title: The outcome of the Birmingham Hip Resurfacing in patients aged < 50 years up to 14 years post-operatively.
abstract: We report the long-term survival and functional outcome of the Birmingham Hip Resurfacing (BHR) in patients aged < 50 years at operation, and explore the factors affecting survival. Between 1997 and 2006, a total of 447 BHRs were implanted in 393 patients (mean age 41.5 years (14.9 to 49.9)) by one designing surgeon. The mean follow-up was 10.1 years (5.2 to 14.7), with no loss to follow-up. In all, 16 hips (3.6%) in 15 patients were revised, giving an overall cumulative survival of 96.3% (95% confidence interval (CI) 93.7 to 98.3) at ten years and 94.1% (95% CI 84.9 to 97.3) at 14 years. Using aseptic revision as the endpoint, the survival for men with primary osteoarthritis (n = 195) was 100% (95% CI 100 to 100) at both ten years and 14 years, and in women with primary osteoarthritis (n = 109) it was 96.1% (95% CI 90.1 to 99.9) at ten years and 91.2% (95% CI 68.6 to 98.7) at 14 years. Female gender (p = 0.047) and decreasing femoral head size (p = 0.044) were significantly associated with an increased risk of revision. The median Oxford hip score (OHS, modified as a percentage with 100% indicating worst outcome) at last follow-up was 4.2% (46 of 48; interquartile range (IQR) 0% to 24%) and the median University of California, Los Angeles (UCLA) score was 6.0 (IQR 5 to 8). Men had significantly better OHS (p = 0.02) and UCLA scores (p = 0.01) than women. The BHR provides excellent survival and functional results in men into the second decade, with good results achieved in appropriately selected women.
authors.affiliation: Royal Orthopaedic Hospital, Birmingham B31 2AP, UK. gsm@doctors.org.uk
authors.forename: G S
authors.initials: GS
authors.lastname: Matharu
authors.forename: C W
authors.initials: CW
authors.lastname: McBryde
authors.forename: W B
authors.initials: WB
authors.lastname: Pynsent
authors.forename: P B
authors.initials: PB
authors.lastname: Pynsent
authors.forename: R B C
authors.initials: RB
authors.lastname: Treacy
mesh_terms: D000293:Adolescent; D000328:Adult; D019644:Arthroplasty, Replacement, Hip / Q000706:statistics & numerical data*; D005260:Female; D006085:Graft Survival / Q000502:physiology; D006622:Hip Prosthesis / Q000706:statistics & numerical data*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015207:Osteoarthritis, Hip / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D011446:Prospective Studies; D011475:Prosthesis Failure; D011859:Radiography; D012086:Reoperation / Q000706:statistics & numerical data; D017678:Sex Distribution; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
keywords: Functional outcome; Gender; Head size; Hip resurfacing; Metal-on-metal; Osteoarthritis; Survival