Birmingham Hip Arthroplasty: Five to Eight Years of Prospective Multicenter Results

doi:10.1016/j.arth.2008.07.016

The Journal of Arthroplasty

Volume 24, Issue 7, October 2009, Pages 1044-1050

https://doi.org/10.1016/j.arth.2008.07.016 Get rights and content

Abstract

Pioneering centers report excellent results of Birmingham resurfacing arthroplasty. Results from pioneering surgeons are not usually reproduced when implants are used at other centers. We therefore studied patients' satisfaction, postoperative hip function, and survival of Birmingham hip resurfacing in a group, operated by nonpioneering surgeons. The median first year postoperative Harris hip score was 95, and this score was sustained for a period of 8 years. The cumulative survival at 8 years was 95.7%. Most of the failures were in the first year; commonest cause of the first year failures was fracture of femoral neck. This complication is not seen as a substantial problem in the pioneering surgeons' studies. We therefore conclude that this complication is not related to the prosthesis and that its occurrence can be reduced.

Section snippets

Material and Methods

In this study, we included all patients who had BHR resurfacing arthroplasty between 1997 and 2000, reported at the time of surgery to the Oswestry Outcome Center. Patients operated on by pioneering surgeons were not included. Most of the surgeons were from the United Kingdom (41) and Australia (14). Most of the patients were from the United Kingdom (75%), Australia (18%), and South Africa (3%). Others were from France, Sweden, Spain, and Netherlands.

From the surgeon carrying out the operation,

Results

There were 653 patients (Table 1) with 679 resurfaced hips. Twenty-six patients (4%) had bilateral hip resurfacing arthroplasty. Of the patients, 60% were males and 40% were females. The predominant preoperative diagnosis was osteoarthritis. They were operated on by 58 surgeons in 8 different countries. The median age at operation was 51 years (range, 15.8-87.9 years). All operations were performed through the posterior approach. Ten patients died during follow-up. Median follow-up was 6 years

Discussion

The aim of this study was to determine satisfaction, hip function, and survival of the Birmingham hip prosthesis in a group of patients operated on by nonpioneering surgeons. The overall survival of the resurfacing arthroplasty was 95.7% at 8 years and not significantly affected by age or sex of the patients.

We assessed the hip function by Harris and D'Aubigné hip scores and added a question on patient satisfaction (Table 3). Most of the patients achieved excellent postoperative hip scores (

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Cited by (61)

Hip Resurfacing: A Single Surgeon U.S. Series With Minimum Ten-Year Follow-up
2022, Journal of Arthroplasty
Metal-on-metal hip resurfacing is an alternative to total hip arthroplasty (THA). The aim of this study was to determine implant survivorship, analyze patient-reported outcomes measures and to determine patient satisfaction for patients who underwent metal-on-metal hip resurfacing at a large US academic institution by a single surgeon with a minimum of 10-year follow-up.
Patients who underwent hip resurfacing from September 2006 through November 2009 were included. Patient demographics and variables were collected from a prospectively maintained institutional database and patients completed an additional questionnaire with patient-reported outcomes measures.
A total of 350 patients (389 hips) out of 371 (433 hips) with a minimum 10-year follow-up were successfully contacted (94.3% follow-up). Mean age was 53 years, 258 were male (73%). 377 out of 389 hips (96.9%) did not require additional surgery. Gender was significantly related to implant survivorship (males 99.0%, females 90.9%; P < .001). 330 patients (369 hips, 94.8%) were satisfied with their surgery. Males had higher proportion of satisfaction scores (P = .02) and higher modified Harris Hip Score (odds ratio = 2.63 (1.39, 4.98), P = .003). Median modified Harris Hip Score score for non-revised hips was 84.0 [80.0; 86.0] versus those requiring revision, 81.5 [74.0; 83.0], (P = .009).
At a minimum 10-year follow-up, hip resurfacing, using an implant with a good track record, demonstrates 99.0% survivorship in male patients with an average age of 52 years. We believe that the continued use of metal-on-metal hip resurfacing arthroplasty in this population is justified by both positive patient reported outcomes and survivorship.
Mid-Term Results and Predictors of Patient-Reported Outcomes of Birmingham Hip Resurfacing
2017, Journal of Arthroplasty
Citation Excerpt :
Patients with BHRs have consistently shown high average PRO results postoperatively. Studies have reported mean HOOS subscale scores in the 80s-90s, UCLA activity ranging from 6.6 to 8.3, and SF-12 PCS scores ranging from 51.9 to 52.2 [4,7,28,30-33,35,40,45]. Our study mirrors previous literature with mean HOOS subscale scores ranging from 83.5 to 92.0, UCLA activity of 6.9, and VR-12 PCS of 49.8 at 6.2-year follow-up.
Birmingham hip resurfacing (BHR) is the only Food and Drug Administration approved resurfacing option currently available in the United States. While adequate BHR outcomes are established, there is a paucity of US-based literature demonstrating factors critical to improve patient reported outcomes (PROs). This study answers: (1) What is the implant survivorship in a large US cohort? (2) Which preoperative factors result in higher PRO scores over 5 years postoperatively?
A retrospective 541 hip single-surgeon cohort with mean of 6.2 years follow-up (range 5-8.1) was collected. Preoperative patient/implant variables, including postoperative radiographic acetabular inclination and femoral component position, clinical outcomes, and follow-up PRO questionnaire information were collected. Validated PROs included the Hip Disability and Osteoarthritis Outcome Score (HOOS), Veterans Rand-12, and University of California Los Angeles (UCLA) activity. PROs were modeled with ordinary least squares then used to create nomograms.
Average patient age was 53 years with 391 (72%) males. Seven hips were revised, resulting in an overall survival of 98.8% at 5 years. Predictive modeling identified preoperative variables (sex, body mass index, smoking, and comorbidity) that had statistically significant associations with HOOS pain (P = .049), HOOS activities of daily living (P = .017), UCLA activity (P < .001), and Veterans Rand-12 physical (P < .001) PROs at latest follow-up. Nomograms predicted follow-up PROs using preoperative patient-specific variables.
This study documents excellent survival of the largest reported single-center cohort of BHRs in the United States with a mean 6.2 years follow-up. Multivariate modeling shows male nonsmokers with low body mass index, and no comorbidities will have less hip pain, better function in daily life, higher activity, and better general physical health after BHR arthroplasty.
Joint perception after hip or knee replacement surgery
2012, Revue de Chirurgie Orthopedique et Traumatologique
Les arthroplasties du genou et de la hanche sont reconnues efficaces. Cependant, les sujets ayant une articulation prothétique rapportent rarement la possibilité de sensation de retour à leur articulation native.
La perception articulaire ressentie par les patients suite au remplacement articulaire de la hanche est supérieure à celle du genou et dans les deux cas, cette perception est directement liée au résultats cliniques mesurés avec des scores validés.
La perception articulaire par le patient d’une reconstruction prothétique a été évaluée chez 347 patients comprenant 46 prothèses unicompartimentales de genou (PUC), 119 prothèses tricompartimentales de genou (PTG), 93 resurfaçages de hanche (RTH) et 89 prothèses totales de hanches (PTH). La perception articulaire des sujets, leur satisfaction ainsi que le score clinique de WOMAC ont été comparés.
La perception articulaire était significativement inférieure pour les arthroplasties de genou (PTG et PUC) en comparaison aux arthroplasties de hanche (PTH ou RTH) (p < 0,001). Le score de WOMAC était aussi significativement moins favorable pour les arthroplasties de genou par rapport aux hanches (p < 0,0001). Toutefois, il n’y avait aucune différence significative de perception articulaire et aux scores cliniques entre les PTG et PUC ainsi qu’entre les RTH et les PTH. La perception articulaire était fortement corrélée avec le score de WOMAC pour tous les groupes (R² = 0,951).
Aucune différence n’a été trouvée après réalisation de chirurgies plus conservatrices comme le RTH ou la PUC en comparaison des arthroplasties traditionnelles (PTH ou PTG). Démontrant des résultats inférieurs à la hanche, les arthroplasties de genou méritent une attention particulière et peuvent encore être améliorées. L’évaluation de la perception articulaire utilisée dans ce travail peut être considérée comme un outil clinique intéressant puisque fortement liée à des scores cliniques validés mais plus complexes à appliquer.
Niveau III. Étude prospective cas–témoin.
Joint perception after hip or knee replacement surgery
2012, Orthopaedics and Traumatology: Surgery and Research
Knee and hip arthroplasties are recognized as being effective. However, subjects with a prosthetic joint rarely report returned sensation comparable to their native joint.
Joint perception by patients following hip joint replacement is better than following knee replacement and in both cases this perception is directly related to the clinical results measured with currently validated scores.
Patient joint perception in prosthetic reconstruction was evaluated in 347 patients, 46 who underwent unicompartmental knee arthroplasty (UKA), 119 tricompartmental knee arthroplasty (TKA), 93 hip resurfacing (HR), and 89 total hip arthroplasty (THA). The subjects’ joint perception, their satisfaction, and the WOMAC clinical score were recorded and compared.
Joint perception was significantly worse for knee arthroplasties (TKA and UKA) compared to hip arthroplasties (THA or HR) (P < 0.001). The WOMAC score was also significantly less favorable for knee arthroplasties than for hip arthroplasties (P < 0.0001). However, there was no significant difference for the clinical scores between TKA and UKA as well as between HR and THA. Joint perception was strongly correlated with the WOMAC score for all groups (R² = 0.951).
No difference was found after more conservative surgeries such as HR or UKA compared to traditional arthroplasty procedures (THA or TKA). Demonstrating inferior results in comparison to the hip, knee arthroplasties deserve particular attention and can still be improved. The assessment of joint perception used in this study can be considered a valuable clinical tool that is strongly correlated to validated, but more complex to apply, clinical scores.
Level III prospective case – control study.
Birmingham Hip Resurfacing for osteoarthritis - a Canadian retrospective cohort study with a minimum 10-year follow-up
2022, Canadian Journal of Surgery
Young men with osteoarthritis of the hip are a growing segment of the population requiring arthroplasty, and there is compelling evidence that the Birmingham Hip Resurfacing (BHR) system provides good functional outcomes and durability in young, active men. We reviewed the survivorship and clinical outcomes of patients who underwent BHR with a minimum follow-up of 10 years.
We analyzed survivorship using the Kaplan–Meier method. Functional scoring was performed using the Harris Hip Score (HHS), the University of California, Los Angeles (UCLA) Activity Score, and a visual analogue scale (VAS).
In total, 211 patients (243 hips) were included in the study. Of these, 107 patients (127 hips) were available for long-term clinical follow-up, with a mean duration of 12.4 ± 1.4 years. The proportion of male participants with BHRs surviving past 13 years was 93.8% (95% confidence interval [CI] 87.9%–100%) compared with 87% (95% CI 77.8%–97.3%) of female patients. Eleven patients (11 hips) underwent BHR revision. Upon final follow-up, the median HHS was 93.9 in males and 93.6 in females (p = 0.27); median UCLA Activity Score was 8.2 in males and 7.2 in females (p < 0.001), and the median VAS score was 81.9 in males and 81.3 in females (p = 0.35). The median acetabular component inclination was 45.5° ± 6.0° (range 34.6°–57.2°) in males and 44.6° ± 5.9° (range 29°–58.9°) in females. The most common femoral head size was 50 mm with a 56 mm or 58 mm cup (36.3%).
This study confirms that BHR provides good to excellent functional outcomes, lasting functional improvements, and acceptable durability beyond 10 years in men. Survivorship following BHR is inferior in women; however, HHS and VAS scores were similar in women and men.
Les hommes jeunes aux prises avec une arthrose de la hanche constituent un segment croissant de la population appelé à subir une arthroplastie, et selon des preuves solides, les dispositifs de resurfaçage BHR (Birmingham Hip Resurfacing) donnent des résultats fonctionnels bons et durables chez les hommes jeunes actifs. Nous avons passé en revue la survie prothétique et l’issue clinique chez des patients qui ont reçu un dispositif de resurfaçage BHR et qui ont été suivis pendant au moins 10 ans.
Nous avons analysé la survie prothétique par la méthode de Kaplan–Meier. Le calcul du score fonctionnel a été fait au moyen du score de Harris (HHS), du score d’activité UCLA (University of California, Los Angeles) et d’une échelle analogique visuelle (ÉAV).
En tout, 211 patients (243 hanches) ont été inclus dans l’étude. Parmi ces patients, 107 patients (127 hanches) étaient disponibles pour un suivi à long terme d’une durée moyenne de 12,4 ± 1,4 ans. La proportion de participants de sexe masculin ayant reçu un dispositif BHR dont la survie a dépassé 13 ans était de 93,8 % (intervalle de confiance [IC] à 95 % 87,9 %–100 %), contre 87 % (IC à 95 % 77,8 %–97,3 %) chez les femmes. Onze patients (11 hanches) ont fait l’objet d’une révision du dispositif BHR. Au suivi final, le score HHS médian était de 93,9 chez les hommes et de 93,6 chez les femmes (p = 0,27); le score d’activité UCLA était de 8,2 chez les hommes et de 7,2 chez les femmes (p < 0,001) et le score médian à l’ÉAV était de 81,9 chez les hommes et de 81,3 chez les femmes (p = 0,35). L’inclinaison médiane du composant acétabulaire était de 45,5 ° ± 6,0 ° (éventail 34,6 °–57,2 °) chez les hommes et de 44,6 ° ± 5,9 ° (éventail 29 °–58,9 °) chez les femmes. La taille la plus commune des têtes fémorales était de 50 mm, avec des cupules de 56 mm ou 58 mm (36,3 %).
Cette étude confirme que le dispositif BHR offre d’excellents résultats cliniques, des améliorations fonctionnelles à long terme et une durabilité acceptable au-delà de 10 ans chez les hommes. La survie prothétique est inférieure chez les femmes qui reçoivent un dispositif BHR; par contre les scores HHS et à l’ÉAV ont été similaires chez les femmes et les hommes.
Safety and Efficacy of Same-Day Hip Resurfacing
2020, Orthopedics

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Birmingham Hip Arthroplasty: Five to Eight Years of Prospective Multicenter Results

Abstract

Section snippets

Material and Methods

Results

Discussion

J Bone Joint Surg Br

J Arthroplasty

J Arthroplasty

J Arthroplasty

J Arthroplasty

J Arthroplasty

Resurfacing hip replacement—an audit of activity in the United Kingdom 2002-2003

Hip Int

Birmingham hip resurfacing arthroplasty. A minimum follow-up of five years

J Bone Joint Surg Br

Early results of primary Birmingham hip resurfacings. An independent prospective study of the first 230 hips

J Bone Joint Surg Br

Outcome of Charnley total hip replacement across a single health region in England: the results at five years from a regional hip register

J Bone Joint Surg Br

Wear of the cup in the Charnley LFA in the young patient

J Bone Joint Surg Br

Total hip arthroplasty with cement in patients who are less than fifty years old. A sixteen to twenty-two-year follow-up study

J Bone Joint Surg Am

Charnley total hip arthroplasty in patients less than fifty years old. A twenty to twenty-five-year follow-up note

J Bone Joint Surg Am

Total hip arthroplasties in patients less than forty-five years old

J Bone Joint Surg Am

Total hip arthroplasties in patients younger than 45 years. A nine- to ten-year follow-up study

Clin Orthop Relat Res

Long-term results of Charnley low-friction arthroplasty in young patients

J Bone Joint Surg Br

Early failure of total hip replacements implanted at distant hospitals to reduce waiting lists

Ann R Coll Surg Engl