Theoretic advantages are less bone destruction,
less bone resection, normal femoral loading, avoidance of stress
shielding, maximum proprioceptive
feedback, and restoration of normal anatomy. In addition,
reduced risk of dislocation, less leg inequality problems, and
easier revision should convince surgeons to favor metal-on-metal
A resurfacing is suitable for the treatment
of a hip with severe arthritis when the femoral head bone
quality is good. It is used more often in young and active
patients than older and less active patients because
conventional replacements do not last long in young and active
patients. Further, a younger patient is more likely to need a
revision of an artificial hip at some stage later in life, and
it is easier to successfully revise a BHR.
The fundamental difference between a BHR and
a conventional total hip replacement (THR) is in the femoral
(thigh) side. A THR has a long stem inserted into the canal in
the thigh bone. Hence the natural femoral head and part of the
neck are removed and weight is transmitted through the stem
directly into the upper third of the thigh bone. In a
resurfacing, the aim is to preserve most of the femoral head and
neck. The resurfacing femoral component therefore has a thin (3
to 4 mm) hollow ball surface that directly transmits weight to
the femoral head bone underneath it and a very small stem that
is not designed to transmit weight. The socket component can be
similar in both the THR and a BHR.
The Birmingham Hip Resurfacing is the answer
to younger patients with severe hip pain due to arthritis. These
patients are too young for a total hip replacement because of
the severe limitations after the surgery.
Unlike traditional hip replacement surgery, resurfacing does not
remove as much of your leg bone. Instead, the process simply
machines away the rough damaged surface of the hip joint bones
and replaces them with more durable high carbide cobalt chrome.
For younger patients concerned with the potential of multiple
revision surgeries over their lifetimes, saving natural bone is
especially important. But hip bone conservation is good for
older patients as well if their bones are strong enough to
accept the implant.
The BIRMINGHAM HIP RESURFACING System has been shown to actually
enhance bone strength around your hip. (Kishida, Sugano 2004
JBJS) The more you walk on your resurfaced hip, the stronger it
The BHR is not “experimental surgery”. Although its use in the
US has been
approved by the FDA only last year, there have been over 60,000
implanted worldwide since 1996. At 10 years follow up, 98% of
have survived. A 1,626-hip study found that 99.5% of patients
responded they were “Pleased” or “Extremely pleased” with the
results of their Birmingham Hip Resurfacing surgery.
resurfacing is a bone conserving alternative to conventional
total hip replacement ( THR). Unlike THR, hip resurfacing does
not involve the removal of the femoral head and neck nor removal
of bone from the femur. Rather, the head, neck and femur bone is
preserved in an effort to facilitate future surgery should it be
necessary and to enable the patient to take advantage of newer
technology or treatments in the future. Refer to the interactive
animations on this website for detailed descriptions of both hip
resurfacing and total hip replacement.
The current generation of hip resurfacing
devices utilize a metal-metal bearing rather than the
metal-polyethylene bearings that were utilized in the 1970’s and
1980’s. Metal-metal bearings have demonstrated a much higher
level of wear resistance as well as reduced bone loss and
inflammatory tissue reaction about the hip joint as compared to
Hip resurfacing is anatomically and
biomechanically more similar to the natural hip joint resulting
in increased stability, flexibility and range of motion.
Further, dislocation risk is virtually eliminated. Higher
activity levels are typically achieved with less risk than with
a THR should a revision ever be necessary. These benefits are
realized because the head diameter that results from resurfacing
is very similar to the patient’s normal head diameter and these
larger head sizes are typically much larger than the femoral
balls utilized in conventional THR. It should be noted, however,
that THR with larger femoral balls is now available and these
devices can also result in a high degree of stability with
minimized risk of dislocation.
Advantages of Surface Replacement
While every orthopaedic treatment has both benefits and risks,
there are some advantages unique to surface replacement.
The preservation of bone has several potential advantages. The
first is that more bone is retained in the femur, should another
hip replacement become necessary. Over time, any hip replacement
may loosen or show signs of wear. In a young, active population,
there is a high likelihood that more than one hip replacement
operation may be necessary over the lifetime of the patient. The
more bone that remains during a revision (re-do) hip operation,
the greater the chances of success.
The second advantage to a surface replacement is that the
preservation of bone allows for a much larger ball size. This
allows for greater stability of the hip joint and a lower risk
of dislocation. The dislocation rate after surface replacement
of the hip has been shown in some studies to be about 10 times
lower than for a traditional hip replacement.
resurfacing maintains the natural size of the
femoral head and neck. Proprioceptive feedback from the
preserved metaphyseal bone and joint capsule continue and
there is normal biomechanical function.8,26 The resurfaced
hip is stable and capable of an excellent range of motion.
With a limited amount of implanted material, infection if it
occurs, can be dealt with easily. Because the femur is not
decapitated, hip resurfacing is less invasive (rather than small
incision) surgery. There is less pain and blood loss from
resurfacing compared to conventional replacement with an earlier
return of function. Unique disadvantages are the possibility of
a femoral neck fracture or a collapsed femoral head
From NY Times Article by Dr. Pritchett
There has been good literature and a good track record with
favorable 10-year results. While it is a difficult surgery and
the learning curve is steep, (the procedure) will hold up on a
long-term basis and can be a permanent solution for eligible
Think about the hip joint as a ball and socket.
Total hip replacement is like removing the ball
and replacing it with a metal ball, whereas
resurfacing is capping the ball.
Two years after the surgery, he
finds resurfacing patients do have slightly more
range of motion in their movements than his
older patients who’ve undergone total hip