Birmingham Hip Resurfacing at 20 years.

Area of Science:

• Orthopedic Surgery
• Biomaterials Science
• Clinical Outcomes Research

Background:

• The Birmingham Hip Resurfacing (BHR) arthroplasty, a metal-on-metal hip resurfacing device, has been utilized for coxarthrosis since 1997.
• Long-term data on BHR survivorship and patient outcomes are crucial for understanding its efficacy and safety profile.

Purpose of the Study:

• To evaluate the 20-year clinical and radiographic outcomes of consecutive Birmingham Hip Resurfacing (BHR) arthroplasties.
• To assess implant survivorship, functional scores, and serum metal ion levels at two decades post-implantation.

Main Methods:

• A consecutive series of 234 Birmingham Hip Resurfacing (BHR) implants in 217 patients (1999-2001) were analyzed.
• Data collected included patient-reported outcome measures, imaging (radiograph, ultrasound), serum metal ion assessment, and registry data for revision analysis.
• Kaplan-Meier survivorship analysis was performed, with revision for any cause as the endpoint.

Main Results:

• At a mean follow-up of 20.9 years, the cumulative implant survival rate was 96.5% for males and 87% for females (p=0.029).
• Excellent functional outcomes were reported, with high scores on the Oxford Hip Score, Hip disability and Osteoarthritis Outcome Score, Forgotten Joint Score, and EuroQol 5-dimension 3-level questionnaire.
• Ultrasound revealed no pseudotumors, and mean serum cobalt and chromium levels were within acceptable ranges, suggesting good tolerability.

Conclusions:

• Birmingham Hip Resurfacing (BHR) arthroplasty demonstrates excellent long-term survivorship and functional outcomes, especially in younger male patients.
• The metal-on-metal resurfacing implant appears to be well-tolerated at 20 years, with no significant soft-tissue complications or concerning metal ion levels.