Birmingham Metal-on-metal total hip resurfacing (BHR) is a bone-conserving option for patients with advanced articular damage. While the outcomes of Total Hip Replacement (THR) are well documented, there is a paucity of literature comparing the patient reported outcomes of BHR versus THR. This study aims to compare the patient reported outcomes for an impact on quality of life between patients who had a BHR vs. THR after correcting for selection bias.

Patients who underwent a BHR or THR between July 2003 and December 2006 were included. Patient questionnaires included demographic details, co-morbidities, WOMAC, SF-36 Scores. In addition, a 4 point Likert scale was used to measure satisfaction post-operatively. The above data was collected pre-operatively and at 1, 2, 3 and 5 years post-operatively. Data was analysed with SPSS (version 19) software package. All analysis was adjusted for Age, gender, Co-morbidity and pre-operative score by using Multivariate regression analysis using a General Liner Model to rule out the effect of these predictors on outcomes between groups.

337 patients were included (205 for THR and 132 for BHR). BHR patients were younger than THR patients (49 vs. 67 years, p<0.01), were more likely to be male (68% vs. 42% of THR, p<0.01), reported fewer co-morbidities (1.06 vs. 1.59, p<0.01). BHR patients reported better WOMAC pain and function scores at 5 years (p<0.05). For SF-36 scores, BHR patients reported higher scores for all 8 domains at 1 year and 5 year follow up (p<0.05). BHR patients reported higher satisfaction than THR group for return to Activities of Daily Living and Recreational activities at 1 and 5 years (p<0.05)

After correction for patient variability, BHR patients reported better improvement in pain and function and enjoyed a better quality of life in relation to return to ADL and recreational activities over to 5 years post-surgery.

Introduction

Surgical spacesuits are in widespread use. Only one previous study (JBJS 1998) has assessed the quality of the environment within the space suit. They demonstrated that surgical spacesuits could allow re-breathing of carbon dioxide (CO₂). However, they had no control group and performed a vigorous exercise protocol which may have been an unfair test. The design of helmet systems has also evolved in the last decade. We have conducted the first investigation into CO₂ levels inside the modern space suit. There is a Workplace Exposure Limit for inspired CO₂ as determined by the Health and Safety Executive (UK), which is 0.506kPa. We wondered whether re-breathing of CO₂ in space suits would lead to inspired CO₂ which breaches this level.

This study compared the demographic, clinical and patient-reported outcomes after total hip replacement (THR) and Birmingham Hip Resurfacing (BHR) carried out by a single surgeon. Patients completed a questionnaire that included the WOMAC, SF-36 scores and comorbid medical conditions. Data were collected before operation and one year after. The outcome scores were adjusted for age, gender, comorbid conditions and, at one year, for the pre-operative scores. There were 214 patients with a THR and 132 with a BHR. Patients with a BHR were significantly younger (49 vs 67 years, p < 0.0001), more likely to be male (68% vs 42% of THR, p < 0.0001) and had fewer comorbid conditions (1.3 vs 2.0, p < 0.0001). Before operation there was no difference in WOMAC and SF-36 scores, except for function, in which patients awaiting THR were worse than those awaiting a BHR.

At one year patients with a BHR reported significantly better WOMAC pain scores (p = 0.04) and in all SF-36 domains (p < 0.05). Patients undergoing BHR report a significantly greater improvement in general health compared with those with a THR.