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What is Birmingham Hip Resurfacing?
Birmingham Hip Resurfacing (BHR) is a special type hip replacement for young men with arthritis of their hips.
It differs from a ‘conventional’ Total Hip Replacement (THR) in two main ways:
BHR has the same dimensions as the normal hip, allowing more normal function, including the potential to play competitive and extreme sports.
Because BHR just replaces the surfaces of the joint, less of the normal bone is removed, making any revision, if required, potentially easier.
The BHR was developed in Birmingham, England, by Dr Derek McMinn, and released in 19
96. The first case in Hong Kong was performed at Matilda International Hospital on 27 May 2003 and about 500 BHRs have been performed at Matilda since.
The BHR was FDA approved in 2006 and is in use at top US hospitals such as the Hospital for Special Surgery in New York.
Data from the National Joint Register for England & Wales shows the BHR has the best longevity of all types of hip replacement for young men (55 and under) with osteoarthritis.
The BHR is a ‘metal-on-metal’ bearing made from Cobalt-Chrome metal alloy.
Who can benefit from a BHR?
Men up to 55 years old and over 5’6” (168cm) tall with arthritis of their hips.
Arthritis is inflammation of the hip due to disease or injury. Usually it becomes painful, especially with activity, such as walking, and at night.
Why do young people get arthritis?
The most common type of arthritis is ‘osteoarthritis’ – also known as ‘degenerative arthritis’ or ‘wear and tear’. In practice most ‘wear and tear’ is from sports involving kicking and lunging, such as tennis or football or martial arts.
A common problem in Asians is avascular necrosis (AVN), a condition where there is loss of blood supply to the bone, causing bone collapse, followed by arthritis.
Other problems leading to arthritis are infection, injury, slipped upper femoral epiphysis, impingement, Perthes disease, and some forms of hip dysplasia.
Sometimes osteoarthritis occurs for no obvious reason, in which case it is described as ‘primary’ osteoarthritis.
Depending on the exact anatomy, some forms of arthritis are suitable for resurfacing, and some are better treated by conventional total hip replacement.
Shouldn’t I wait as long as possible before having a hip operation?
Total hip replacement was introduced in the UK in 1962. It was a revolutionary procedure, but young people would wear out the early designs of artificial hips after around 20 years, thus requiring a second (or ‘revision’) hip replacement, which is usually more difficult than the first, and may not last as long – therefore younger people were advised to wait as long as possible.
Fortunately hip replacements have improved in the last sixty-plus years, and we believe the BHR (and, indeed all modern total hip replacements) will last indefinitely in most cases, so we now advise most people not to wait if they have hip pain that is unpleasant and not controlled by simple drugs.
Is there anyone who should not have BHR?
- The patients who do best are young men with osteoarthritis.
- Taller men do especially well – and the largest implants are suitable for men over 7’ (213cm) tall. In very tall men, conventional hip replacement designs often reach their limits, whereas resurfacings come into their own.
- The smallest hip resurfacing implants are suitable for men over about 5’6” (168cm) tall.
- Older men who are in good health and very physically active may benefit from BHR.
- Men with severe damage to their hips from AVN or other conditions may not be suitable for resurfacing.
- Men who are very sedentary or older will probably not benefit from resurfacing.
- Resurfacing is not currently recommended for women – though new designs of resurfacings are in development that are intended for women.
Can I return to sport?
Many patients have returned to sport at all levels, including: martial arts; rock climbing; Marathon running; Rubgy; horse riding; and many others.
The most famous sportsman with a BHR is tennis player Andy Murray, but there are many other professional sportsmen, including Major League Baseball players and National Hockey League skaters, playing as well (or better) than before their hip resurfacing.My hip is badly damaged.Can I still have a BHR?
Even if you have lost the top [headand neck] of your thigh bone you may still be able to enjoy theadvantages of the large diametermetal on metal bearing by havinga ‘hybrid BHR’ – where a metalstem is placed into the thigh bone,much like a conventional THR, witha modifi ed BHR ball, and standardBHR socket.e with significant osteoporosis should not haveOnly those with significant osteoporosis should not haveBHR.
My hip is badly damaged.Can I still have a BHR?
If the damage is not too severe it may still be possible to have a BHR. Plan B is a conventional total hip replacement. Matilda International Hospital always has THRs on standby, so it is simple to convert to THR during the operation if BHR is not possible.
What does the BHR involve?
Under a general or regional anaesthetic a cut is made in the side of the leg, the tendons of some of the muscles are carefully cut to expose the hip joint, which is dislocated.The arthritic joint and a thin layer of bone are removed and replaced with the appropriate size Birmingham implants. The tendons are stitched back to the bone. The operation takes about an hour and a half.
You can walk with crutches the same day, and can usually go home the next day.
Are there other types of hip resurfacing?
Only the BHR is available in Hong Kong. The BHR is the most popular design worldwide. The next most popular design is very similar to the BHR. Unfortunately a number of other designs of resurfacing from the early 2000s were unsuccessful and were withdrawn. New designs are in development, using ceramics and plastics in addition to metals.
What are the risks?
The general risks are the same as for a THR:
- Infection (less than 0.5%);
- Deep venous thrombosis (less than 1%);
- Pulmonary embolus (less than 0.2%);
- Anaesthetic or medical problems (about 1% depending on one’s age and general health)
- Nerve injury (less than 1%)
- The specific risk of BHR is of a fracture in the thigh bone below the BHR [less than 1%].
- The risk of dislocation is very low (about 0.5%)
There is a small increase in metal ions in the blood after a metal-on-metal hip resurfacing. So far no problems have been identified as a result.
When can I return to work?
Office work – about 1 week – walking with crutches and limiting hours.
Commercial pilots – 10-12 weeks.
Can I have two BHRs in one operation?
Yes. It’s safe, and it saves rehabilitation time, as well as hospital costs.
What rehabilitation is needed?
Ideally one would see one’s physiotherapist before the operation for ‘prehabilitation’ – learning in advance how to walk with crutches, get in and out of bed and into and out of a car, how to climb and descend stairs, and get to the bathroom. This allows people to go home quickly.
It’s best to take things very easy for the first 6 weeks (walking maximum 1,500 -2,000 steps per day) to allow the tendons to heal, and to take things quite easy for another 6 weeks (walking up to 3,000 steps per day) to allow the bone to regain its strength. After 3 months, there are no formal restrictions on activity. Most people are ready to do light jogging at 6 months, and fully recovered – competitive sport – at about one year.
Usually one would see one’s surgeon at 2 weeks, then 6 weeks, 3, 6 and 9 months, and then once a year.
When can I fly?
It’s safe to fly immediately – so if one has flown to Hong Kong for the operation it’s safe to fly home after a few days.
It’s a good idea to put off business trips for about 6 weeks – not because it’s not safe to fly – but it’s much harder work and one will be tired.
When can I drive?
Right hip: 6 weeks.
Left hip: Manual gearbox car: 6 weeks.
Left hip: Automatic gearbox or electric car: A few days – as soon as you feel well enough, and are not taking any medicines which interfere with driving.
Don’t drive earlier, as there is significant legal risk in the event of an accident.
