title: Birmingham Hip Resurfacing in Patients 55 Years or Younger: Risk Factors for Poor Midterm Outcomes.
abstract: Birmingham hip resurfacing (BHR) is the only Food and Drug Administration-approved hip resurfacing system available in the United States and is used as an alternative to conventional total hip arthroplasty in younger patients. The purpose of this study is to report on the midterm outcomes of BHR in patients 55 years and younger, and specifically to examine the risk factors for aseptic failure, all-cause revision, and complications in this patient population.
  
  
  
  Four hundred forty-two consecutive patients with 5-year follow-up were retrospectively reviewed. Multivariate analyses were conducted to control for potential confounding factors identified by univariate analyses.
  
  
  
  Mean follow-up was 71.68 ± 10.24 months. Among the potential risk factors, only female gender and smaller head sizes had a significant univariate relationship with aseptic revision, all-cause revision, and all-cause complications. When both risk factors were included in a multivariable logistic regression model, analyses showed both variables were closely related, with female gender a better predictor of adverse outcomes than head size (ie, small head size can be thought of as a proxy for female gender). The 5-year implant survival is 95.1% females compared to 99.0% in males.
  
  
  
  Hip resurfacing with BHR has excellent survival rates in young patients with degenerative hip disease. Although this study suggests that females with small templated head sizes may not be suitable candidates for BHR, further studies are needed to better understand the underlying differences in gender.
authors.affiliation: Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Mohamad J
authors.initials: MJ
authors.lastname: Halawi
authors.affiliation: Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio.
authors.forename: David
authors.initials: D
authors.lastname: Brigati
authors.affiliation: Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio.
authors.forename: William
authors.initials: W
authors.lastname: Messner
authors.affiliation: Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Brooks
mesh_terms: D000293:Adolescent; D000328:Adult; D019644:Arthroplasty, Replacement, Hip / Q000379:methods / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011474:Prosthesis Design; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D016896:Treatment Outcome; D014481:United States; D014486:United States Food and Drug Administration; D055815:Young Adult
keywords: Birmingham hip resurfacing; complications; midterm outcomes; revision surgery; young patients