title: The ten-year survival of the Birmingham hip resurfacing: an independent series.
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). 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). 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.
authors.affiliation: Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, Windmill Road, Oxford OX3 7LD, UK. david.murray@ndorms.ox.ac.uk
authors.forename: D W
authors.initials: DW
authors.lastname: Murray
authors.forename: G
authors.initials: G
authors.lastname: Grammatopoulos
authors.forename: H
authors.initials: H
authors.lastname: Pandit
authors.forename: R
authors.initials: R
authors.lastname: Gundle
authors.forename: H S
authors.initials: HS
authors.lastname: Gill
authors.forename: P
authors.initials: P
authors.lastname: McLardy-Smith
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000401:mortality* / Q000706:statistics & numerical data*; D015984:Causality; D015897:Comorbidity; D019544:Equipment Failure Analysis / Q000706:statistics & numerical data*; D005260:Female; D057925:Femoracetabular Impingement / Q000453:epidemiology; D006104:Granuloma, Plasma Cell / Q000453:epidemiology*; D006620:Hip Fractures / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011474:Prosthesis Design; D012086:Reoperation / Q000401:mortality; D017678:Sex Distribution; D012737:Sex Factors; D013499:Surface Properties; D055815:Young Adult