Is the Birmingham Hip Resurfacing Worthwhile?

The highest failure rates of cemented hip replacement are in males under 50 years of age, usually from acetabular loosening and polyethylene wear. The metal-on-metal Birmingham Resurfacing offers potential advantages to this group because of its wear properties. It also has a low dislocation rate and consequently less restricted activity.

The aim of this study was to compare early outcome in young patients, treated for osteoarthritis, either by the Birmingham Resurfacing or hybrid cemented stem with an uncemented cup and press-fit polyethylene liner. 54 patients in each arm were matched for age, sex, body mass index, and pre-operative activity. Outcome was measured by the Oxford Hip Score, with supplementary questions about sporting activity and manual work. 37% of hybrid hip replacements undertook sport or heavy manual work despite specific instruction to the contrary.

The Birmingham Resurfacings scored significantly better than the hybrid hip replacements (Mean 3.4 points, 1.3–5.5, 95% Confidence Interval, p<0.05.). Age and duration of symptoms pre-operatively were associated with outcome in the resurfacing group. In the early stages there appears to be justification for using the Birmingham Resurfacing in active young patients. Only long-term follow-up will indicate whether metallosis and neck fracture are lesser complications than polyethylene wear and whether activity can be maintained.