Purpose: We report a series of 117 consecutive metal-on-metal Birmingham Hip Resurfacings in 105 patients with a minimum of 5 year follow up.

Method: Patients were followed up both clinically and radiographically for a minimum of 5 years following implantation. Revision of either the femoral or acetabular component during the study period is defined as failure.

Results: We followed up 114 of 117 hips (97%). We had 4 failures giving us survivorship at 5 years of 97% (95% confidence interval (CI) 94–100). The mean follow up was 72 months and the mean age at implantation 54.5 years old. The mean Oxford Hip Score fell from 41.6 preoperatively to 15.3 postoperatively (p< 0.0001). The mean Harris Hip Score at 5 year follow up was 96.4. The UCLA Activity Scale rose from 3.93 preoperatively to 7.54 postoperatively (p< 0.001). Radiographic analysis revealed neck thinning in 12 patients (10%) and we define a method of measuring this. The average stem shaft angle in our cohort was 130 degrees and the average cup angle was 36 degrees. Heterotropic ossification was present in 17 hips (15%).

Conclusion: This study confirms that metal-on-metal resurfacing produces an excellent clinical and functional outcome in the younger patient who requires surgical intervention for hip disease. The results compare favourably with those from the originating centre and confirm that resurfacing is well suited for younger higher demand patients. It is the first study with a minimum 5 year follow up outside the originating centre.

Introduction: The hip resurfacing in younger patients is being performed more frequently in the UK. At the same time conventional Total Hip Replacement (THR) is also being performed.. We carried out a study to compare the patient satisfaction and outcome following Birmingham Hip Resurfacing (BHR) and Total Hip Replacement (THR) in patients below the age of 55 years.

Methods: There were 93 BHR in 73 patients and 74 THR in 64 patients performed between February 1997 to June 2005.. Retrospective evaluation of notes and complications were identified. We carried out our study using Oxford Hip score and Modified WOMAC questionnaire by postal and telephonic survey.

Results: We found that mean length of stay was 4.5 days for BHR and 6.4 days for THR patients. (P< 0.0001) The dislocation rate was 0% for BHR as oppose to 4% for THR. (P< 0.05) The mean Oxford Hip score improved from pre-operative 43 to 14 for BHR as oppose to 48 to 22 for THR patients. The mean modified WOMAC score improved from 21 to 8.4 for BHR as oppose to 25 pre-operative score to 12 for THR. We also found early and sustained improvement in these scores for BHR as compare to THR during their follow-up within 6 months to 8 years. The improvement in pain score was 100% following BHR as opposed to 84% for THR. Following BHR 70% patients were very active or active as oppose to only 30% of THR patients. Return to the work and sporting activities following BHR was at a mean of 9 weeks as oppose to 14 weeks following THR. (P < 0.05) The level of satisfaction was 98% following BHR as oppose to 84% following THR. (P=0.356).

Fatal pulmonary embolism (PE) after total hip replacement (THR) is a major concern to all orthopaedic surgeons. Our intention was to ascertain death rates and deaths due to PE following total hip replacement where chemical thromboprophylaxis was not used routinely.

We determined retrospectively, the postoperative mortality and fatal pulmonary embolism rates in 1671 consecutive primary total hop replacements in 1547 patients performed as staged procedures between January 1997 and April 2000 at an orthopaedic hospital. The minimum follow-up period was six weeks period after surgery at an orthopaedic hospital. Patients were traced by questionnaires, outpatient appointments and by telephone. Post-mortem records were used to verify cause of death. Follow-up was 100%. The death rate from PE was 0. 12% (CI 0. 03% – 0. 44%) and the all-cause mortality rate was 0. 36% (CI 0. 16% – 0. 78%). All deaths were within the first 10 days during the initial hospital stay. The patient mortality was compared with the population mortality for England and Wales, using standardised mortality ratios (SMRs). The SMR for both sexes combined was 0. 81. We observed a lower mortality in females (SMR=0. 43) but a higher mortality in males (SMR=1. 44) during the first 42 postoperative days compared to the general population.

Fatal PE after THR without routine chemical thromboprophylaxis is very uncommon. The death rate in patients undergoing THR appears to be lower than that in the general population.