The early outcome of Birmingham hip resurfacing: an independent Thai surgeon experiences

Abstract

Background: Modern metal-on-metal total hip resurfacing show improvement outcome as a viable alternative arthroplasty in the young, but in Thailand it remains controversial whether this procedure is appropriate by Thai surgeon. Some in doubt this procedure may need high technical demand and may not valuable in Thailand.

Objective: To analyze the early clinical and radiographic outcomes of Birmingham Hip Resurfacing (BHR) by Thai surgeon in Thailand.

Material and method: Between January 2006 and December 2008, thirty-eight patients (forty hips) who were operated with BHR by same surgeon. The authors evaluated Harris Hip score, Oxford hip score, University of California Los Angeles (UCLA) activity score, Short form-12 score, and complications as well as radiographic alignment and radiolucencies.

Results: At a mean follow up of 16.2 months (3 to 33). The mean pre-operative and last follow up Harris Hip score were 35.1 (27 to 41) and 96.4 (95 to 98) (p < 0.001) respectively. The mean Oxford hip score were 44.3 (37 to 52) and 12.4 (11 to 13) (p < 0.001) respectively. The mean UCLA activity score was 3.4 (3 to 4) and 8.8 (8 to 10) (p < 0.001) respectively. The mean SF12 were 18.2 (14 to 23) and 62.2 (59 to 64) (p < 0.001) respectively. There was no patient with radiological evidence of loosening or thinning of the femoral neck. Four cases had intra-operative transient blood pressure drop while impacting metal cup into circumference sealed acetabulum. However no subsequence post operative complication was detected. There was one case with pulmonary embolism in secondary osteonecrosis from sickle cell anemia and resolve without any complication. One case with fracture neck of femur due to osteochondroma removal at anterosuperior head neck junction which exposure too much cancellous bone. She had got successfully conversion to metal on metal total hip replacement with post operative excellent result. There was no infection, deep vein thrombosis and nerve injury. The survival rate was 97.5%.

Conclusion: As femoral head bone preservation procedure, BHR in this study provides excellent and promise result. Longer study is needed to address more complications. The authors are support the use of BHR in young active patient in Thailand.