Birmingham hip resurfacing (BHR)

Osteoarthritis is often associated with joint pain, stiffness and impaired mobility. In case of severe symptoms, the joint may be replaced by a prosthesis. Hip resurfacing is an alternative to the more common total hip arthroplasty. The Swedish Social Insurance Agency (Försäkringskassan) asked what effects and potential complications the Birmingham Hip Replacement (BHR) had for patients with osteoarthritis compared to the traditional total hip arthroplasty. They also asked about the relationship between cost and effect for these treatment methods compared to each other.


What is the benefit (relationship between effect and possible complications) of Birmingham Hip Resurfacing (BHR) prosthesis versus total hip arthroplasty for patients with osteoarthritis? What is the relationship between cost and effect for these treatment methods compared to each other?

Identified studies

  1. Canadian Agency for Drug and Technologies in Health. Metal on metal total hip replacements or hip resurfacing for adults: A review of clinical effectiveness and cost Effectiveness. November 2012.
  2. Fink Barnes LA, Johnson SH, Patrick DA, Macaulay W. Metal-on-metal hip resurfacing compared with total hip arthroplasty: Two to five year outcomes in men younger than sixty five years. International Orthopaedics 2014;38:2435-2440.
  3. Forsthoefel CW, Brown NM, Barba ML. Comparison of metal ion levels in patients with hip resurfacing versus total hip arthroplasty. Journal of Orthopaedics 2017;14:561-564.
  4. Halawi M, Oak, Sr., Brigati D, Siggers A, Messner W, Brooks P. Birmingham hip resurfacing versus cementless total hip arthroplasty in patients 55 years or younger: a minimum five-year follow-up. Journal of Clinical Orthopaedics and Trauma. (no pagination). 2017.
  5. Heintzbergen S, Kulin NA, Ijzerman MJ, Steuten LM, Werle J, Khong H, et al. Cost-utility of metal-on-metal hip resurfacing compared to conventional total hip replacement in young active patients with osteoarthritis. Value Health 2013;16:942-52.
  6. Jameson SS, Mason J, Baker P, Gregg PJ, Porter M, Deehan DJ, et al. Have cementless and resurfacing components improved the medium-term results of hip replacement for patients under 60 years of age? Patient-reported outcome measures, implant survival, and costs in 24,709 patients. Acta Orthopaedica 2015;86:7-17.
  7. Jameson SS, Mason J, Baker PN, Gregg PJ, Deehan DJ, Reed MR, et al. Implant optimisation for primary hip replacement in patients over 60 years with osteoarthritis: A cohort study of clinical outcomes and implant costs using data from England and Wales. PLoS ONE 2015;10.
  8. Junnila M, Kostensalo I, Virolainen P, Remes V, Matilainen M, Vahlberg T, et al. Hip resurfacing arthroplasty versus large-diameter head metal-on-metal total hip arthroplasty: comparison of three designs from the Finnish Arthroplasty Register. Scand J Surg 2014;103:54-9.
  9. Lingard EA, Muthumayandi K, Holland JP. Comparison of patient-reported outcomes between hip resurfacing and total hip replacement. J Bone Joint Surg Br 2009;91:1550-4.
  10. Marshall DA, Pykerman K, Werle J, Lorenzetti D, Wasylak T, Noseworthy T, et al. Hip resurfacing versus total hip arthroplasty: A systematic review comparing standardized outcomes. Clinical Orthopaedics and Related Research 2014;472:2217-2230.
  11. Matharu GS, Pynsent PB, Dunlop DJ. Revision of metal-on-metal hip replacements and resurfacings for adverse reaction to metal debris: A systematic review of outcomes. HIP International 2014;24:311-320.
  12. McMinn DJ, Snell KI, Daniel J, Treacy RB, Pynsent PB, Riley RD. Mortality and implant revision rates of hip arthroplasty in patients with osteoarthritis: registry based cohort study. Bmj 2012;344:e3319.
  13. Mokka J, Makela KT, Virolainen P, Remes V, Pulkkinen P, Eskelinen A. Cementless total hip arthroplasty with large diameter metal-on-metal heads: short-term survivorship of 8059 hips from the Finnish Arthroplasty Register. Scand J Surg 2013;102:117-23.
  14. Moroni A, Savarino L, Hoque M, Cadossi M, Baldini N. Do ion levels in hip resurfacing differ from metal-on-metal THA at midterm? Clin Orthop Relat Res 2011;469:180-7.
  15. Ortiz-Declet VR, Iacobelli DA, Yuen LC, Perets I, Chen AW, Domb BG. Birmingham hip resurfacing vs total hip arthroplasty: A matched-pair comparison of clinical outcomes. J Arthroplasty, 2017.
  16. Pailhé R, Reina N, Cavaignac E, Sharma A, Lafontan V, Laffosse JM, et al. Prospective study comparing functional outcomes and revision rates between hip resurfacing and total hip arthroplasty: Preliminary results for 2 years. Orthopedic Reviews 2013;5:93-96.
  17. Pollard TC, Baker RP, Eastaugh-Waring SJ, Bannister GC. Treatment of the young active patient with osteoarthritis of the hip. A five- to seven-year comparison of hybrid total hip arthroplasty and metal-on-metal resurfacing. J Bone Joint Surg Br 2006;88:592-600.
  18. Schuh R, Neumann D, Rauf R, Hofstaetter J, Boehler N, Labek G. Revision rate of Birmingham Hip Resurfacing arthroplasty: comparison of published literature and arthroplasty register data. Int Orthop 2012;36:1349-54.
  19. Seppänen M, Karvonen M, Virolainen P, Remes V, Pulkkinen P, Eskelinen A, et al. Poor 10-year survivorship of hip resurfacing arthroplasty. Acta Orthop 2016;87:554-559.
  20. Smith T, Nichols R, Donell S, Hing C. The clinical and radiological outcomes of hip resurfacing versus total hip arthroplasty: a meta-analysis and systematic review (Structured abstract). Acta Orthopaedica 2010;81:684-695.
  21. Swank ML, Alkire MR. Minimally invasive hip resurfacing compared to minimally invasive total hip arthroplasty. Bull NYU Hosp Jt Dis 2009;67:113-5.
  22. Wong JML, Liu YL, Graves S, de Steiger R, Author A, Queen’s Hospital BH, et al. What Is the Rerevision Rate After Revising a Hip Resurfacing Arthroplasty? Analysis From the AOANJRR. Clinical Orthopaedics and Related Research 2015;473:3458-3464.

SBU Enquiry Service consists of systematic literature searches to highlight studies that can address questions received by the SBU Enquiry Service from Swedish healthcare or social service providers. Relevant references are compiled by an SBU staff member, in consultation with an external expert when needed. The quality of the studies identified is not systematically reviewed.

Published: 4/20/2018
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