I would like to comment on Smith&Nephew’s BHR decision to exclude
females and smaller sizes than 48 mm.
The decision has been based on the renewed NICE criteria. I wouldn’t
say that I don’t want best outcomes for all of my patients. But if
you compare those criteria to other surgical outcomes it looks
extremely strict. I think it would be just consequent if the
collected data would have been collected the same way. The data
results could never be lets call it clean like they have been
collected. They are naturally influenced by so many things. For
example: Revision of resurfacing is so much easier (also the
decision is easier) than revision of THRs especially of cemented
stems, or let’s face the understandable poor results by some
surgeons especially in the past because of only few numbers of
performed resurfacings. That’s all in the statistics!
I question also to base important decisions only on one registry.
And on top: What’s about the data collected by the international
group of experts doing resurfacing?
Advantages of resurfacing are well known. Even with possible higher
risks we still would have very good outcomes. We also improved the
follow up procedure and by doing so we do prevent really bad
surprises. Female patients must not excluded of a well functioning
method because of existing data. At the end maybe they won’t be
allowed anymore to even receive THR under certain circumstances like
If you compare the complication rate of hip surgery with other
surgery like hernia repair, appendicitis or bigger surgeries for
example you would be very happy with results we have in hip surgery
of males and females as well.
In conclusion we will continue resurfacing on women. We also
continue to avoid smaller sizes than 46 like we did in the past.
Instead of BHR we use ADEPT or ICON in the future, both are implants
with excellent registry results.
Dr Raimund Voelker
ATOS Munich / GERMANY
PS: >1000 hip resurfacings to date performed by Dr Voelker
In my own data even 44 worked fine by the way.