Fourteen year follow-up of Birmingham Hip Resurfacing in patients under the age of 50, by C. W. McBryde, R.B.C. Treacy, W.B. Pynsent & P.B. Pynsent.

1. Fourteen year follow-up of
Birmingham Hip Resurfacing
in patients under the age of 50
C. W. McBryde, R. B. C. Treacy, W. B. Pynsent & P. B. Pynsent
Research & Teaching Centre,
Royal Orthopaedic Hospital,
Birmingham, U.K

2. Survival of hip replacement in the under 50

3. Oct 2011 - 3668 THRs under age 55
15 year survival 62% uncemented and 58% cemented
Finish arthroplasty register

4. The Case Series
Single surgeon consecutive all-
inclusive series (RBCT)
All NHS (public) patients
Data collected prospectively and
supplemented retrospectively

5. Demographics
447 BHRs in 393 patients
August 1997 to April 2006
267 (60%) male and 180 (40%) female
Mean age 41.1 years (range 15-49)
Median follow up 8.0 yrs (range 5.0-
14.0)

6. Indications for primary surgery

7. Surgery
All performed by RBCT
Laminar air flow theatre
Posterior approach with release of glut. max.
Posterior capsulectomy and anterior
capsulotomy
Head prepared with standard instrumentation
Low viscosity cemented femur, uncemented
acetabulum

8. Revisions, Oxford hip score, Radiology.
4 tranches of targeted mail shots to addresses
from the ROH and Oswestry databases
Personal home visit and telephone calls
Patient tracking via independent private
agency
Very time consuming and expensive
Methods

9. Time to find patients from 1st April 2009
Time (months)
Numberofpatients

10. Estimated 10 year survival assuming all
lost to follow-up have failed
Survival at 10 years
Cumulativeproportionsurviving
As of December 2011
- none lost to follow-up

11. Cumulativeproportionsurviving
Time (years)
Survival 89.2% at 14 years
Survival 95.1% at 10 years
KM survival of 447 BHRs
in patients under the age of 50

12. Revision Sex Age Diagnosis Head size Time (years)
Reason for
revision
1 f 49 OA 46 0.5 Loose-acet
2 m 44 OA 54 0.5 Infection
3 f 49 OA 42 0.7 #NOF
4 f 49 OA 46 1.8 NA
5 f 48 OA 46 2.2 Infection
6 f 43 OA 42 5.3 Infection
7 m 42 AVN 50 5.9 Loose-fem
8 f 26 DDH 42 6.3 Loose-fem
9 f 42 OA 42 6.7 Loose-fem
10 m 30 RA 46 7.1 NA
11 f 17 Inflam 42 9.4 Loose-fem
12 m 30 AVN 50 9.5 Loose-fem
13 f 17 AVN 42 9.9 AVN
14 f 49 OA 50 10.2 Pain
15 f 36 OA 46 10.8
Implant
fracture
16 m 43 Perthe’s 50 11.8 Loose-fem

13. Cumulativeproportionsurviving
Time (years)
Aseptic femoral loosening

14. Cumulativeproportionsurviving
Time (years)
Infection
#Nof
Pain
AVN

15. KM survival of 195 BHRs in male patients with OA
under the age of 50 (aseptic revisions)
Cumulativeproportionsurviving
Time (years)
Survival 100% at 14 years
Male, OA under 50 years

16. KM survival of 105 BHRs in female patients with OA
under the age of 50 (aseptic revisions)
Cumulativeproportionsurviving
Time (years)
Survival 95.9% at 10 years
Survival 87.2% at 14 years
Female, OA under 50 years

17. Cumulativeproportionsurviving
Time (years)

18. Male 10 year survival - 100% (100-100)
Female 10 year survival - 95.9% (90.2-99.9)
Cox-prop hazard - p = 0.024
Head size highly significant - small worse
Cox-prop hazard - p = 0.004
7 deaths during follow-up - all unrelated
Results

19. Oxford hip score -standards developed from 6,602
Time (years)
Score(%)
95%
75%
50%
25%
5%

20. Oxford hip scores for under 50 group
Time (years)
Score(%)
711/1394 (51%) post -op scores
below median standard

21. Oxford hip score
Time (years)
Score(%)
Flooring effect.
Do we need a different scoring system?

22. No comparative group
Radiographic analysis available on 44%
Metal ions not available
Designer surgeon series
Limitations of this case series

23. JBJS Br March 2012 - Melbourne group
230 BHRs mean fu 10 years
94.5% overall, male 97.5%, female 89.1%
7% lost to follow-up
Women/ small size - is it still acceptable to
resurface women?
BHR results from independent centre

24. No aseptic failure in male patient with OA (195
cases 100% survival at 14 years)
Higher revision rate in women - but still
acceptable, within NICE guidelines
Small sizes (<46) and other diagnoses
(abnormal anatomy) be cautious
Conclusions

25. Birmingham Hip resurfacing provides excellent
results in previously difficult to treat group
Reactions to metal debris are rare
Bad designs and poor surgery have tarnished
an otherwise great advance in hip surgery
Conclusions