BIRMINGHAM HIP◊ (BHR◊) Resurfacing System
An alternative to total hip replacement.
Younger active male patients who suffer from hip pain due to non-inflammatory arthritis (degenerative joint disease) such as osteoarthritis, traumatic arthritis, avascular necrosis, or dysplasia/DDH, or inflammatory arthritis such as rheumatoid arthritis, may benefit from the bone-conserving approach of the BIRMINGHAM HIP Resurfacing System (BHR).
Unlike total hip replacement, which removes all of the bone within your ball and socket hip joint, the BHR resurfaces just a few centimeters of bone, preserving more of your original joint.
Candidates for Hip Resurfacing
Hip resurfacing is intended for younger active male patients in need of a hip replacement. The suitability of resurfacing as an appropriate treatment for you should be determined by your surgeon, including by a review of your bone quality and the size of your femoral head. Please discuss your options with your surgeon.
The BHR was CE marked in January 1997 and has been implanted in hospitals in Europe since then. It was approved for use in the United States by the Food and Drug Administration in 2006.
The BHR has two parts: the femoral head (the ball) and the acetabular component (the socket).
The benefits of the BHR technique and implant for appropriate patients may be significant. The implant's head size, its bearing surfaces and its bone-sparing technique could make it the right choice for active patients. In fact, the implant's rate of survivorship for men under the age of 65 is comparable to - and in many cases, better than - standard total hip replacements after ten years of use1.
While the implant closely matches the size of your natural femoral head (hip ball), it is substantially larger than the femoral head of most total hip replacements. This increased size helps to reduce the risk of dislocation of the implant after surgery2.
The BHR implant conserves substantially more bone than a total hip replacement. Since it preserves the natural femoral neck and most of the natural femoral head, a well-placed BHR reduces concerns about post-operative leg length discrepancy. Also, should you need the implant to be replaced at some point in the future, you would be a candidate for a standard hip replacement stem as opposed to needing a longer "revision" stem-type, as is often the case when a traditional total hip replacement needs to be replaced.
Total hip replacement requires the removal of the natural femoral head and the insertion of a hip stem down the shaft of the femur. Hip resurfacing, by contrast, preserves both the femoral head and the femoral neck.
During the procedure, your surgeon will only remove a few centimeters of bone around the femoral head, shaping it to fit tightly inside the BHR implant. Your surgeon will also prepare the acetabulum for the metal cup that will form the socket portion of the ball-and-socket joint.
The femoral component is cemented over the top of the prepared femoral head like a tooth cap, and the acetabular component is pressed into place much like a typical hip replacement component would be.
Why BIRMINGHAM HIP™ Resurfacing?
Long-term successful outcomes around the globe:
- The Australian Orthopaedic Association National Joint Replacement Registry Annual Report 20153 showed BHR survivorship of 90.2% at 14 years follow-up, the longest of any resurfacing device.
- BHR continues to be the most implanted resurfacing device world-wide and is the only hip resurfacing device with 14 years of registry data.
- Great Britain's Oswestry Outcomes Centre's patient registry revealed BHR 10-year survivorship of 95.4%, with 98.6% of patients rating their opinion of the experience as pleased or extremely pleased4.
Any surgery presents some risks for the patient. There are potential risks with hip resurfacing surgery such as fracture, infection, loosening, dislocation and wear that may result in the need for additional surgery. Females should not be implanted with the BHR. You should always follow your surgeon's recommendations as regards what you should and should not be doing after you have been implanted with a BHR. Early device failure, breakage or loosening may occur if you do not follow your surgeon's recommendations on activity level. Early failure can happen if you do not guard your hip joint from overloading due to activity level, failure to control body weight, or if you experience impact accidents such as falls. Hip resurfacing surgery is intended to relieve hip pain and improve hip function. Talk to your doctor to determine what treatment may be best for you.
- Data on file, Smith & Nephew.
- S. S. Jameson, D. Lees, P. James, Serrano-Pedraza, P. F. Partington, S. D. Muller, R. M. D. Meek, M. R. Reed. Lower rates of dislocation with increased femoral head size after primary total hip replacement. J Bone Joint Surg [Br] 2011;93-B:876-80.
- Australian Orthopaedic Association National Joint Replacement Registry Annual Report. Adelaide: AOA; 2015.
- Robinson E, Richardson JB, Khan M. MINIMUM 10 YEAR OUTCOME OF BIRMINGHAM HIP RESURFACING (BHR), A REVIEW OF 518 CASES FROM AN INTERNATIONAL REGISTER. Oswestry Outcome Centre, Oswestry, UK.
The information presented about the BHR is for educational and informational purposes only. It does not constitute and is not a substitute for medical advice. Only your physician can advise whether the BHR may be suitable for you and your condition. You should consult your physician about whether the BHR constitutes an appropriate treatment option for you, and about the associated risks, benefits, contraindications, warnings and possible outcomes.
Not everyone who receives a product or treatment will experience the same or similar results; results may vary depending on a number of factors, including each patient's specific circumstances and condition, and compliance with post-operative recommendations. Smith & Nephew is not responsible for the selection of any treatment by a physician to be used on a particular patient. Smith & Nephew makes no representations, warranties, guarantees or assurances as to the availability, accuracy, currency or completeness of the information presented or its contents. Smith & Nephew shall not be liable for any damages or injury resulting from your reliance on any information provided. Your use of the information is at your own risk.
BIRMINGHAM HIP◊ Resurfacing System: Important MRI Safety Information
Magnetic Resonance Imaging (MRI) scans are a commonly used diagnostic tool for a variety health related issue. Overseen by a radiologist, these scans use magnetic fields and pulses of radio wave energy to create images of organs and structures inside the body.
Because of the technology used in MRI scanning, some artificial implants, like the BIRMINGHAM HIP Resurfacing System, can affect the imaging quality or negatively impact the scanning due to their use of metallic components.
Below is the information your radiologist will need to ensure the appropriate scanning protocol is used based on non-clinical testing conducted by Smith & Nephew.
MRI SAFETY INFORMATION
Smith & Nephew, Inc. BIRMINGHAM HIP Resurfacing (BHR) System implants are manufactured from a non-ferromagnetic material, cobalt-chromium-molybdenum alloy. Smith & Nephew has performed non-clinical Magnetic Resonance Imaging (MRI) studies on BHR implants which are determined to be MR Conditional in accordance to ASTM F2503-08, Standard Practice for Marking Devices and Other Items for Safety in the Magnetic Resonance Environment. MR Conditional refers to an item that has been demonstrated to pose no known hazards in a specified MR environment with specified conditions of use.
Non-clinical testing has demonstrated that the BHR System is MR Conditional. A patient with this device can be safely scanned in an MR system meeting the following conditions:
- Static magnetic field of 1.5 and 3.0 Tesla only
- Maximum spatial gradient magnetic field of 3,000 gauss/cm (30 T/m) or less
- Maximum MR system reported, whole body averaged specific absorption rate (SAR) of 2 W/kg (Normal Operating Mode)
- Cylindrical Quadrature transmit coils only
Under the scan conditions defined above, the BHR System is expected to produce a maximum temperature rise of 7.1° C after 15 minutes of continuous scanning.
In non-clinical testing, the image artifact caused by the device extended up to 10.2 cm from the BHR system when imaged with a gradient pulse sequence, and up to 7.6 cm from the device when imaged with a spin echo pulse sequence and a 3 Tesla MRI system.
Be sure to share this information with your radiologist.
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