Recent BHR news flash for females & others
Notice & Discussion of Recent BHR Data:
John Rogerson, M.D. 6/19/15
We recently (June 3, 2015) received notification from Smith & Nephew, Inc.,
the manufacturer and distributor of the Birmingham hip resurfacing prosthesis (BHR),
of a voluntary removal (NOT RECALL) from the market of a number
of the smaller prostheses sizes (see below Dr. letter about females). Please
note, no further action is needed if you are not having any symptoms of pain or
decreased function following BHR hip resurfacing. If you are symptomatic, please
contact us to set up a follow-up appointment for further evaluation.
Mid-term data analysis from the National Joint Registry of England & Wales
indicates that prosthetic head sizes below 46 mm in diameter and prostheses
implanted in females performed less well and exceeded current revision rate
benchmarks for total hip arthroplasty. Male patients, in contrast, with head
sizes 50 mm and above performed better than the same benchmarks.
The data analyzed included all BHR’s implanted in England and Wales by all
orthopedic surgeons regardless of their volume or experience. Dr. McMinn and
Dr. Treacy’s data (the inventors of modern day BHR hip resurfacing) show much
better mid-term results compared to the registry data at 16 years (see below Dr.
McMinn data and results).
The registry data analysis, unfortunately, did not take into consideration
the component implant position, the surgeon’s volume of cases, the increased
activity level of the resurfacing patients, hip dysplasia versus osteonecrosis
versus osteoarthritis, and a number of other factors which might explain the
result differences in these two patient population databases.
Fortunately, our data correlates well with Dr. McMinn’s results. Our
females with osteoarthritis have a known revision rate of 0.4% since 2006, and
1.3% for females with hip dysplasia arthritis, with both groups enjoying a very
high level of activity.
Be that as it may, as of June 3, 2015 we will no longer be able to perform
BHR hip resurfacing in the female population at large or in males with femoral
head sizes templated below 50 mm. I personally feel that this is most
unfortunate for these younger patients, male or female, who want to remain
For patients who are no longer BHR candidates, I believe the next best option
in the younger hip arthritis population is a metal-on-polyethylene total hip
prosthesis with a porous coated titanium stem and socket shell, with a
ceramicized zirconium metal (Oxinium) femoral head and a highly cross-linked
polyethylene socket insert. Unfortunately, because the plastic insert is now
mandated, high-impact activities would not be encouraged after total hip
arthroplasty, even with this prosthesis.
I will keep you apprised of more information as it becomes available to me.