Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, Windmill Road, Oxford OX3 7LD, UK.
Abstract
Recent events have highlighted the importance of implant design for survival and wear-related complications following metal-on-metal hip resurfacing arthroplasty.
The mid-term survival of the most widely used implant, the Birmingham Hip Resurfacing (BHR), has been described by its designers.
The aim of this study was to report the ten-year survival and patient-reported functional outcome of the BHR from an independent centre. In this cohort of 554 patients (646 BHRs) with a mean age of 51.9 years (16.5 to 81.5) followed for a mean of eight years (1 to 12), the survival and patient-reported functional outcome depended on gender and the size of the implant.
In female hips (n = 267) the ten-year survival was 74% (95% confidence interval (CI) 83 to 91), the ten-year revision rate for pseudotumour was 7%, the mean Oxford hip score (OHS) was 43 (sd 8) and the mean UCLA activity score was 6.4 (sd 2).
[Earlsview note – this means 26% failure rate for female recipients of BHR’s]
In male hips (n = 379) the ten-year survival was 95% (95% CI 92.0 to 97.4), the ten-year revision rate for pseudotumour was 1.7%, the mean OHS was 45 (sd 6) and the mean UCLA score was 7.6 (sd 2).
In the most demanding subgroup, comprising male patients aged < 50 years treated for primary osteoarthritis, the survival was 99% (95% CI 97 to 100).
[Earlsview note – so how many young men? Also this means that the failure rate in the >50 yr males was higher than 5% reported above. BUT what was it?]
This study supports the ongoing use of resurfacing in young active men, who are a subgroup of patients who tend to have problems with conventional THR.
In contrast, the results in women have been poor and we do not recommend metal-on-metal resurfacing in women. Continuous follow-up is recommended because of the increasing incidence of pseudotumour with the passage of time.
11 thoughts on “26% Failure in Female Smith & Nephew BHR’s – The ten-year survival of the Birmingham… [J Bone Joint Surg Br. 2012] – PubMed – NCBI”
brookssaid:
Excellent piece Earl — ever on the job, always at the wheel that drives the site!
(I think I may have simply ‘snapped’ had my Google Machine not provided me with your view, the only one possible to the survivor of the growing MoM nightmare).
So we see that a comprehensive study with the younger, more demanding female patient does show a higher rate of failure in our sister specimens (that’s what we are to these doctors, of course). That is consistent with what we have suspected all along, and finally proves higher usage of these metal monstrosities results in higher failure rates.
But yes, why the ‘deficiencies’ in the study of younger male patients? No quantification, no specifics? But as you noted, an interesting discrepancy seen in the higher 5% figure. If I was S&N, I wouldn’t want anyone looking at the younger demographic, though, because they know what’s going on out here and want no light shed on it.
No, they don’t want to go anywhere near those pesky young males for statistics, as logically stronger bodies might result in even more havoc than even we might imagine. Maybe S&N will recall the BHR line for women only, a public relations-based concession. Like their PR move with the infrequently used R3 acetabular metal liner.
“See public, we recall ’em if they don’t perform as the company expected! Why would we do this if we weren’t totally honest in all aspects of our business dealings? We do care about you. Love and kisses”!
(From your trusted and obviously extremely concerned friends at S&N!)
Arguably though, more woman have had trouble with the BHR, but this study truly does show a steady erosion of S&N’s obstinate infallibility. There is now no question in my mind:
The Truth Will Out
It’s just a matter of time, as you can’t have so many living examples of MoM hell around the world without them all finally being counted. And the Genie nears the top of the bottle!
Arguably though, more woman have had trouble with the BHR.
Whilst waiting in the Royal Ortho Hospital here in Birmingham England , I got talking to a lady who had here hip replaced some years ago.
It turns out that it had to be removed and she now has the ceramic type fitted.
She is now classed as dissabled as it just keeps disclocating on here all the time.I had a 54mm head short stem resurfacing in may of last year, I was’nt made aware of the medical problems and they were never explained to my by the Hospital or my surgeon . ? Why NOT if this has been going on for years.
I now constantly think about the possabilitys of a ticking time bomb inside me waiting to ruin my life for good.
I attended a well man clinic at my local Dr surgery the other week to have my old man check over (52) . Whilst there I spoke about the problems coming to light regarding the MOM hips. Being a regitered nurse for many years for the NHS she hand not heard of this. I then explained all about Earls blog that I have been following since having my hip done. She has took the web page deatils and is going to do some reading of the blog and do a bit of research into the side effects as I have explained to her my health had gone down hill ater six months of having the operation, ie , Breathing, fatigue, sleepless nights and depresion coupled with uselessness as a man now being unable to work.
seems that all surgeons like to think they know best and don’t follow the developments as closely as they should.
And quite a number get big grants from Orthopaedic companies for “research” and other stuff so here you have some apparent conflict.
The only way to monitor this is to have regular x-rays, blood tests for metal ions, and just watch out for any unusual problems you cannot explain easily.
You may be one of the lucky ones where all is OK for 10 – 15 years?
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Excellent piece Earl — ever on the job, always at the wheel that drives the site!
(I think I may have simply ‘snapped’ had my Google Machine not provided me with your view, the only one possible to the survivor of the growing MoM nightmare).
So we see that a comprehensive study with the younger, more demanding female patient does show a higher rate of failure in our sister specimens (that’s what we are to these doctors, of course). That is consistent with what we have suspected all along, and finally proves higher usage of these metal monstrosities results in higher failure rates.
But yes, why the ‘deficiencies’ in the study of younger male patients? No quantification, no specifics? But as you noted, an interesting discrepancy seen in the higher 5% figure. If I was S&N, I wouldn’t want anyone looking at the younger demographic, though, because they know what’s going on out here and want no light shed on it.
No, they don’t want to go anywhere near those pesky young males for statistics, as logically stronger bodies might result in even more havoc than even we might imagine. Maybe S&N will recall the BHR line for women only, a public relations-based concession. Like their PR move with the infrequently used R3 acetabular metal liner.
“See public, we recall ’em if they don’t perform as the company expected! Why would we do this if we weren’t totally honest in all aspects of our business dealings? We do care about you. Love and kisses”!
(From your trusted and obviously extremely concerned friends at S&N!)
Arguably though, more woman have had trouble with the BHR, but this study truly does show a steady erosion of S&N’s obstinate infallibility. There is now no question in my mind:
The Truth Will Out
It’s just a matter of time, as you can’t have so many living examples of MoM hell around the world without them all finally being counted. And the Genie nears the top of the bottle!
Arguably though, more woman have had trouble with the BHR.
Whilst waiting in the Royal Ortho Hospital here in Birmingham England , I got talking to a lady who had here hip replaced some years ago.
It turns out that it had to be removed and she now has the ceramic type fitted.
She is now classed as dissabled as it just keeps disclocating on here all the time.I had a 54mm head short stem resurfacing in may of last year, I was’nt made aware of the medical problems and they were never explained to my by the Hospital or my surgeon . ? Why NOT if this has been going on for years.
I now constantly think about the possabilitys of a ticking time bomb inside me waiting to ruin my life for good.
I attended a well man clinic at my local Dr surgery the other week to have my old man check over (52) . Whilst there I spoke about the problems coming to light regarding the MOM hips. Being a regitered nurse for many years for the NHS she hand not heard of this. I then explained all about Earls blog that I have been following since having my hip done. She has took the web page deatils and is going to do some reading of the blog and do a bit of research into the side effects as I have explained to her my health had gone down hill ater six months of having the operation, ie , Breathing, fatigue, sleepless nights and depresion coupled with uselessness as a man now being unable to work.
all the Best
Rick
Rick
seems that all surgeons like to think they know best and don’t follow the developments as closely as they should.
And quite a number get big grants from Orthopaedic companies for “research” and other stuff so here you have some apparent conflict.
The only way to monitor this is to have regular x-rays, blood tests for metal ions, and just watch out for any unusual problems you cannot explain easily.
You may be one of the lucky ones where all is OK for 10 – 15 years?
Earl
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