Hip Resurfacing
By Peter Lammens, BS, MD, FRCS (C)
The Birmingham Hip
The orthopedic pendulum has swung again. Sometimes surgical techniques are left behind only to be refined later with more success. Such is the case with a treatment of hip arthritis that was all but abandoned decades ago. The new Birmingham Hip Replacement (BHR) has a different metal on metal bearing surface and different insertion technique than the earlier method, and a nine-year track record with excellent results.
This new concept was introduced in 1997 and was designed using knowledge gained from first generation metal on metal total hips and a better understanding of hip resurfacing principles.
The
advantage of the BHR system is that it is a bone conserving total hip
system. This
means that much less of the patient's natural bone is removed. Bone conservation combined with the virtual
elimination of dislocations and excellent survivorship, make the BHR ideal for
the younger more active patient.
The metal on metal prostheses designed in the 1950s have extremely low wear rates and the metallurgy learned from these implants has been incorporated in the BHR system to produce an excellent weight-bearing surface. The use of cement on the femur side of the joint has made the device stronger and more durable.
As with almost any medical procedure, the BHR is not for every patient with hip arthritis. The target patient is a healthy, active person under 60 years old with lesser amounts of bone destruction limited to the weight-bearing surface. Significant bone destruction usually requires a total hip replacement. Females over 60 run the risk of fractures due to osteoporosis.
Ironically, the surgical incision is slightly larger than for total hip replacements but recovery is usually much quicker, with some patients returning to activity in one month.
Sometimes perfecting old techniques is better than developing new ones. Medical technology is about moving forward, but sometimes we must take a step back!
