Birmingham Hip Resurfacing (BHR) is a special type hip replacement for young men with arthritis of their hips.
It differs from a ‘conventional’ Total Hip Replacement (THR) in two main ways:
The BHR was developed in Birmingham, England, by Dr Derek McMinn, and released in 1996. The first case in Hong Kong was performed at Matilda International Hospital on 27 May 2003 and about 500 BHRs have been performed at Matilda since.
The BHR was FDA approved in 2006 and is in use at top US hospitals such as the Hospital for Special Surgery in New York.
Data from the National Joint Register for England & Wales shows the BHR has the best longevity of all types of hip replacement for young men (55 and under) with osteoarthritis.
The BHR is a ‘metal-on-metal’ bearing made from Cobalt-Chrome metal alloy.
Men up to 55 years old and over 5’6” (168cm) tall with arthritis of their hips.
Arthritis is inflammation of the hip due to disease or injury. Usually it becomes painful, especially with activity, such as walking, and at night.
The most common type of arthritis is ‘osteoarthritis’ – also known as ‘degenerative arthritis’ or ‘wear and tear’. In practice most ‘wear and tear’ is from sports involving kicking and lunging, such as tennis or football or martial arts.
A common problem in Asians is avascular necrosis (AVN), a condition where there is loss of blood supply to the bone, causing bone collapse, followed by arthritis.
Other problems leading to arthritis are infection, injury, slipped upper femoral epiphysis, impingement, Perthes disease, and some forms of hip dysplasia.
Sometimes osteoarthritis occurs for no obvious reason, in which case it is described as ‘primary’ osteoarthritis.
Depending on the exact anatomy, some forms of arthritis are suitable for resurfacing, and some are better treated by conventional total hip replacement.
Total hip replacement was introduced in the UK in 1962. It was a revolutionary procedure, but young people would wear out the early designs of artificial hips after around 20 years, thus requiring a second (or ‘revision’) hip replacement, which is usually more difficult than the first, and may not last as long – therefore younger people were advised to wait as long as possible.
Fortunately hip replacements have improved in the last sixty-plus years, and we believe the BHR (and, indeed all modern total hip replacements) will last indefinitely in most cases, so we now advise most people not to wait if they have hip pain that is unpleasant and not controlled by simple drugs.
Many patients have returned to sport at all levels, including: martial arts; rock climbing; Marathon running; Rugby; horse riding; and many others.
The most famous sportsman with a BHR is tennis player Andy Murray, but there are many other professional sportsmen, including Major League Baseball players and National Hockey League skaters, playing as well (or better) than before their hip resurfacing.
Even if you have lost the top [head and neck] of your thigh bone you may still be able to enjoy the advantages of the large diameter metal on metal bearing by having a ‘hybrid BHR’ – where a metal stem is placed into the thigh bone, much like a conventional THR, with a modified BHR ball, and standard BHR socket with significant osteoporosis should not have Only those with significant osteoporosis should not have BHR.
If the damage is not too severe it may still be possible to have a BHR. Plan B is a conventional total hip replacement. Matilda International Hospital always has THRs on standby, so it is simple to convert to THR during the operation if BHR is not possible.
Under a general or regional anaesthetic a cut is made in the side of the leg, the tendons of some of the muscles are carefully cut to expose the hip joint, which is dislocated. The arthritic joint and a thin layer of bone are removed and replaced with the appropriate size Birmingham implants. The tendons are stitched back to the bone. The operation takes about an hour and a half.
You can walk with crutches the same day, and can usually go home the next day.
Only the BHR is available in Hong Kong. The BHR is the most popular design worldwide. The next most popular design is very similar to the BHR. Unfortunately a number of other designs of resurfacing from the early 2000s were unsuccessful and were withdrawn. New designs are in development, using ceramics and plastics in addition to metals.
The general risks are the same as for a THR:
There is a small increase in metal ions in the blood after a metal-on-metal hip resurfacing. So far no problems have been identified as a result.
Yes. It’s safe, and it saves rehabilitation time, as well as hospital costs.
Ideally one would see one’s physiotherapist before the operation for ‘prehabilitation’ – learning in advance how to walk with crutches, get in and out of bed and into and out of a car, how to climb and descend stairs, and get to the bathroom. This allows people to go home quickly.
It’s best to take things very easy for the first 6 weeks (walking maximum 1,500 -2,000 steps per day) to allow the tendons to heal, and to take things quite easy for another 6 weeks (walking up to 3,000 steps per day) to allow the bone to regain its strength. After 3 months, there are no formal restrictions on activity. Most people are ready to do light jogging at 6 months, and fully recovered – competitive sport – at about one year.
Usually one would see one’s surgeon at 2 weeks, then 6 weeks, 3, 6 and 9 months, and then once a year.
It’s safe to fly immediately – so if one has flown to Hong Kong for the operation it’s safe to fly home after a few days.
It’s a good idea to put off business trips for about 6 weeks – not because it’s not safe to fly – but it’s much harder work and one will be tired.
Don’t drive earlier, as there is significant legal risk in the event of an accident.