Indications for revision following Birmingham Hip Resurfacing

Aims

The literature reports excellent medium- to long-term results of Birmingham Hip Resurfacing (BHR). However, revision risks after hip resurfacing vary across implant types, particularly as a result of variations in adverse reactions to metal debris (ARMD). We aimed to characterize the indications for BHR revision and to identify factors associated with specific failure modes.

Methods

We identified all patients who underwent a BHR at our institution between July 1997 and July 2022. Patients were categorized by sex, age, and BHR head size. Indications for revision were grouped into consensus clinical categories, and Kaplan-Meier survival analysis was performed.

Results

Out of a total of 4,513 BHR cases over 25 years, 392 (8.7%) were revised. Overall implant survival in males was 95.3%. A total of 4.7% (n = 148) of males were revised compared with 17.8% (n = 244) of females (p < 0.001). The most common indication for revision was aseptic loosening (n = 98; 2.2%). A total of 92 patients (2.0%) underwent a revision for adverse reaction to metal debris (ARMD). Female sex was significantly associated with revision for ARMD (p < 0.001). Revision for periprosthetic fractures occurred early while revision for ARMD occurred late (median 0.6 years (IQR 0.1 to 5.6) vs 10.5 (IQR 8.1 to 14.0), respectively; p < 0.001). Revision rates in femoral heads < 50 mm were significantly higher compared with ≥ 50 mm (17.4% (n = 247) vs. 4.7% (n = 145), respectively; p < 0.001). Revision for ARMD in males with heads ≥ 50 mm was 0.4% (n = 13) over 25 years.

Conclusion

This 25-year BHR institutional analysis represents the largest series reported to date and demonstrates that the indication for revision is associated with patient and implant factors. Revision rates for males are low and compare favourably to the best results of total hip arthroplasties. These results legitimize the continued use of metal-on-metal resurfacing in selected groups and form a basis for evaluation of all new resurfacing designs using different material combinations.

Cite this article: Bone Joint J  2026;108-B(10):1224–1230.