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Birmingham Hip Arthroplasty (BHA)

What is a Birmingham Hip Arthroplasty?

A/Professor Andrew Dutton Birmingham Hip Arthroplasty Illustration

The Birmingham Hip Resurfacing System relieves hip pain and improves hip function. It is a bone-conserving treatment that uses an all-metal bearing.

This two-part system involves a metal cap placed over the resurfaced femoral ball, while a metal cup fits into the pelvic socket or acetabulum. It restores a good hip range of motion and also allows younger patients to save the hip bone and preserve it for future surgical options. 

Since it was first used in July of 1997, there have been almost 200,000 BHR implantations worldwide.

Frequently Asked Questions on Birmingham Hip Arthroplasty

  • There is less bone resection at the femur than conventional total hip replacement
  • Good, long-term outcomes
  • Ease of revision
  • Less risk of dislocation
  • Shorter recovery time

In BHA, the surfaces of the ball and socket are resurfaced. Once the ball at the top of the thigh bone is removed, a stemmed component with a ball at the top is drilled into the marrow cavity of the thigh bone. The ball will articulate with the socket that is fitted into the pelvis.

The distinction between the implants used is that in THR, the femoral stem is longer which involves more bone trauma. Meanwhile, the Birmingham implant is designed to have a shorter stem which means minimal bone loss.

THR is done on patients whose femoral head and neck bone quality is relatively poor, or not strong enough to support BHA. This approach is also appropriate where the anatomy of the hip makes it unsuitable for the use of a smaller implant.

A BHR requires that a patient have good femoral head bone quality. It will be prepared to accept the femoral component in the resurfacing procedure.

Hip resurfacing can be performed as an overnight procedure and can take two to three hours of operating time. The process involves the following details:

A/Professor Andrew Dutton Birmingham Hip Arthroplasty Ball Socket Illustration
  • An incision is made over the outer edge of your hip joint approximately 20-30cm in length.
  • It removes 4-5mm of a damaged bone surface from the head of the femur (thigh bone) and from the surface of the acetabulum (socket).
  • The bone surfaces are then replaced with metal covers or shells.
  • The surgical cut is close with sutures, and surgical staples are used to close the skin.
  • The staples are removed a fortnight after surgery, while sutures dissolve. It is then dressed securely for the next 48 hours.

Its bone-conserving nature and implant design are intended to reduce the risk of dislocation. It also promotes good implant survivorship making it a safe solution for young and active patients.

Concerns with a BHA:

  • Metal Ions in the bloodstream so it is not done for young females who may want to become pregnant and those with kidney issues.
  • There have been some studies that demonstrate concern between metal ions and certain blood cancers.
  • Metal wear particles may produce a foreign body rejection reaction.

Femoral neck fracture in those patients with a predisposition to osteoporosis or weak bones.

It’s uncertain to determine the lifespan of a Birmingham implant as there are different factors that come into play.

During your first year, doctors will recommend conservative, low-impact activities like walking, swimming, or bicycling. These movements help strengthen the femoral neck and muscles around your resurfaced joint. Healing time is shorter with BHA, unlike total hip replacement where you can return to these activities after the first year after surgery.

Metal bearings offer a good chance at regaining possible functional recovery because these are not brittle, unlike ceramics. Due to the implant’s large diameter, it has the capacity to withstand impact and rarely dislocates, compared to smaller diameter polyethylene and ceramic bearings. This makes it faster for a patient to return to unrestricted activity.

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