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26% Failure in Female Smith & Nephew BHR’s – and higher failure in older males…

The ten-year survival of the Birmingham… [J Bone Joint Surg Br. 2012] – PubMed – NCBI.

J Bone Joint Surg Br. 2012 Sep;94(9):1180-6.

The ten-year survival of the Birmingham hip resurfacing: An independent series.


Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, Windmill Road, Oxford OX3 7LD, UK.


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.

[PubMed – in process]