Birmingham Hip Resurfacing

Hip resurfacing is ideal for many younger, active patients who suffer from hip pain. Many people stay physically active far into their late fifties and beyond so there’s an increased need for an alternative to total hip replacement that accommodates their age and lifestyle.

What Is the BIRMINGHAM HIP* Resurfacing Device?

Your hip is a socket and ball joint where the thighbone and pelvis come together. As your leg moves, the ball of your thighbone (called the femoral head) moves and rotates against the socket portion of your pelvic bone (called the acetabulum). If your hip joint is diseased due to certain kinds of arthritis, or previous damage, it will become less functional and more painful over time. When your hip pain increases to the point that it can not be helped by usual measures such as pain medicine and exercises (physical therapy) and your ability to move your hip decreases, affecting your ability to do your daily activities, it may become necessary to surgically replace the hip joint.

The BIRMINGHAM HIP™ Resurfacing (BHR™) device has two parts: a socket in the shape of a shallow cup (acetabular component), and a cap in the form of a ball head (femoral resurfacing component). See Figure 1.

The cup replaces the damaged surface of your hip socket (acetabulum). The cap covers the ball-shaped bone at the top of your thigh (femoral head), and the cap has a small stem that is inserted into the top of your thighbone. The cap moves within the cup. The surfaces that rub against each other (the bearing couple) are made from highly-polished metal. This type of bearing couple is called a metal-on-metal bearing couple.

Hip resurfacing versus a total hip replacement:

With a hip resurfacing device, the surgeon covers your hip socket with a metal cup, and covers your femoral head with a metal cap. (See Figure 1) The BHR System is a hip resurfacing device. With a total hip replacement device, the surgeon covers your hip socket with a cup and replaces your femoral head with a metal ball attached to a long metal stem. The metal stem is inserted into your thighbone. (See Figure 2)

BIRMINGHAM HIP* Resurfacing System Surgery

BIRMINGHAM HIP Resurfacing System surgery has helped more hip pain patients around the world than any other hip resurfacing surgery available. Their experience – and yours – can be broken down into three basic parts.

• Before Surgery – Getting Ready
• Day of Surgery – What to expect
• After Surgery – Smart Recovery Strategies

BEFORE SURGERY – GETTING READY

BIRMINGHAM HIP* Resurfacing System procedure starts with an appointment with your orthopaedic surgeon.

This initial surgical consultation may include X-rays, a medical history and physical, and a list of your medications and allergies. Your surgeon may review the BIRMINGHAM HIP Resurfacing System procedure and answer any questions you have about hip pain, hip resurfacing or any other pre-surgical issues.

Your doctor may want you to meet with a Physical Therapist (PT) even before the surgery. The PT may give you some tips on preparing your house for rehabilitation, and on how you should sleep, get out of bed, sit, get up, and walk following surgery. Some things you can do before surgery to prepare for the rehabilitation period are:

• Add extra cushions to couches and chairs. The extra height will make it easier for you to lower and raise yourself from the chair.
• Have armchairs available. During rehabilitation, you may be told only to sit in armchairs, as you will need the arms to help you sit down and get up.
• Arrange to have an elevated toilet seat and/or support bars fitted in your bathroom.
• Move items you may need to reach to shelves or tables above waist level.
• Remove all throw rugs and anything else on the floor that might cause you to slip or trip and fall.

DAY OFSURGERY – WHAT TO EXPECT

After being admitted you will be taken to the appropriate pre-surgical area where the nursing staff will take your vital signs, start intravenous (IV) fluids, and administer medications as needed. You will be asked to empty your bladder just prior to surgery, and to remove all jewelry, contacts, etc. Once you change into a surgical gown you will be taken to the operating room. The anesthesiologist will meet you and review the medications and procedures to be used during surgery.

Your surgeon will start the operation with a technique to approach the hip joint. There are several different surgical approaches available, and your surgeon will choose the approach which best suits his or her experience. There are subtle differences in each approach which will result in slight variations in the post-operative regimes used in the recovery and rehabilitation from the surgery.

The surgeon then prepares the bone for resurfacing, using specialized instruments supplied by Smith & Nephew , the manufacturer of BIRMINGHAM HIP* Resurfacing System implants. The head of the femur is prepared to receive the resurfacing component, and the socket is shaped to accept the new resurfacing cup. Once this is accomplished the socket is inserted in a position to give stability to the hip, and allow the bone to grow around it. This encourages long-term security in the newly refinished hip joint. Finally, the resurfacing head component is fixed into position using bone cement.

Following a careful inspection of all components your surgeon will then close the surgical approach path with sutures. It is common for the surgeon to leave a drainage tube exiting from just below the incision for a couple of days after BIRMINGHAM HIP Resurfacing System surgery, but in some cases it is not necessary.

AFTER SURGERY – SMART RECOVERY STRATEGIES

Most patients are in the hospital from 4 to 6 days. The surgery usually takes 2 to 4 hours to perform. You will use walking support (canes, crutches) for about six weeks after surgery while your hip muscles are healing. You may be told not to bend your hip or waist to more than a 90-degree angle during the healing time (rehabilitation).

Before you go home, your Physical Therapist (PT) will teach you to climb stairs and how to move from a bed, chair, and car. Your PT may also give you a list of exercises to do at home every day. These exercises will help you become as independent as possible in your personal care and daily activities after you return home. Physical therapy will also help prepare you for more difficult exercises, movement, and activity.

The weeks after hip surgery

Most of your therapy and healing (rehabilitation) will occur once you have checked out of the hospital. Your PT will design an exercise program to increase motion and strength of your hip, and will teach you the exercises, making sure you know proper way to do the

exercises before you begin. The success of your rehabilitation is very dependent on how dedicated you are to the physical therapy program.

Walking is the key to a speedy return to your active lifestyle. But don’t overdo it. Swimming is good, but you shouldn’t attempt other sporting activities, including golf, until getting cleared by your surgeon. Talk to your doctor about planning a regular exercise and stretching program.

Precautions after BIRMINGHAM HIP Resurfacing System surgery

The first six to 12 months after a BIRMINGHAM HIP Resurfacing System operation are the most vulnerable for the new hip joint. You’ll want to try out your new resurfaced hip. But you’ll also want to be smart, and take it slowly.

Avoid heavy lifting and high-impact activities like jogging or jumping. Don’t twist or squat. Driving can resume around four to five weeks after hip resurfacing surgery, pending physician approval, as can sexual relations – but try to avoid extreme movements of the hip for around three months.

Some pain is normal and expected during your rehabilitation period, and the pain should slowly decrease in the weeks following surgery. If you experience any serious, mmediate, constant hip pain or pressure or feeling of unsteadiness, or if you are suddenly unable to put weight on your hip after the early post-operative pain has gone away, you should contact your doctor. These signs (symptoms) may be a signal of a serious problem (such as bone breakage, dislocation, infection, device loosening, movement, or breakage). Any of these problems may require medical attention including additional surgery. Remember to listen to what your body tells you, and what your doctor recommends. If you begin to have pain or swelling, contact your physician for advice.

Follow your doctor’s schedule for examinations after surgery. Routine examinations will include regular X-ray exams to look for any problems such as hip bone or device breakage, position changes, or anything abnormal. X-rays will also check the progress of bone healing around the implant.

Your new hip device may activate metal detector alarms. Tell the security attendant about your artificial hip when passing through security checkpoints in airports, stores, and public buildings.

Specific potential benefits of the BIRMINGHAM HIP* Resurfacing System include:

• The BHR’s metal cup will not chip or crack as ceramic components can.
• The BHR does not cause thighbone (femoral shaft) fractures as total hip replacement systems can.
• The BHR may make future revision surgery easier because hip resurfacing surgery leaves your femoral head in place and there is no large metal stem placed in the thighbone.
• Revision surgery of a total hip replacement where your femoral head has already been removed and a large stem is already in place can be a more difficult operation.
• Dislocation of the ball head from the socket is less common with the BHR device than with total hip replacement devices. In the clinical study, 0.3% of BHR patients experienced dislocation, compared with between 1% and 4.2% of total hip replacement patients from comparison studies.

Some of the Potential Risks of the BIRMINGHAM HIP* Resurfacing System

The potential risks of any hip joint replacement include:

• Damage to blood vessels, or temporary or permanent nerve damage during surgery,
• Sudden drop in blood pressure during surgery due to the use of bone cement
• Blood circulation problems because of surgery or during recovery including blood clots in the legs or lungs or heart attack.
• Allergic reactions to the device material or to medications you are given,
• Surgical wounds that take a long time to heal due to many reasons such as poor skin condition, infection, poor blood circulation, bad hygiene, etc
• Infection related to surgery and wound healing. Infections may occur months to years after surgery and these infections are difficult to treat and may require reoperation with removal surgery and later replacement at another time.
• Dislocation of the hip, device loosening/shifting, or device wear/breakage due to muscle and fibrous tissue lack of firmness (laxity). Device placement in the wrong position in the bone, poor attachment of the device to the bone, too much weight or activity put on the device, or accidents affecting the hip joint like falls (trauma),
• Damage to the bones and tissue (tissue necrosis) near the hip joint, including loss of the surrounding bone (osteolysis) or staining of the hip joint fluid (metallosis) due to wearing away of the metal parts over time.
• Change in the length of the leg in which the device is placed,
• Device breakage due to weakening of the metal over time (fatigue fracture),
• Bone breakage due to osteoporosis or accidents (trauma),
• Bone loss or too much bone formation near the implants in response to the surgery or to the presence of the device in the bone.

These potential adverse effects may require medical attention or additional surgery. Rarely do complications lead to death.

The potential risks of the BHR device as compared with a total hip replacement system include:

• The risk of femoral neck scratching (notching) during surgery that can lead to femoral neck fracture after surgery. This occurred in less than 1% of BHR patients in the clinical study.
• The risk of femoral head collapse. This occurred in less than 1% of BHR patients in the clinical study.
• The risk of femoral head collapse. This occurred in less than 1% of BHR patients in the clinical study.
• The risk of avascular necrosis. This occurred in 1% of the BHR patients in the clinical study.
• If the ball cap part of BHR device must be removed (revised), your surgeon will likely put a total hip replacement metal stem in your thighbone (see Figure 2).

These complications may require surgery to change from the BHR device to a total hip replacement device. You should compare these risks to the potential benefits of a BHR system, as described above.

What Do the Clinical Studies Show?

A clinical study was performed to evaluate the safety and effectiveness of the BHR device. Complication (safety) information was collected from the entire group of 2,385 study hips. Effectiveness information was collected from the first 1,626 of the 2,385 hips because these 1,626 hips have the longest follow-up. There is 5 year follow-up information for 546 of these 1,626 hips.

Safety Data

The overall complication rate and the types of complications in the BHR study group were generally similar to the complications reported for other hip replacement systems. Complications led to revision surgery in 27 out of 2,385 hips. The 1.13% revision rate at 5-years after surgery from all complications was comparable to the revision rates reported for total hip replacement devices. There were no deaths related directly to use of the device in the study. All deaths were from other medical problems.

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