We present the clinical results and survivorship of consecutive 100 Birmingham Hip Resurfacings in 90 patients at a minimum follow-up of ten years. All procedures were carried out by an independent surgeon who commenced a prospective study in 1998. Patients were assessed clinically using the Western Ontario and McMaster Universities osteoarthritis index, Short-Form 36, Harris hip score and University of California, Los Angeles activity score. Radiological analysis was performed by an independent observer and blood metal ion levels concentrations were measured at ten years post-operatively in 62 patients. The median acetabular component inclination was 46.2° (34° to 59°) and anteversion 11.0° (0° to 30°). The median chromium concentration in the unilateral group was 1.74 (0.41 to 15.23) and for the bilateral group was 2.98 (1.57 to 18.01). The equivalent values for cobalt were 1.67 (0.54 to 20.4) and 1.88 (1.38 to 19.32).

In total there were eight failures giving an overall survival at ten years of 92% (95% confidence interval (CI) 86.7 to 97.3). BHR in male patients had an improved survivorship of 94.6% (95% CI 89.4 to 100) compared with females at 84.6% (95% CI 70.7 to 98.5), but this did not reach statistical significance (p = 0.119). Four of the nine BHRs with a bearing diameter of 42 mm failed.

The overall results were consistent with data produced from other centres in that the clinical outcome of large male patients was extremely encouraging, whereas the survival of the smaller joints was less satisfactory.

Aims. The Birmingham Hip Resurfacing (BHR) arthroplasty has been used as a surgical treatment of coxarthrosis since 1997. We present 20-year results of 234 consecutive BHRs performed in our unit. Methods. Between 1999 and 2001, there were 217 patients: 142 males (65.4%), mean age 52 years (18 to 68) who had 234 implants (17 bilateral). They had patient-reported outcome measures collected, imaging (radiograph and ultrasound), and serum metal ion assessment. Survivorship analysis was performed using Kaplan-Meier estimates. Revision for any cause was considered as an endpoint for the analysis. Results. Mean follow-up was 20.9 years (19.3 to 22.4). Registry data revealed that 19 hips (8.1%) had been revised and 26 patients (12%) had died from causes unrelated to the BHR. Among the remaining 189 hips, 61% were available for clinical follow-up at 20 years (n = 115) and 70% of patients had biochemical follow-up (n = 132). The cumulative implant survival rate at 20 years for male patients was 96.5% (95% confidence interval (CI) 93.5 to 99.6), and for female patients 87% (95% CI 79.7 to 94.9). The difference was statistically significant (p = 0.029). The mean Oxford Hip Score, Hip disability and Osteoarthritis Outcome Score, and Forgotten Joint Score were 45 (29 to 48), 89 (43 to 100), and 84 (19 to 100), respectively. The mean scores for each of the five domains of the EuroQol five-dimension three-level questionnaire were 1.2, 1.0, 1.2, 1.3, and 1.1, and mean overall score 82.6 (50 to 100). Ultrasound showed no pseudotumour. Mean cobalt and chromium levels were 32.1 nmol/l (1 to 374) and 45.5 nmol/l (9 to 408), respectively. Conclusion. This study shows that BHRs provide excellent survivorship and functional outcomes in young male patients. At 20 years, soft-tissue imaging and serum metal ion studies suggest that a metal-on-metal resurfacing implant can be well tolerated in a group of young patients. Cite this article: Bone Joint J 2023;105-B(9):946–952

Aims. The Birmingham Hip Resurfacing (BHR) was introduced in 1997 to address the needs of young active patients using a historically proven large-diameter metal-on-metal (MoM) bearing. A single designer surgeon’s consecutive series of 130 patients (144 hips) was previously reported at five and ten years, reporting three and ten failures, respectively. The aim of this study was to extend the follow-up of this original cohort at 25 years. Methods. The study extends the reporting on the first consecutive 144 resurfacing procedures in 130 patients for all indications. All operations were undertaken between August 1997 and May 1998. The mean age at operation was 52.1 years (SD 9.93; 17 to 76), and included 37 female patients (28.5%). Failure was defined as revision of either component for any reason. Kaplan-Meier survival analysis was performed. Routine follow-up with serum metal ion levels, radiographs, and Oxford Hip Scores (OHSs) was undertaken. Results. Overall implant survival was 83.50% (95% confidence interval (CI) 0.79 to 0.90) at 25 years, and the number at risk was 79. Survival in male patients at 25 years was 89.5% (95% CI 0.83 to 0.96) compared to 66.9% for female patients (95% CI 0.51 to 0.83). Ten additional failures occurred in the period of ten to 25 years. These involved an adverse reaction to metal debris in four patients, a periprosthetic femoral neck fracture affecting five patients, and aseptic loosening in one patient. The median chromium levels were 49.50 nmol/l (interquartile range (IQR) 34 to 70), and the median cobalt serum levels were 42 nmol/l (IQR 24.50 to 71.25). The median OHS at last follow-up was 35 (IQR 10 to 48). During the 25-year study period, 29 patients died. Patient survival at 25 years was 75.10% (95% CI 0.67 to 0.83). Conclusion. This study demonstrates that MoM hip resurfacing using the BHR provides a durable alternative to total hip arthroplasty (THA), particularly in younger male patients with osteoarthritis wishing to maintain a high level of function. These results compare favourably to the best results for THAs. Cite this article: Bone Joint J 2024;106-B(6):540–547

Aims. It is not known whether change in patient-reported outcome measures (PROMs) over time can be predicted by factors present at surgery, or early follow-up. The aim of this study was to identify factors associated with changes in PROM status between two-year evaluation and medium-term follow-up. Patients and Methods. Patients undergoing Birmingham Hip Resurfacing completed the Veteran’s Rand 36 (VR-36), modified Harris Hip Score (mHHS), Tegner Activity Score, and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) at two years and a minimum of three years. A change in score was assessed against minimal clinically important difference (MCID) and patient-acceptable symptom state (PASS) thresholds. Binary logistic regression was used to assess the relationship between patient factors and deterioration in PASS status between follow-ups. Results. Overall, 18% of patients reported reductions in mHHS total score exceeding MCID, and 21% reported similar reductions for WOMAC function scores. Nonetheless, almost all patients remained above PASS thresholds for WOMAC function (98%) and mHHS (93%). Overall, 66% of patients with mHHS scores < PASS at two years reported scores > PASS at latest follow-up. Conversely, 6% of patients deteriorated from > PASS to < PASS between follow-ups. Multivariable modelling indicated body mass index (BMI) > 27 kg/m. 2. , VR-36 Physical Component Score (PCS) < 51, VR-36 Mental Component Score (MCS) > 55, mHHS < 84 at two years, female sex, and bone graft use predicted these deteriorating patients with 79% accuracy and an area under the curve (AUC) of 0.84. Conclusion. Due to largely acceptable results at a later follow-up, extensive monitoring of multiple PROMs is not recommended for Birmingham Hip Resurfacing patients unless they report borderline or unacceptable hip function at two years, are female, are overweight, or received a bone graft during surgery. Cite this article: Bone Joint J 2019;101-B:1431–1437

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

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

It is accepted that resurfacing hip replacement preserves the bone mineral density (BMD) of the femur better than total hip replacement (THR). However, no studies have investigated any possible difference on the acetabular side. Between April 2007 and March 2009, 39 patients were randomised into two groups to receive either a resurfacing or a THR and were followed for two years. One patient’s resurfacing subsequently failed, leaving 19 patients in each group. Resurfaced replacements maintained proximal femoral BMD and, compared with THR, had an increased bone mineral density in Gruen zones 2, 3, 6, and particularly zone 7, with a gain of 7.5% (95% confidence interval (CI) 2.6 to 12.5) compared with a loss of 14.6% (95% CI 7.6 to 21.6). Resurfacing replacements maintained the BMD of the medial femoral neck and increased that in the lateral zones between 12.8% (95% CI 4.3 to 21.4) and 25.9% (95% CI 7.1 to 44.6). On the acetabular side, BMD was similar in every zone at each point in time. The mean BMD of all acetabular regions in the resurfaced group was reduced to 96.2% (95% CI 93.7 to 98.6) and for the total hip replacement group to 97.6% (95% CI 93.7 to 101.5) (p = 0.4863). A mean total loss of 3.7% (95% CI 1.0 to 6.5) and 4.9% (95% CI 0.8 to 9.0) of BMD was found above the acetabular component in W1 and 10.2% (95% CI 0.9 to 19.4) and 9.1% (95% CI 3.8 to 14.4) medial to the implant in W2 for resurfaced replacements and THRs respectively. Resurfacing resulted in a mean loss of BMD of 6.7% (95% CI 0.7 to 12.7) in W3 but the BMD inferior to the acetabular component was maintained in both groups. These results suggest that the ability of a resurfacing hip replacement to preserve BMD only applies to the femoral side

Introduction. The BIRMINGHAM HIP. ◊. Resurfacing is a metal-on-metal (MOM) hip implant system approved by the US FDA in 2006. The approval required a multicenter, prospective, post-approval study (PAS). Our purpose is to report the current minimum 10-year results. Methods. 253 patients (280 hips) had surgery between October 2006 and December 2009 at one of 5 sites. We report revisions, survivorship, EQ-5D, Harris Hip Score (HHS), radiographic findings, and metal levels including cobalt (Co) and chromium (Cr). The mean age at surgery was 51 years, 74% male, BMI 28, osteoarthritis 95%. 243 (87%) of hips have known outcome or 10-year minimum follow-up (fup). Prior to 10 years, 5 patients died, 20 hips were revised, and 37 hips did not complete 10-year fup. Results. The 10-year component survivorship is 92.9% (95% CI 89.8–96.1%). The reasons for revision were femoral neck fracture (3), femoral loosening (5), acetabular loosening (1), pseudotumor (3), osteolysis (2) and the remaining 6 for a combination of pain, noise, or metal levels. The EQ-QAL VAS improved (mean preop: 70, 1-year: 89, p<0.001) and was stable through 10 years (87, p=0.05). The HHS improved (mean preop: 57, 1-year: 96, p<0.001) and remained stable through 10 years (96, p=0.93). Radiographically, no surviving components have migrated. 4.6% (10/218) have osteolysis. The Co and Cr levels increased at 1 year (median Co preop: 0.12 ppb, 1-year: 1.5 ppb, p<0.001; Cr preop: 0.60 ppb, 1-year: 1.70 ppb, p<0.001) and remained stable through 10 years (Co 10-year: 1.29 ppb, p=0.28; Cr 10-year: 1.36 ppb, p=0.88). The number of patients with a Co or Cr >7 ppb at one and 10 years remained similar (1-year: 3.4% (7/205), 10-year: 4.4%, (9/205), p=0.61). Conclusion. This prospective, multicenter PAS demonstrated this resurfacing is safe and durable. 10-year survivorship for males less than 55 years old is 98.3% (95% CI 95.9–100%)

The Articular Surface Replacement (ASR) hip resurfacing arthroplasty has a failure rate of 12.0% at five years, compared with 4.3% for the Birmingham Hip Resurfacing (BHR). We analysed 66 ASR and 64 BHR explanted metal-on-metal hip replacements with the aim of understanding their mechanisms of failure. We measured the linear wear rates of the acetabular and femoral components and analysed the clinical cause of failure, pre-revision blood metal ion levels and orientation of the acetabular component. There was no significant difference in metal ion levels (chromium, p = 0.82; cobalt, p = 0.40) or head wear rate (p = 0.14) between the two groups. The ASR had a significantly increased rate of wear of the acetabular component (p = 0.03) and a significantly increased occurrence of edge loading (p < 0.005), which can be attributed to differences in design between the ASR and BHR. The effects of differences in design on the in vivo wear rates are discussed: these may provide an explanation as to why the ASR is more sensitive to suboptimal positioning than the BHR

The early designs of hip resurfacing implants suffered high rates of early failure, making it impossible to obtain valuable mid-term radiostereophotogrammetric (RSA) results. The metal-on-metal Birmingham Hip Resurfacing arthroplasty has shown promising mid-term results and we present here the first mid-term RSA analysis of a hip resurfacing implant. The analysis was performed in 19 hips at five years post-operatively. The mean acetabular component translation and rotation, and femoral component translation were compared with the previous RSA measurements at two and six months, and one and two years. There was no statistical significance (t-test, p ≤ 0.05) between these consecutive movements, indicating the mid-term stability of the implant

The dysplasia cup, which was devised as an adjunct to the Birmingham Hip Resurfacing system, has a hydroxyapatite-coated porous surface and two supplementary neutralisation screws to provide stable primary fixation, permit early weight-bearing, and allow incorporation of morcellised autograft without the need for structural bone grafting. A total of 110 consecutive dysplasia resurfacing arthroplasties in 103 patients (55 men and 48 women) performed between 1997 and 2000 was reviewed with a minimum follow-up of six years. The mean age at operation was 47.2 years (21 to 62) and 104 hips (94%) were Crowe grade II or III. During the mean follow-up of 7.8 years (6 to 9.6), three hips (2.7%) were converted to a total hip replacement at a mean of 3.9 years (2 months to 8.1 years), giving a cumulative survival of 95.2% at nine years (95% confidence interval 89 to 100). The revisions were due to a fracture of the femoral neck, a collapse of the femoral head and a deep infection. There was no aseptic loosening or osteolysis of the acetabular component associated with either of the revisions performed for failure of the femoral component. No patient is awaiting a revision. The median Oxford hip score in 98 patients with surviving hips at the final review was 13 and the 10th and the 90th percentiles were 12 and 23, respectively

Few independent studies have reported the outcome of resurfacing arthroplasty of the hip. The aim of this study was to report the five-year clinical outcome and seven-year survival of an independent series. A total of 610 Birmingham Hip Resurfacing arthroplasties were performed in 532 patients with a mean age of 51.8 years (16.5 to 81.6). They were followed for between two and eight years; 107 patients (120 hips) had been followed up for more than five years. Two patients were lost to follow-up. At a minimum of five years’ follow-up, 79 of 85 hips (93%) had an excellent or good outcome according to the Harris hip score. The mean Oxford hip score was 16.1 points (. sd. 7.7) and the mean University of California Los Angeles activity score was 6.6 points (. sd. 1.9). There were no patients with definite radiological evidence of loosening or of narrowing of the femoral neck exceeding 10% of its width. There were 23 revisions (3.8%), giving an overall survival of 95% (95% confidence interval 85.3 to 99.2) at seven years. Fractured neck of femur in 12 hips was the most common indication for revision, followed by aseptic loosening in four. In three hips (three patients) (0.5%), failure was possibly related to metal debris. Considering that these patients are young and active these results are good, and support the use of resurfacing. Further study is needed to address the early failures, particularly those related to fracture and metal debris

Introduction. The Birmingham Hip Resurfacing (Smith & Nephew London, UK) is the most popular hip resurfacing (HR) in the UK. However, it is now subject to two Medical Device Alerts (MDA) from the Medicines and Healthcare products Regulatory Agency (MHRA). Patients/Materials & Methods. A cross-sectional survey of primary metal-on-metal hip procedures recorded on the National Joint Registry for England, Wales and Northern Ireland (NJR) until 5. th. November 2013 was performed. Cost-analysis was based on an algorithm for surveillance of HR at a tertiary referral centre and followed previous MHRA guidance. NIHR NHS Treatment costs were used. The local protocol encompassed: patient outcome scoring (Oxford hip score), blood metal ion measurement (cobalt, chromium), cross-sectional imaging (MRI) and discussion at an internet-enabled multidisciplinary team meeting (iMDT) in addition to routine hip surveillance. Results. A total of 33996 patients have Hip Resurfacings in the UK. 18478 have BHR and 9457 are female or small men. Costs:. Cobalt and Chromium levels £34.64. Single site MRI scan £438.91. Review of medical notes is £97.98. New Patient Appointment £137. Every patient requires at least 1 set of blood tests, an MRI and discussion in iMDT in our unit at a minimum cost of £571.53. This excludes clinic appointments; repeat testing, or costs of revision surgery and litigation. Total minimum cost to NHS £5.4 million. Discussion. It is important to not ignore nationally delivered guidance and therefore this patient group now requires comprehensive follow up as described by the MHRA. Other HR devices may now need to be considered to require further follow-up with inherently increased costs to the NHS. Conclusion. We recommend a streamlining of review via regional iMDTs in order to effectively manage MDA's and minimise potential costs

Surface replacement arthroplasty (SRA) has been proposed as a viable option for the treatment of osteoarthritis in young, active patients. Positive results of the Birmingham Hip Resurfacing (BHR) in select patient groups have been described in international series and registry data. We report 5–10 year U.S. follow-up for the BHR at our high volume institution. 314 patients (361 hips) between 2006–2011 underwent BHR at our institution and agreed to participate in research. Demographic features, modified Harris Hip Score, UCLA Activity Score, and satisfaction were recorded for patients with minimum 5-year follow-up (90%). Radiographs were evaluated for implant position and “at risk” signs. Complications, reoperations, and revisions were investigated. Mean modified Harris Hip and UCLA scores significantly improved postoperatively to scores of 89.96 and 7.90 (p < 0.001), respectively. Kaplan-Meier estimated survival for all-cause revision was 96.7% [95% CI 94.7 – 98.7%] at 5 years and 91.5% [95% CI 85.3 – 97.6%] at 10 years. Estimated survival for aseptic revision in males less than 60 years old with a primary diagnosis of osteoarthritis was 99.5% [95% CI 98.7 – 100%] at 5 years and 98.8% [95% CI 97.0 – 100%] at 10 years. 14 patients required revision, including 5 revisions for adverse local tissue reaction. Our study demonstrated excellent survivorship and clinical outcomes at 5–10 year follow up for the BHR. These results mirror other series and registry data published outside of the United States. Continued long-term follow-up and additional studies are necessary to validate the long-term safety and outcomes of the BHR, especially in young active arthroplasty patients

Aims

The hip’s capsular ligaments passively restrain extreme range of movement (ROM) by wrapping around the native femoral head/neck. We determined the effect of hip resurfacing arthroplasty (HRA), dual-mobility total hip arthroplasty (DM-THA), conventional THA, and surgical approach on ligament function.

Competitive dancers represent a unique patient population in the setting of hip arthroplasty given the high degree of hip strength and mobility required by their profession. We sought to determine the clinical outcomes and ability to return to competitive dance after total hip arthroplasty (THA) or hip resurfacing arthroplasty (HRA) among competitive dancers.

Active competitive dancers who underwent primary THA or HRA at a single institution with minimum one-year follow-up were included in the study. Primary outcomes included (1) the rate of return to competitive dance, (2) three PROMs (modified Harris Hip Score [mHHS], Hip Disability and Osteoarthritis Outcome Score for Joint Replacement [HOOS-JR], and Lower Extremity Activity Scale [LEAS]), and (3) post-operative complications.

Forty-nine hips in 39 patients (mean age 56±13 years; 80% female) were included. Mean follow-up was 4.9±5.1 years. Thirty-seven THAs and 12 HRAs were performed. Ninety-six percent of patients returned to competitive dance activities post-operatively. With respect to PROMs, there were statistically significant improvements in mHHS, HOOS-JR, and LEAS from baseline to ≥ 1 year post-operatively. There were complications in 9/49 (18%) hips post-operatively, five (10%) of which required revision surgery.

Active competitive dancers experienced significant improvements in functional outcome scores after THA or HRA, with a rate of return to competitive dance of 96%.

Aims

The aim of this study was to assess the functional gain achieved following hip resurfacing arthroplasty (HRA).

The management of prosthetic joint infection (PJI) has been widely performed for total hip arthroplasties (THA), but none has compared it with hip resurfacing arthroplasty (RSA). We also carried out a retrospective case-control study comparing the surgical treatment of PJI by surgical debridement and implant retention between RSA and THA in order to clarify whether there was a difference in terms of (1) successful healing of PJI (2) functional scores after recovery (3) risk factors for recurrence of PJI. Our hypothesis was that simple debridement with prosthesis retention regardless of the timeframe allowed to obtain a higher success rate for RSA compared to THA.

From 2010 to 2018, a single-center case-control study based on 3056 RSA found 13 PJI were age-matched (based on the 139 THA PJI treated) with 15 THA PJI (mean age of 53 years old (47–58) for THA and 59 (45–66) for RSA (p=0.34)). We compared their survival (absence of infectious recurrence) and the means differences between the 2 groups (demographical, clinical and biological data).

There was no difference between the 2 groups concerning: age (p=0.3), BMI (p=0.4), initial diagnosis (p=0.4), operating time for primary surgery (p=0.3), the presence of a postoperative hematoma (p=0.4), the type of bacteria (p=0.5), the total duration of antibiotic therapy (p=0.9) and the type of antibiotic therapy (p=0.6). Early postoperative infections (less than 6 weeks) occurred in 7/13 RSA cases (54%) compared to 11/15 THA cases (73%). At the mean follow-up of 5 years (2–7), the success rate without recurrence was significantly higher in the RSA group 100% versus 66.7% (10/15) for the THA group (p=0.044). At the last follow-up, the Oxford Hip Score was higher in the RSA versus THA group's (14 versus 22 p=0.004).

Simple surgical debridement an RSA without changing implants after PJI can be done regardless of the time to onset of infection. This is secondary to the absence of metaphyseal bone invasion and the low content of joint fluid.

The purpose of this study was twofold: first, to determine whether the five-year results of hip resurfacing arthroplasty (HRA) in Canada justified the continued use of HRA; and second, to identify whether greater refinement of patient selection was warranted.

This was a retrospective cohort study that involved a review of 2773 HRAs performed between January 2001 and December 2008 at 11 Canadian centres. Cox’s proportional hazards models were used to analyse the predictors of failure of HRA. Kaplan–Meier survival analysis was performed to predict the cumulative survival rate at five years. The factors analysed included age, gender, body mass index, pre-operative hip pathology, surgeon’s experience, surgical approach, implant sizes and implant types. The most common modes of failure were also analysed.

The 2773 HRAs were undertaken in 2450 patients: 2127 in men and 646 in women. The mean age at operation was 50.5 years (sd 8.72; 18 to 82) and mean follow-up was 3.4 years (sd 2.1; 2.0 to 10.1). At the last follow-up a total of 101 HRAs (3.6%) required revision. Using revision for all causes of failure as the endpoint, Kaplan–Meier survival analysis showed a cumulative survival of 96.4% (95% confidence interval (CI) 96.1 to 96.9) at five years. With regard to gender, the five-year overall survival was 97.4% in men (95% CI 97.1 to 97.7) and 93.6% in women (95% CI 92.6 to 94.6). Female gender, smaller femoral components, specific implant types and a diagnosis of childhood hip problems were associated with higher rates of failure. The most common cause of failure was fracture of the femoral neck, followed by loosening of the femoral component.

The failure rates of HRA at five years justify the ongoing use of this technique in men. Female gender is an independent predictor of failure, and a higher failure rate at five years in women leads the authors to recommend this technique only in exceptional circumstances for women.

Cite this article: Bone Joint J 2013;95-B:1044–50.