Total Hip Replacement: Birmingham Hip resurfacing (Smith and Nephew)
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Hip Resurfacing had been the poor relation of Total Hip Replacement for the past 50 years. Theoretically resurfacing, that spares much of the normal bone stock and replaces worn-out anatomy “like for like” on a size basis, is an intuitive solution. As a design solution resurfacing was also widely accepted in replacement knee and shoulder arthroplasty.
Historically though the use of conventional materials for Hip resurfacing implants had failed to match expectations, even regarding the medium term outcomes. Historic metal/polyethylene bearings, such as the Wagner, Amstutz or Buechel-Pappas, had resulted in greater than 50% failure rates at 5 years.
Metal on metal resurfacing was revived by Derek McMinn in the early ’90’s, using the experience gained from the success and failures in early Hip resurfacing to focus on component size and appropriate alloys and joint manufacturing techniques, particularly in relation to the bearing surfaces. The resulting Birmingham Hip Resurfacing (Smith and Nephew) has shown outstanding longer term results.
What other similar but non-identical implants that have followed from other sources have helped demonstrate is that success with this type of implant is very much design, implant and orientation dependent. What has also become evident is that universally excellent results can be achieved in younger male patients, but there is generally less margin for error in component position in females and those with poor(weak) bone stock
This section is my perspective, as a Surgeon involved in the design, on the optimum operative technique for implantation of a Birmingham Hip resurfacing, and is as I use in my own practice.
Author:Mr Ronan Treacy FRCS(Tr & Orth)
Institution: The Royal Orthopaedic Hospital, Birmingham, UK.