Dr. Rogerson of WI 6-19-2015
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 extremely active.
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.