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 young age.
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