Surface Hippy is an International patient site created by patients to help patients. Want to get started? View Vicky's Message, read a Patient Story or View our Videos.

Doctors Articles
DR. SU SUMMARIZES THE 20TH Year Celebration of the BHR PDF Print E-mail

Hi Debbie, yes, it was wonderful to have the 20th year celebration of the BHR…

Here are some notes:

This was a gathering of experienced and enthusiastic hip resurfacing surgeons from mostly the US, but a couple of surgeons from Europe. It was nice to see that Smith and Nephew put forth the resources to get us together. Since it was a S&N meeting, the results and emphasis were on the Birmingham Hip Resurfacing, the first of which was performed in 1997!

The first section was an update of resurfacing from around the world: US, Europe, Australia, Canada. Starting with the UK, Andrew Manktelow summarized some of the results in the UK registry and other studies. Some of the results showed 97% survival of the BHR from revision, at 10 years, and about 95% at 15 years. Unfortunately, the negative press has taken its toll in the UK, and few surgeons are still performing it, and those who are, are very selective with their criteria. He said that he personally is resurfacing only male patients with large bones, and avoiding it in patients who have AVN or dysplasia.

Next, I did an update of the US experience, using data from our 10 year FDA study. In a multi center study with 359 hips (254 male, 75 females), there have been 19 revisions. The reasons for revision include: femoral neck fracture, implant loosening, and metal related problems, both metallosis and hypersensitivity. The survival curve for the BHR in the entire group of patients was 94% at 10 years, and was higher in male patients (96%) vs. females (87%), For the patients who still have their BHR, activity levels are high, and clinical score parameters are great.

Next, in Canada, Dr. Schemitsch looked at some of the data. 97.4% of resurfacing male patients still had their hip in place. He stated that in Canada, since the healthcare is regulated, very few surgeons performed resurfacing in women, so they were very selective in the beginning and remain selective.

Finally in this section, Antonio Moroni discussed the italian experience with resurfacing. He stated that very few surgeons in Italy perform resurfacing, because of the negative attention from the media. He attributed his excellent results with resurfacing to careful selection, and using a good implant.

Next, I gave the keynote speech for the course, and I titled my talk: BHR 20/20: 20 years of history, and perhaps 20 years forward? I spoke about the history of resurfacing and how we have learned from some mistakes in the last 20 years. In particular, that the implant specifics must be carefully examined, so as to avoid the ASR debacle. Also, the importance of surgical positioning, in order to create a good fluid-film for lubrication. I shared some of Derek McMinn’s 20 year results, since he has had the longest experience with resurfacing. His results show about 97% survival of the BHR in all patients at 20 years, slightly better in men (98%) than women(95%).

The major benefit I believe to patients, besides bone preservation, is the higher activity level. I described the BHR as the first artificial joint to have professional athletes who have returned to sport: the NHL with Ed Jovanovski, MLB with Colby Lewis, and NBA with Tiago Splitter. I then also showed the activity level possible with professional wrestling (the Undertaker), and showed some video. Smith and Nephew made me read a disclaimer that said that this level of activity was not representative of all patents, and they could not condone this level of activity for patients!

I also showed video of my patient, an olympic fencer, who won the gold medal in 2016 with a hip resurfacing. So very compelling evidence that hip resurfacing patients are much more active than THR patients! A participant from the audience asked whether Bo Jackson could have had a more successful return to sports if he had had a BHR vs. a THR. Yes, I definitely think so….

The next section of the course focused on some of the differences between THA and resurfacing. Dr. Schemitsch spoke about the scientific literature, and how there really isn’t compelling data for either side. But some of the scientific information suggests resurfacing is better in terms of a normal gait, as compared to THR. Specifically, walking uphill and stride length were more normal for the resurfacing patients.

Dr. Brooks, my co-chairman of the course, next gave a lecture on a possibility difference between mortality in resurfacing vs. THR patients. This is a controversial topic that was first described by Derek McMinn in 2012. He used the UK joint registry and compared the 5-10 year mortality rates of patients who had a resurfacing vs. an uncemented THR, or a hybrid (partially cemented THR). He used complex statistical analysis to adjust for factors such as age and co-morbidities, trying to limit the comparison to resurfacing vs. THR. He found that the post-surgical mortality of resurfacing patients was significantly lower than that of THR patients. At 6 years, BHR patients had a 4.4% greater chance of still being alive as compared to a THR patient.

The theory is that it might have something to do with the emboli from bone debris, when instrumenting the femoral canal with a total hip. Another possibility is that the activity level of resurfacing patients is ultimately higher, which increases their longevity. Others believe that there is some confounding variable that couldn’t be corrected for with the statistics.

However, Dr. Brooks showed another paper from Oxford that was written by statisticians, that also showed the same results (of course, using the same data set from the UK registry). He states that emerging data from Australia also seems to support this claim. He is trying to show the same findings from his data in the US, but he doesn’t have the complete information to be able to control for some of the variables as in the UK studies.

Next, we had several lectures on how resurfacings may fail…the top 3 reasons are femoral neck fracture (early on, within 3-4 months of surgery, usually); implant loosening, or femoral head collapse, and metal related issues. We talked about monitoring techniques, such as using metal ion information, MRI, ultrasound, and X-rays. I finished with a series of cases to ask my panel of expert surgeons, and we had a lively discussion with the participating surgeon attendees.

The final session was talking about possible future bearing materials. We give a few teasers about the next generation resurfacing implants, which might be using highly cross-linked polyethylene, or using oxinium on oxinium. It is a difficult decision whether a new implant is even necessary or not, given the outstanding 20 year results of the BHR…however, because the smaller sizes have been taken off the market, we concluded that it IS necessary in order to bring resurfacing back as a possibility for women and smaller sized men.

Tribute to the late Vicky Marlow PDF Print E-mail

This lecture titled   “BHR and Other Options” has been released by Derek McMinn as a tribute to Vicky Marlow, owner and founder of this site who was a fantastic voice and advocate for hip resurfacing. Vicky worked tirelessly with hundreds of patients about the benefits of hip resurfacing. With her support and guidance we have been able to get back to our active lives.  We miss you Vicky and will be forever grateful for your unending support.

Acetabular Revision in Hip Resurfacing PDF Print E-mail

Thomas gross MD 1/9/2015

THR= total hip replacement

HRA= hip resurfacing arthroplasty

If an HRA has failed, I try to solve the problem by revising only the acetabular component whenever possible because HRA are functionally better than THR. If only the acetabular component is revised, the patient still has a HRA. If the femoral component is revised, the patient now has a THA.

Currently revising only the acetabular component with a metal/metal (M/M) articulation is only possible with the Biomet Magnum and SNR Birmingham implants. All others have been withdrawn from the market. Wright Conserve can still be revised in this way outside the US, because these perfectly good implants were only withdrawn from the hyper-litigious US market. The failed Depuy ASR and Zimmer Durom can be revised with a custom polyethylene (PE) bearing acetabular component. The only surgeon I know of who has access to these implants is Dr. Pritchett in Seattle. But I am not sure that a PE bearing HRA is better than a THR.


Dr. John S. Rogerson September 2014

Metal-on-metal (MoM), ceramic-on-ceramic (CoC), and ceramicized metal-on-polyethylene (CMoP) bearings all were developed as a reaction to the well recognized mediocre long-term results with metal-on-polyethylene hips in younger, more active patients.

Polyethylene wear increases with increased activity and load, and often elicits an aggressive response from the body where loosening and bone loss occurs (osteolysis), making subsequent revision more difficult.

 Dr. John S. Rogerson, MD April 2015

We have received a number of inquiries in our office regarding the merits of cemented versus non-cemented femoral head components in hip resurfacing arthroplasty.

Bear in mind that my experience with hip resurfacing to date has essentially been associated with the Smith and Nephew Birmingham hip resurfacing system as designed by Drs. McMinn and Treacy.

Addressing the Negative Press PDF Print E-mail

Updated Sepetember 6, 2011

There have been some recent articles in the press that have expressed some concern over Metal on metal and hip resurfacing in general.  To someone just reading up on the procedure, these articles can be very misleading.  Please keep in mind that the articles are written by a journalist (mainly Barry Meier) that wants to "sell" stories and not necessarily pass on good solid objective information.  The above mentioned journalist likes to write HALF truths.  I know for a FACT because he had called me personally and interviewed me for over an hour on the phone.  He asked me for the names of two patients who had hip resurfacing, one success story that was a female and one femoral neck fracture that was a female.  I gave him the names of Kathy the neck fracture and Melissa a gal who had her BHR for over 12 years and was extremely happy with her results.  Barry Meier NEVER even bothered to contact Melissa, the success story.  He ONLY chose to print the negative side of things in his first article that had within the title Women Red Flags about hip resurfacing. 

I am sure you have read some of his work, he has come out with so many HALF truth articles since that first one, either warning women not to get the procedure, or overly emphasizing the VERY small percentage risk of neck fracture without talking about the causes or talking about the excess metal wear without mentioning that the main cause for this is due to surgeon malpositioning of the component.  He fails to mention that the very first pseuodo tumor was found in a patient who had a POLY Total Hip Replacement device, not even a metal on metal device. 

 Also a lot about metal ions, using scare tactics and only quoting the one Oxford study that produced horrible results and a lot of Pseudo Tumors instead of mentioning the details behind that study including the fact that a lot of the surgeons in the study were only trainees and the fact that the components were placed at such ridiculous angles that anything installed that poorly would surely produce negative outcomes.  The ideal cup angle placement should be about 40 degrees and this Oxford study produced cup angles ranging from 10.1 degrees upwards to 80.6 degrees which is astounding and unacceptable. 

The Press fails to mention the real important facts behind their claims.  IMO, and this is just that, my non-medical personal opinion, these articles are extremely biased, misleading and leave out way too many facts.  They are extremely one sided, written in a way to scare people off from an incredible procedure that if done correctly gives patients back our lives.  I sincerely hope that the author of some of these articles never has a hip problem or ever has a close family member, like his wife or sister or in the future his own daughter in need of hip surgery.

This procedure is amazing and I for one am an extremely happy patient that happens to be a female with mild dysplasia and extreme allergy to metal earrings and I am small boned.  My left BHR hip resurfacing is still going strong at close to 6 years post op (December 1, 2005).  It worked so well in my left hip, that I went back on December 6, 2010 to get my right hip done, so I am 9 months post op today from my right BHR hip.  My BHR's literally gave me back my life, a full active life.  I have just started doing the P90X workout and could not imagine doing something that aggressive had I had a THR.

Potential patients researching their options should do their own research and discuss their options with Orthopedic surgeons that do BOTH procedures.  Doctors that have done at a minimum several hundred, preferably at least 500 resurfacings by now, since FDA approval was over 4 years ago.   Do not believe all that you read in the press.  Keep in mind that all Hip Resurfacing surgeons also perform Total Hip Replacement's but most Total Hip Replacement surgeons do NOT perform hip resurfacing. 

Here you will find what some prominent Orthopedic surgeons say to address this negative press....and HERE , as Paul Harvey would the REST OF THE STORY

Below are video interviews with six world renowned Hip Surgeons.  Between the six of them, in May of 2010, they had performed more than 27,000 total hip surgeries and over 13,000 Hip Resurfacings, so by now, those numbers have gone way up.  The first one is with Derek McMinn, the inventor of the BHR device and is in three parts. 

Dr. Su responds to the recent Lancet article PDF Print E-mail
Press Room

October 2012

Dr. Su responds to the recent Lancet article

I would like to take this opportunity to comment on the Lancet article, “Failure rates of metal-on-metal hip resurfacings: analysis of data from the National Joint Registry for England and Wales”, by Professor AW Blom, published on October 2, 2012.

First of all, this is an observational scientific study with valid research design and questions; however, the conclusions point out the limitations of registry studies (more on this to follow).  Overall the conclusions of the study do NOT find any new information that has not already been known since 2010:  that certain hip resurfacing implants perform better than others; that females do worse than males with hip resurfacing; and that larger size implants have a lower revision rate.  These key pieces of information have been well-known and discussed by experienced hip resurfacing surgeons with their patients for at least 2 years already.  Furthermore, there are scientific congresses and courses that have help spread this information to surgeons, including the course that I chaired in May 2010.

Dr. Gross response to the Lancet article PDF Print E-mail

Thomas P. Gross, MD

To download this article in PDF format, click here .

13 years experience. Over 3000 cases.

For more information:

A recent Article in the Lancet medical journal has criticized hip resurfacing arthroplasty (HRA) as less durable than cemented 28mm total hip replacement (THR). I take exception to the inappropriate conclusion that the authors drew from this highly flawed study.

How safe are metal-on-metal hip implants? Derek McMinn Responds PDF Print E-mail

April 16, 2012

Dear Dr Carome

We read with interest the comments attributed to you by Deborah Cohen in her piece1 in the British Medical Journal on the 28th of February 2012, that “this is one very large uncontrolled experiment exposing millions of patients to an unknown risk.” These comments are being quoted as first principles by the newspapers and law firms around the world. The comments have been widely reported in the lay press and have caused massive patient alarm and helped bring the profession of orthopaedic surgery, the regulatory bodies, the medical device industry and the operation of hip replacement into disrepute.

The earliest successful total hip replacements (THRs) which were introduced into clinical usage by McKee in 19602 were made of cobalt-chrome metal-on-metal bearings. It was only a few years later in 1962 that Sir John Charnley started using metal on ultrahigh molecular weight polyethylene bearings in what are today termed conventional total hip replacements.

The Swedish National Hip Arthroplasty Register in its report in 20003 noted that in young patients (men and women under the age of for 55 years with osteoarthritis) the performance of conventional hip replacements was dismal with a 19% implant failure rate at 10 years and a 67% failure rate at 16 years. In contrast the performance of conventional total hip replacements in older patients is very satisfactory. There was therefore a need to develop more robust implant types for use in younger more active patients. We have been involved in that development and one of us is the co-designer of the Birmingham Hip Resurfacing (BHR).

Derek McMinn's Response to new MHRA Guidelines on MoM THR's PDF Print E-mail
Wednesday 29th February 2012

Response to new MHRA Guidelines on MoM Total Hip Replacements

There have been several press reports regarding the new MHRA (Medicines and Healthcare products Regulatory Agency) guidelines on metal-on-metal (MoM) hip replacements. We have had a number of enquiries from concerned patients. We have also been receiving calls and emails from patients who have enjoyed excellent quality of life following their BHRs - in some cases, performed over 10 years ago. These patients are understandably very angry that BBC Newsnight, amongst others, has produced such a biased, one-sided story leaving hundreds of people unnecessarily "terrified of poisoning, cancer, yearly blood tests and possible surgery to remove the metal hip," as one of our patients puts it.

Derek McMinn addresses the 4Corners Dispatches program PDF Print E-mail

May 16, 2011

The Dispatches program 'Going Under the Knife' aired on the 16th of May 2011 and 'The One Show' program aired on the 24th of May 2011 raise two or three important questions.

TV Programs 'Dispatches' and 'The One Show' highlighted failures with ASR resurfacings. Do these apply to the BHR as well?

These TV programs did a good job of bringing to attention the sad saga of failures with the ASR hip. Although the experience of only one Centre was highlighted, this experience with ASR failures is widespread. What the programs did not show was the experience of the same Centre with Birmingham Hip Resurfacings (BHR). Their data in the figure below clearly shows that wear‐related failures with the BHR are extremely low (1.3%) and that failures are highly implant specific. BHR is now being used in their Centre again.