 p<0.001) in favour of THR. Survivorship of the currently available RSA in males under 55 was 93.7% at 18 years, however THR survivorship was superior to RSA. These results, generalisable to UK practice, should be set against perceived benefits in functional status offered in RSA when counselling patients

Purpose: To find the incidence of Periprosthitic fracture following Birmingham Hip Resurfacing over the age of 65 yrs – in Ashford & St. Peters Hospitals. Method: We have done an audit to study the total number of patients who had Femoral neck fractures following Birmingham Hip Resurfacing, comparing them with the incidence of Femoral neck fracture in the age group of 65 yrs & above, from the period of March 2000 to January 2006 in Ashford & St. Peters Hospitals (NHS & Private). Between March 2000 and January 2006, 327 Birmingham hips were inserted by 8 surgeons. Fracture of the neck of the femur occurred in 5 patients, an incidence of 1.53%. Results:. 1 Intra op fracture & 4 post op fractures. Out of the total number of patients, 131 were above the age of 65years, with mean age of 68.80 years & a range of 65–77 years. No Femoral neck fractures were found in this age group. Conclusion: Incidence of Femoral neck fracture is NIL in the age group of 65 yrs & above compared to 1.53% over all

Hip resurfacing is a technically demanding surgical procedure. Notching of the femoral neck and mal positioning of the femoral Implant are the most frequently seen complications in hip resurfacing. Navigation is expected to bring additional safety and precision to the surgical procedure. Goal of this pilot study is to check usability and reliability of a new application developed for an established navigation system for Orthopedics. During a first developer release of the application 28 patients have been operated in 4 hospitals (Belgium, Canada, Germany and United Kingdom) from 2005-11-14 to 2005-12-22 with a Hip Resurfacing Implant (Durom®, Zimmer). The patient group consisted of 23 man and 5 women with an average age of 46 years (ranging from 29 to 66 years), mostly with primary cox arthrosis as indication. 7 surgeons have been navigating the femoral preparation with a therefore developed application on the Navitrack® system (ORTHOsoft Inc.). The protocol includes preoperative X-ray, intra-operative data and postoperative X-ray. The mean Operation time (Incision to Closure) was 124 minutes (ranging from 88 to 150 minutes). In two cases navigation needed to be aborted due to mechanical failure of the instrumentation (K-wire jammed in guide) and surgery has been completed with the conventional instrumentation. The remaining cases have been completed without any Software or Hardware problems. The additional time required for navigation during those first cases has been approximately 10 minutes. In all cases the planned CCD angle was achieved within a range of +/− 5° without notching the femoral neck. Navigation has the potential to improve precision in placement of the femoral component. The pilot study did prove the usability, safety and precision of the new Navitrack® CAS Durom Hip Resurfacing application. Combined with the already available cup navigation the system has an attractive potential to provide a tool helping the surgeon in achieving optimal outcome of a hip resurfacing

My experience with Birmingham Hip Resurfacing began in July 2000 and continues to this day for selected cases including OA, AVN, CDH and also following old fracture deformity and Femoral/Pelvic osteotomy. Early on, the criteria for patient selection expanded with increasing experience and positive acceptance by patients but then moderated as adverse reports including those from our National Joint Replacement Registry suggested a need for caution with Surface Replacement. Over 10 years, (July 2000 — July 2010), a personal series of 243 BHRs were followed (169 male — 74 female) with only one return to theatre in that time (4 days post op. to revise a poorly seated acetabular cup in a dysplastic socket). There were no femoral neck fractures in that 10 year period but 3 femoral cap/stem lucencies were known (2 female-1 male) with insignificant symptoms to require revision. The complete 10 year series of cases were then matched in the Australian National Joint Replacement Registry. No other revisions were identified by the Registry for all 243 cases. Soon after completing this encouraging outcome study however 3 revision procedures have been necessary (2 for sudden late head/neck failure including one of the three with known cap/stem lucencies and one for suspected pseudotumour/ALVAL). One healing stress fracture of the femoral neck and another further cap/stem loosening have also presented recently but with little in the way of symptoms at this stage. Surprisingly, there is little indication which case is likely to present with problems even in the presence of many cases done earlier where one would be cautious now to use a BHR but which have ongoing good outcomes. (e.g., AVN or the elderly osteoporotic patient). My journey therefore with Birmingham Hip Resurfacing over that first 10 years has been very positive and I believe it retains an important place for the younger patient with good bone quality. However it has become only recently apparent in my series of 243 cases that late onset unpredictable problems can arise which is likely to further narrow my selection criteria for this procedure. The likely outcome will be that it will have a more limited place in my joint replacement practice despite the very positive early experience

Purpose. This study was performed to evaluate clinical and radiographic outcomes of Hip Resurfacing Arthroplasty for treatment of haemophilic hip arthropathy. Material & Method. Between 2002 and 2013, 17 cases of hip resurfacing arthroplasties were performed in 16 haemophilic patients (13 cases of haemophilia A, 2 cases of haemophilia B, 2 cases of von Willebrand disease). The average age of the patients was 32.5(range: 18∼52) years. The average follow up period from the operation was 6.3 (range: 2∼13) years. In this study, the subjects that completed follow-up were composed of 5 cases composed of patients who were treated with Conserve plus. ®. hip resurfacing system, 5 cases composed of patients who were treated with Durom. ®. hip resurfacing system, 4 cases who were treated with ASR. ®. hip resurfacing system, and 3 cases who were treated with Birmingham. ®. hip resurfacing system. The Modified Harris hip score, the range of motion of the hip joint, perioperative coagulation factor requirements and complications associated with bleeding were evaluated as part of the clinical assessment. For the radiographic assessment, fixation of component, presence of femoral neck fracture, osteolysis, loosening and other complications were evaluated. Results. The modified Harris hip score improved from 65.4(47–80) points before surgery to 97.8(90–100) points at the last follow-up. The average further flexion improved from 103° (70–135) to 110°(80–130) after surgery. The average abduction improved from 22.4° (0–45) to 41.3° (20–50) after surgery. All the patients showed a significant reduction in pain. The mean requirement of factor VIII reduced from 2470 units per month before surgery to 1125 units per month at the time of the last follow-up. However, in the case of high-titer inhibitor to factor VIII, haemophilia B, von Willebrand disease, the average monthly factor requirement was not changed due to bleeding episode of other joints. There was two cases of re-bleeding. There were no femoral neck fracture, no osteolysis, and no implant loosening in last follow up. Conclusion. Hip resurfacing arthroplasty for haemophilic hip arthropathy in patients with mild deformity or relatively preserved range of the hip joint motion can bring reliable pain relief, functional improvement, and reduction of factor requirement for over two years follow-up study. However, bleeding-associated complications are a cause for concern, especially for patients with antibodies against coagulation factors

Introduction. Hip Resurfacing Arthroplasty (HRA) has been performed in the United States for over 10 years and is an alternative to standard Total Hip Arthropastly (THA). It is appealing to younger patients with end stage osteoarthritis who seek to maintain active lifestyles. Benefits of HRA versus THR include a larger femoral ball size, potential to return to impact activities, decreased dislocation rates, and restoration of normal hip biomechanics. Patients ≤50 years old are a particularly challenging patient group to treat with THA because of their young age and high activity level, and as such, are well-suited for HRA. However, there are limited reports in the literature about clinical, radiographic and functional outcomes for this patient cohort. We present results of a clinical investigation at our institution for this patient cohort with minimum 5-year follow up, including long term survivorship and outcome scores. Methods. HRA, using the Birmingham Hip Resurfacing (BHR), was performed for 538 procedures between 2006–2009 by a single surgeon at a United States teaching hospital. After Institutional Review Board approval, medical and radiographic study records were retrospectively reviewed. Harris Hip Scores (HHS) were routinely collected. Patients who had not returned for follow-up examination were contacted by telephone for information pertaining to their status and implant, and a modified HHS was also administered. A Kaplan Meier survival curve was constructed to evaluate time to revision. Statistical analysis was performed (SAS version 9.3; SAS Institute, Cary, NC). Results. Of the 538 patients who underwent HRA from 2006–2009, 238 were aged ≤50 years (44%). Five-year follow up data was obtained from 209 of these patients (88%), using medical record documentation, and telephone survey as needed. The mean follow-up for all patients was 6 years (range 5–8 years). A total of 3% (8/238) were revised. Reasons included: (i) femoral loosening in 4, (ii) Iliopsoas impingement in 1, (iii) metallosis/adverse tissue reaction in 1, (iv) femoral neck fracture following motor vehicle accident in 1, and (v) unknown reasons in 1. Of the 238 patients, 55 (23%) were female, 2 (2/55; 3.6%) of whom have since undergone revision surgery for either metallosis/adverse tissue reaction, or unknown reasons. Of the 53 women who retained their BHR at 5-year follow up, the average HHS was 96.5. Of the 238 patients, 183 (77%) were male patients, 6 (6/183; 3.2%) of whom have since undergone revision surgery for femoral component loosening, iliopsoas impingement, or femoral neck fracture sustained in a motor vehicle accident. At 5-year follow-up, 177 male patients retained their implant and had an average Harris Hip Score of 98.8. The overall implant survival was 96.6% at approximately 5 years. Conclusion. In our cohort of patients aged ≤50 treated with BHR [Fig. 1], our results demonstrated 5-year survivorship of 96.6%, with average HHS of 98.8 in males and 96.5 in females. This study demonstrates HRA is a successful alternative to traditional THA in a challenging cohort of younger, active patients

Introduction. Patients presenting with osteoarthritis as late sequelae following pediatric hip trauma have few options aside from standard Total Hip Replacement (THR). For younger more active patients, Hip Resurfacing Arthroplasty (HRA) can be offered as an alternative. HRA has been performed in the United States over the past decade and allows increased bone preservation, decreased hip dislocation rates versus THR, and potential to return to full activities. Patients presenting with end-stage hip arthritis as following prior pediatric trauma or disease often have altered hip morphology making HRA more complicated. Often Legg-Calve-Perthes (LCP) patients present with short, wide femoral necks, and femoral head distortion including coxa magna or coxa plana. There often can be acetabular dysplasia in conjunction with the proximal femoral abnormalities. Slipped Capital Femoral Epiphysis (SCFE) patients have an alteration of the femoral neck and head alignment, which can make reshaping the femoral head difficult. In particular, the femoral head is rotated medially and posteriorly, reducing the anterior and lateral offset. We present a cohort of 20 patients, with history of a childhood hip disorder (SCFE or LCP), who underwent HRA to treat end-stage arthritis. Fifty percent had prior pediatric surgical intervention at an average age of 11. Method. After Institutional Review Board approval, data was reviewed retrospectively on patients with pediatric hip diseases of SCFE and LCP who underwent HRA using the Birmingham Hip Resurfacing (BHR) by a single orthopaedic surgeon at a teaching institution. Harris Hip Scores (HHS), plain radiographs and blood metal ion levels were reviewed at routine intervals (12 months and annually thereafter). Those who had not returned for recent follow-up were contacted via telephone survey for a modified HHS. Results. Twenty patients had mean follow up of 2.8 years (range 1–7 years). Twelve had LCP and 8 SCFE. Median implant duration was 2.4 years. One-year metal ion testing revealed median chromium level of 2.3 ppb and median Cobalt level of 1.5 ppb. At one-year follow up, plain radiographs demonstrated all patient implants to be well-fixed, without radiolucent lines or osteolysis. Two patients at three and five-year follow-up exhibited heterotopic ossification. Mean HHS for LCP at 6 weeks post-operative was 88, and 98 at one year. Mean HHS for SCFE at 6 weeks post-operative was 77.5, and 98.6 at one year. LLD was significantly improved with an average pre-operative LLD of 12.6 mm and post op of 2.6 mm (p-value <0.001). At most recent follow-up, all retained their implants with overall average HHS of 98. Conclusion. At minimum of one-year following HRA, an increase in functional outcomes is found in patients who underwent HRA for osteoarthritis associated with LCP and SCFE with a mean HHS of 98. No increase was found in complications including femoral neck fracture or implant loosening despite technical challenges of the procedure related to proximal femoral morphologic abnormalities, or presence of acetabular dysplasia [Fig 1]

The purpose of this study is to show our experience with Birmingham Hip Resurfacing which we think it is a procedure that will play a big role in hip replacement surgery, especially for young people. Methods:. Operative Records from the Theatre Registrar Book, Implant register Book and the theatre computer records. Other similar studies from other Hospitals. Birmingham Hip Resurfacing – Ashford and St. Peter’s Hospitals Experience for the period March 2000 to January 2004. The total number of cases done for the period: 290. The number of patients: 277. Male: 160. Female: 130. Right Hip: 145. Left Hip: 120. Side not recorded: 25. Both sides done: 13. Primary cases: 286. Revisions: 4. The youngest male done aged: 25 years. The youngest female done aged: 33 years. The oldest male done aged: 75 years. The oldest female done aged: 72 years. Mean age: 56.5 years. Conclusion: Birmingham Metal on Metal Resurfacing started by Mr. Derek McMinn at about 13 years ago. Our results and results world-wide are encouraging. The failure rate of THR in young patients is very high, and the revision is difficult and requires a major reconstructive operation. Therefore BHR is a good alternative in our opinion

Hip Resurfacing in its current metal on metal hybrid fixation form has been performed in large numbers in Australia since 1999. Outcomes from the Australian Orthopaedic Association National Joint Replacement Registry are shown. While there is a wide range of outcomes these can be shown to depend on patient factors and implant factors. Use of one of the successful implants (for example the Birmingham Hip) in a young male patient with osteoarthritis by a suitably trained surgeon can lead to good results. In the AOA NJRR the 10 year cumulative percent revision rate for the Birmingham Hip in male patients under the age of 60 at the time of surgery is 3.3%