title: Survival and functional outcome of the Birmingham Hip Resurfacing system in patients aged 65 and older at up to ten years of follow-up.
abstract: OBJECTIVE
  Limited evidence exists regarding the outcomes of hip resurfacing in elderly patients. The primary study aims were to determine the survival and functional outcome following Birmingham Hip Resurfacing (BHR) in patients ≥65 years at up to ten years of follow-up. Secondary aims were to explore factors affecting survival and functional outcome.
  
  
  METHODS
  Between 1997 and 2012, data were prospectively collected on 180 BHR (162 patients; mean age 69.2 years; 62 % male) implanted by one designing surgeon. Mean follow-up was six (range one to 14.4) years with no loss to follow-up. Outcomes of interest were implant survival, functional outcome [Oxford Hip Score (OHS)] and radiological evidence of implant failure.
  
  
  RESULTS
  Three hips were revised, giving an overall cumulative survival of 96.4 % [95 % confidence interval (CI) 90.3-100] at ten years. Survival of 111 male BHR was 98.9 % (95 % CI 94.8-100) at ten years (one revision) compared with 91.9 % (95 % CI 77.0-100) in 69 female BHR (two revisions). Survival was affected by age (p = 0.014) and femoral head size (p = 0.024) but not by gender (p = 0.079). Median pre-operative OHS was 50.0 % [interquartile range (IQR) 37.5-68.8], improving to 4.4 % (IQR 0-10.4) postoperatively. Men had significantly better postoperative OHSs compared with women (median male OHS 2.1 % versus 6.3 % female OHS; p = 0.021).
  
  
  CONCLUSIONS
  Good survival and functional outcomes were achieved with the BHR at ten years in men and women ≥65 years. Despite registry findings to the contrary, age alone should not be a contraindication for hip resurfacing in centres with expertise in this procedure.
authors.affiliation: The Royal Orthopaedic Hospital, Birmingham, UK, B31 2AP.
authors.forename: Regis
authors.initials: R
authors.lastname: Pailhe
authors.forename: Gulraj S
authors.initials: GS
authors.lastname: Matharu
authors.forename: Akash
authors.initials: A
authors.lastname: Sharma
authors.forename: Paul B
authors.initials: PB
authors.lastname: Pynsent
authors.forename: Ronan B
authors.initials: RB
authors.lastname: Treacy
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D015207:Osteoarthritis, Hip / Q000601:surgery*; D016896:Treatment Outcome