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(608) 231-3410
2 Science Court, Suite 101
Madison, Wisconsin 53711

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Birmingham Hip Resurfacing

OrthoTeam Clinic is no longer accepting new BHR patients. 

99.5% of patients responded they were “Pleased” or “Extremely pleased” with their Birmingham Hip Resurfacing surgery in a 1,626-hip study.

Compared to traditional total hip replacements, Birmingham Hip Resurfacing can have you home and on your feet in as little as one week. The implant is more stable and longer-lasting, and it can allow for more strenuous physical activity.

What is BHR and how does it benefit me?

The Hip Resurfacing Implant

The Birmingham Hip Resurfacing implant is not brand new. It has been in use around the world since 1997 and has since been implanted more than 125,000 times. It was approved by the FDA for use in the United States in 2006. Although hip resurfacing is not a new concept, the technology behind the ground-breaking Birmingham Hip was developed by British orthopedic surgeons Mr. Derek McMinn and Mr. Ronan Treacy. The two surgeons now train orthopedists from around the globe on behalf of London-based medical device manufacturer Smith & Nephew. US surgeons given access to this implant may travel to England for specialized training or may train at one of the few US centers capable of hosting these focused sessions.

Hip Resurfacing Procedure

Until just recently, your orthopedist would likely be recommending total hip replacement surgery at this point of your disease state. While it is clearly a more bone-sacrificing procedure than hip resurfacing, total hip replacement is a safe and effective surgery, and is performed more than 300,000 times per year in the United States. As you may know, total hip replacement requires the removal of the femoral head and the insertion of a hip stem down the shaft of the femur. Hip resurfacing, on the other hand, preserves the femoral head and the femoral neck. During the hip resurfacing procedure, Dr. Rogerson will only remove a few millimeters of bone around the femoral head, shaping it to fit tightly inside the Birmingham Hip Resurfacing implant. Your surgeon will prepare the acetabulum for the metal cup that will form the socket portion of the ball-and-socket joint. While the resurfacing component slides over the top of the femoral head like a tooth cap, the acetabular component is pressed into place much like a total hip replacement component would be.

If you would like to talk to someone and discuss this life changing surgery more, please give us a call, (608) 231-3410.

Learn why Dr. Rogerson endorses BHR

The benefits to patients of the Birmingham Hip Resurfacing technique and implant are clear. The implant’s head size, its bearing surfaces, and its bone-sparing technique make it a preferred choice for young, active male patients. While the implant’s rate of survivorship is comparable to standard total hip replacements after five years, these three key advantages set the resurfacing technique and implant apart from its total hip replacement counterparts.

The most noticeable aspect of this implant is its size. While it closely matches the size of your natural femoral head, it is substantially larger than the femoral head of a total hip replacement. This increased size translates to greater stability in your new joint, and it decreases the chance of dislocation of your implant after surgery. Dislocation is a leading cause of implant failure in total hip replacement. While total hip implants dislocate at a rate of one to three-percent over the lifetime of the implant, a study of 2,385 Birmingham Hip Resurfacing patients found that dislocation occurred in only 0.3 percent of cases five years after surgery.

Birmingham Hip Resurfacing takes advantage of one of the orthopedic medical industry’s most technologically advanced bearing surfaces. That means that the surfaces of the ball and the socket are made from materials that dramatically reduce joint wear when compared to traditional hip implant materials. In this case, both the ball and socket are made from tough, smooth cobalt chrome metal. Traditionally, only the ball is made from cobalt chrome, and the socket is lined with a plastic cup. While this plastic cup has some design advantages, it does wear out over the course of many years since it rubs against the metal ball at a rate of nearly two million footsteps per year in physically active adults. The plastic particles released into the area around the joint as a result of this plastic wear can lead to a condition called osteolysis, which causes the bone around the implant to soften, become unstable, and ultimately a corrective surgery and new implant are required. However, when both surfaces of a hip implant are made from cobalt chrome, wear particles are reduced by 97 percent, thus potentially extending the life of the implant. There may be risks associated with metal-on-metal hip implants, though. While no evidence has been established on the subject, some are concerned that the increased level of metal ions found in the blood of metal-on-metal hip recipients may have negative effects on the human body. For this reason, some surgeons may not implant such a device in a patient with kidney disease (since healthy kidneys filter ions from your body).

Perhaps the greatest benefit of the Birmingham Hip Resurfacing implant is the fact that it conserves substantially more bone than a total hip replacement. This is important for two key reasons. First, unlike a total hip replacement, the Birmingham Hip Resurfacing preserves your natural femoral neck. It is this neck length and angle that determines the natural length of your leg, and since it is not removed and replaced with an artificial device during a resurfacing procedure, concerns regarding leg length discrepancy are virtually non-existent. Second, if your surgeon should determine you need to have your Birmingham Hip implant replaced at some point in the future, you may undergo a regular total hip replacement surgery. If you had originally undergone total hip replacement instead of hip resurfacing, you would be dealing with a more traumatic and complex procedure and you would be receiving a more invasive implant.



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BHR Post-Op Patient Slideshow

Scroll through to see what our BHR patients have been up to now that they are pain free…

Is Hip Resurfacing right for you?

OrthoTeam Clinic is no longer accepting new BHR patients. 

Who is a Candidate for Hip Resurfacing?

Hip resurfacing is intended for young, active males who are under 60 years of age and in need of a hip replacement. Males over 60 who are living non-sedentary lifestyles may also be considered for this procedure. However, this can only be further determined by a review of your bone quality. There are certain causes of hip arthritis that result in extreme deformity of either the head of the femur or the hip socket. These cases are usually not candidates for hip resurfacing.

As of June 3rd, 2015, Smith and Nephew (the manufacturer of the BHR prosthesis) has declared that the BHR is now contraindicated for all female patients. For more information, visit the McMinn Centre website.

Non-Surgical Alternatives to Hip Resurfacing

Before deciding on hip resurfacing, your physician may try several non-surgical, conservative measures to relieve the pain and inflammation in your hip. Explore some of your options below:

Lifestyle Modification
The first alternative to hip resurfacing or replacement involves such lifestyle modification measures as weight loss, avoiding activities involving long periods of standing or walking, and the use of a cane to decrease the stress on the painful hip. Following an anti-inflammatory diet, in particular decreasing your wheat intake can also drastically improve your body’s overall inflammation.
Anti-inflammatory Medications
Arthritis pain is primarily caused by inflammation in the hip joint. Reducing the inflammation of the tissue in the hip can provide temporary relief from pain and may delay surgery. Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) may be prescribed to decrease the inflammation associated with arthritis. A classification of NSAIDs, called Cox-2 inhibitors, are often very effective in decreasing pain. Curcumin (found inside the spice Turmeric) is a potent anti-inflammatory agent, as well as the herbs rosemary, lavender, lemon balm, and salvia.
Exercise and Physical Therapy
Exercise and physical therapy may be prescribed to improve the strength and flexibility of your hip and other lower extremity muscles. Your exercise program may include riding a stationary bike, light weight training and flexibility exercises. An aquatic therapy program is especially effective for the treatment of arthritis since it allows mild resistance while removing weight bearing stresses. For an appropriate exercise program, contact an experienced physical therapist.
Two dietary supplements, Glucosamine and Chondroitin sulfate (commonly available in a combined tablet), may decrease the symptoms of hip arthritis. Glucosamine and Chondroitin sulfate are both naturally occurring molecules, and issues associated with both remain under active research.

A personal message from Dr. Rogerson

Reasons to Choose Birmingham Hip Resurfacing

When I realized that I had hip arthritis a number of years ago and would be facing hip replacement surgery in the future, I began to search for alternatives to our traditional metal on plastic arthroplasty. Like many baby boomers, I desire to remain very active and would like to continue to play tennis into a “ripe old age”. Unfortunately, once a traditional hip replacement is performed, high impact activities are restricted because of increased polyethylene (plastic) wear and early loosening of the prosthesis. Other advancements such as ceramic bearings, highly cross-linked poly, Oxonium heads, and even large metal on metal heads with a stem still didn’t solve this dilemma because of the stress shielding of the femoral shaft and weakening of the bone over time making future revision of the replacement more difficult.

When I became aware of metal on metal hip resurfacing, I was enthused because I felt that this was the only prosthesis that could potentially allow a level of even high impact activities and not “burn any bridges”.

Doctor’s Message

My major initial concern was the increased metal ion levels in the blood compared to traditional metal on plastic replacements. After several years of cautious observation and review of the literature on this issue, I ultimately decided that these concerns were not significant as long as the components were positioned correctly, and I would ultimately opt for hip resurfacing. At about that time, one of my tennis acquaintances asked if I thought metal on metal resurfacing was a viable option. He was happy to hear my enthusiastic response since he was scheduled to head to Belgium for the procedure. I saw him five weeks later after bilateral hip resurfacings walking without aids with a smooth gait and realized there was something very different about this prosthesis. As other patients gained knowledge of this procedure, I began to refer many of them to Dr. De Smet in Belgium and then monitored their recovery. After following more than 50-60 “surface hippies” who returned to the U.S., I felt that the results were nothing short of miraculous.

Over subsequent years I traveled to numerous meetings, received training in the U.S., England and Belgium and studied and compared the resurfacing prostheses available globally at that time. The original concept and development of the metal on metal resurfacing prosthesis was introduced by Drs. McMinn and Treacy in Birmingham, England and there have been a number of modifications and refinements since its inception. The type of metal utilized, the tolerances between the surfaces, how the porous coating is applied to the acetabular (socket) component and the cementing thickness and technique on the femoral component are critical to its success. The Birmingham prosthesis utilizes a metal that has been successfully implanted for greater than 40 years in Europe in the original Ring stemmed prosthesis and retrievals have shown remarkably little wear or bony reaction. There have been more than 120,000 implanted worldwide and greater than 16 years of well documented clinical experience with what appears to be the most successful performance among the various prostheses globally.

“There have been more than 120,000 [BHR prosthesis] implanted worldwide and greater than 16 years of well documented clinical experience with what appears to be the most successful performance among the various prostheses globally.”

This is one reason I felt comfortable testifying for it along with Drs. McMinn and Rorabeck in Washington, D.C. in September of 2005 at the FDA panel review where it was ultimately approved for use in the United States.

Other companies have subsequently introduced their own resurfacing prostheses. The Wright Medical Conserve Plus had a reasonable design, but the metal was heat treated and the instrumentation not precise, so that is not an appealing option for me. DePuy and Zimmer introduced different designs with different metal formulations and tolerances and did not attain FDA approval. They subsequently were recalled off the market after performing poorly. The Stryker Corin prosthesis had a different metal coating treatment and has not flourished, and the Biomet prosthesis has yet to attain FDA approval.

I started implanting the BHR in 2006 and have now performed over 800 hip resurfacing procedures and have been extremely happy with the results in young, active patients with severe arthritis. They have routinely been able to resume unlimited activity of all types with a 98.6% success rate. We recently reported our results to the FDA and they compared favorably with Dr. McMinn and Treacy’s experience.

In summary, I was pleased that the Birmingham hip resurfacing was the first hip resurfacing prosthesis to win FDA approval because it is, I feel, the best design, metal and instrumentation with the longest and largest track record globally on the market. I am equally happy to have been chosen as one of the first forty orthopedists in the U.S. to be trained to implant it, and very pleased with our clinical results.

John S. Rogerson, M.D.
June 2015

Birmingham Hip Resurfacing – Take the Next Step

Are you a female?

As of June 3rd, 2015, Smith and Nephew (the manufacturer of the BHR prosthesis) has declared that the BHR is now contraindicated for all female patients. For more information, visit the McMinn Centre website.


Where to start?

After reading about Birmingham hip resurfacing, you may be interested to learn whether or not you are a good candidate for the procedure. Please take a moment to answer the following questions:

  Do I have a metal allergy?

  Do I have insulin dependent diabetes?

  Do I have rheumatoid arthritis that is poorly controlled or that requires prednisone medication to treat?

  Do I have lupus?

  Do I have chronic kidney failure?

  Do I have other immuno-compromising diseases such as amyloidosis?

If you answered “yes” to one or more of the above questions, you are not a good candidate for hip resurfacing.

Do you think you are a good BHR candidate?

For confirmation that you are a good BHR resurfacing candidate, please download and fill out the following two forms:

Send these forms along with plain films or digital x-rays (standing AP pelvis, and cross table lateral or frog lateral) to Dr. Rogerson for your free BHR analysis.

*Important! Outside digital films must have a marker placed by the x-ray technician in order for Dr. Rogerson to properly assess the size of your bones and determine if BHR is right for you. Please request that a marker is utilized!

John S. Rogerson, M.D.
Attn: BHR analysis
2 Science Ct.
Madison, WI. 53711

You should expect to hear from our office about whether or not you are a BHR candidate within one week of receiving your materials for review. Additional testing may be required to determine if you are an appropriate BHR candidate. If you have not heard from our office after 2 weeks of sending your materials please call to make sure we received everything. (608) 231-3410.