Hip Resurfacing - Birmingham Hip Resurfacing (BHR)  Resurfacing or Surface Replacement Arthroplasty is a bone-conserving alternative to conventional Total Hip Replacement (THR). Unlike THR, hip Resurfacing does not involve the removal of the femoral head and neck nor removal of bone from the femur. Rather, the head, neck and femur bone is preserved in an effort to facilitate future surgery should it be necessary and to enable the patient to take advantage of newer technology or treatments in the future. The current generation of hip Resurfacing devices utilize a metal bearings have demonstrated a much higher level of wear resistance as well as reduced bone loss and inflammatory tissue reaction about the hip joint as compared to metal-polyethylene bearings. Derrek McMinn designed the Birmingham Hip Resurfacing in Birmingham, England and released it for use in the UK in 1997. Hip Resurfacing - Doctors  Hip Resurfacing is anatomically and biomechanically more similar to the natural hip joint resulting in increased stability, flexibility and range of motion. Further, dislocation risk is virtually eliminated. Higher activity levels are typically achieved with less risk. These benefits are realized because the head diameter that results from Resurfacing is very similar to the patient's normal head diameter and these larger head sizes are typically much larger than the femoral balls utilized in conventional Total Hip Replacement (THR). For your FREE personalized quote, register here Hip resurfacing allows younger, active people to return to any activities they enjoyed previous to their hip problems. The large size cap and cup of the BHR are the same size as a person's original femur bone and are designed to prevent dislocations. There are many athletes with resurfaced hips that continue to compete at the professional level in a myraid of activities. They include: - Cory Foulk finished a marathon three months after his surgery, and finished 11th in the Ultraman world championship eleven months later.
- Jim Roxburgh continues to participate in the martial arts after having both hips resurfaced in 2004.
- Ian MacLaren of the Torashin Karate Club is believed to be the first 5th dan Karate-ka in the world to have had both hips resurfaced.
- Floyd Landis, 2006 Tour de France Winner.
Video of Birmingham Hip Resurfacing (BHR) by Dr. Vijay C Bose Please note that this video shows graphical surgical content and designed for educational purposes How much money is needed for this procedure? Register here for free quote. Birmingham Hip Resurfacing Surgery - Patients Guide Prepared by Dr. Vijay C Bose and Team The anesthetist will be seeing you the day prior to the surgery, or earlier if required. Usually a general anesthetic is preferred for BHR due a variety of technical reasons. After the surgery, the patient will be in the recovery room for about 3 hours after which he will be shifted to the wards. Strict adherence of instructions regarding visitors is mandatory. Only one person who will be known as the primary attendant is allowed inside the patients room.
Should the patient have any other visitor, the primary attendant will come outside the room to speak to them. The patients family must actively discourage visitors for the first 3 post-op days. Only the patient is permitted to eat inside the room.
It is preferable to take only liquids on the day of surgery and progress to a normal diet the following morning. The medical team will give instructions on ankle pump exercises. A sterile towel is kept between the dressing and the bed sheet.
1st post-op day The intravenous fluids are discontinued if patient is taking orally. For the first 48 hours following any surgery; pain is common due to the cutting of tissues. For this pain powerful (narcotic analgesics eg. Tramadol is given). The patient can request the nurse for these injections. These medicines also cause slight dizziness. If the patient feels comfortable, he can start walking with a walker on the first post-op day. If dizzy due to medications, the walking is postponed to the next day. The patient has to do deep breathing exercises, Static quadriceps and gluteal contraction exercises. The last dose of narcotics are given for this night. 2nd post-op day Usually non-narcotic pain medication like inj. Diclofenac is given on the morning and blood sample taken for hemoglobin estimation. Drains are removed and the wound inspected. Last dose of antibiotic is given and the I/V cannula removed. All medications are changed to the oral formulations. Typically the following are given: - Iron & vit preparation
- chymerol forte
- oral painkillers like proxyvon and gastro protective agents like pantaprazole
Patient is also fitted with a pair of below knee Ted Stockings. Some patients will receive blood-thinning injections if indicated.
Patient walks with the help of a walker with the assistance of a physiotherapist for short distances. Patient goes to the x-ray dept for check x-rays. One can start lying on the un-operated side with a pillow in-between the thighs (not knees or legs). Day 3 Patient can walk for longer distances as comfortable. He can also start sitting in a chair with a pillow height. It is important to keep in mind that the capacity of recovery following surgery is very different among individuals. Therefore these milestones are only guidelines and variability is common. Patient continues the exercise programme in bed as per the instruction booklet. Day 4 Dressing are done again and sticker type dressing ( Curapor or Surgiwear) is done if there is no wound ooze. Patient can start to use the western type toilet and wear normal clothes that are comfortable like pyjamas, lungi, dhoti or baggy shorts. If the surgeon permits a shower is possible with a special (surgiwear swimproof) dressing applied for this purpose From this point on the mobilization programme is variable for each individual patient. In principle they progress to elbow crutches when the phsyio deems fit. Day 5 Once they can climb stairs with the help of elbow crutches, they are ready for discharge.
Usually the patient is fit to travel by car taking the front seat. The sitting is accomplished by first sitting on the car seat with the feet on the road and then lifting each leg individually into the car
Patient from abroad or those who need to take a flight back Plesae keep the following points in mind during the flight: - To carry a bottle of water to ensure adequate intake of fluids
- Compulsory wearing of TED stockings during the flight.
- Requesting an aisle seat and taking a few steps in the corridor every half hour
- To do the ankle pump exercises when seated
At home At home they walk with a pair of crutches usually for about 10-15 days and when completely comfortable discard the crutch on the side of the operation first. Then when the other crutch is also felt unnecessary, this is also discarded. Walking, climbing stairs or cycling can be done for long periods of time. Patient reports back to the hospital at about 12 days for removal of skin clips. Outstation patients can get this removed by a doctor locally. A letter to this regard will be given at the time of discharge. The next follow up visit is at 6 weeks when a check x-ray is repeated. Outstation patient can do this locally and post the x-ray to the doctor. A request for this is also given at the time of discharge. The subsequent compulsory visit to the doctor is at 6 months post-op. Post-op restrictions in Birmingham Hip Resurfacing There is no post-op restrictions after a Hip Resurfacing operation and the patient can use it as a normal hip. However the soft tissues around the hip joint, which were contracted at the time of the hip disease, will take time to relax following the excellent movement that has been restored in the hip. Hence if there is pain while attempting a certain activity like sitting on the floor, it implies the patient is not yet ready for that particular activity. One can give a gap of about a week and then try it again. Like wise the activity level improves in a stepwise manner till the soft tissues also become normal. Patient is ready for sports (inclusive of contact sport) at about 3 months post-op. How much money is needed for this procedure? Register here for free quote. Frequently Asked Questions Prepared by Dr. Kaushal Malhan and Team Is this a minimally invasive?
This operation can be done by a minimally invasive approach and the invasion can be kept to less than 10cms. The operation also involves minimal damage to bone. Do I need blood transfusion during the surgery?
We generally do not need blood transfusions during the operation. Is it a very painful operation?
Pain control techniques and minimal injury to soft tissue and bone during surgery help to keep the patients comfortable in the post operative period. When do we remove the stitches and is it very painful?
Absorbable sutures are used. These need not to be removed. How long do I have to stay in hospital?
Local patients are discharged four days after the operation, but overseas patients may have to stay for 8-10 days after surgery. When can I start walking and climbing stairs after the operation?
Most patients start walking with support on the second postoperative day after removal of the drain. Team of physiotherapist takes you through a standardized protocol of mobilization and stair climbing is achieved before discharge. Do I need lots of physiotherapy after surgery?
The amount of physiotherapy needed depends on the condition of your joint and muscles before the operation. Most patients do not need much suppressed physiotherapy. Will I be able to sit on the floor after surgery?
Yes, this surgery will allow you to do that safely unless another problem prevents it. What is the ASR/BHR?
Hip resurfacing or surface replacement arthroplasty uses specialized implants that are fixed into the bone. Two international companies sell such implants at present. 1) Smith and Nephew (MMT) (BHR) Birmingham Hip Resurfacing.
2) Johnson and Johnson (ASR) Articular Surface Replacement.  What is the advantage of Hip Resurfacing over conventional total hip replacement?
Conventional Total Hip Replacements usually consist of a long metal component that is fixed into the femur (thigh bone) articulating with a polyethylene cup cemented into the pelvis. Conventional hip replacements sacrifice a large quantity of normal bone. The very nature of fixation of these implants causes progressive bone loss due to stress shielding. The problem of bone loss gets compounded by osteolysis due to polyethylene debris from the cup. All these reduce the bone stock and make any future revision procedures difficult. The polyethylene cups gradually thin down due to wear and need replacing. The head of the femoral component is small in diameter, so as to reduce friction at the cost of stability. This increases the risk of hip dislocation i.e. hip coming out of joint Click here for price of this procedure. Free quote. Problems with Conventional Total Hip Replacement Bone loss Increased risk of dislocation Cannot squat or sit on the floor without the risk of dislocating the hip Range of movement is less Cannot safely indulge in sporting activities Revision Surgery difficult Feels less like a normal natural hip Possibility of change in leg length after surgery Are there any implants used?
Modern techniques allow us to replace the diseased human hip with artificial implants which ensure near normal movements and function. Huge advances have been made in terms of the materials, the method of fixation and structure of these implants. The purpose of all these changes is to increase the longevity, reduce complication rate and improved function after surgery. Hip Resurfacing (bone conserving hip replacement (BHR), surface replacement ) with a metal-on-metal articulation is another step in this direction
Sources: Wockhardt Hospitals, Smith and Nephew and Johnson and Johnson
McMinn D, Treacy R, Lin K, Pynsent PB. Metal on metal surface replacement of the hip: experience of the McMinn prosthesis. Clin Orthop, 329 (Suppl), 89-98, 1996.
Daniel J, Pynsent P.B, McMinn. D.J.W. Metal-on Metal resurfacing of the hip in patients under the age of 55 years with osteoarthritis. J Bone Joint Surg, Vol. 86-B, 2004. Doctors For your free personalized package details, click here. Implant Makers - Smith & Nephew Orthopaedics is a global provider of leading-edge joint replacement systems for knees, hips and shoulders; trauma products to help repair broken bones and a range of other medical devices to help alleviate pain in joints and promote healing.
About Smith & Nephew Orthopaedics BIRMINGHAM HIP Resurfacing implant - Smith & Nephew Orthopaedics BIRMINGHAM HIP Resurfacing FAQ
- Wright Medical Technology makes CONSERVE family of Hip Products. Wright's goal in designing the CONSERVE Family of Implants, which work to provide a bone conserving, minimally invasive approach to hip resurfacing and hip replacement.
- Corin Group is invloved in development, manufacture and distribution of a wide range of reconstructive orthopaedic devices. Products include hip resurfacing, total hip replacement, unicondylar knee replacement, mobile bearing total knee replacement, ankle replacement, shoulder replacement, ligament reconstruction and augmentation, spinal reconstruction, trauma products, and theatre disposables. Latest generation surgical instruments, together with minimally invasive systems and surgical navigation support this wide range of orthopaedic implants.
Optimom Large Diameter Metal-on-Metal Total Hip Replacement System
A new approach to stemmed total hip arthroplasty for patients in whom the condition of the femoral head or neck does not allow resurfacing, Corin has developed Optimom, a metal-on-metal stemmed large diameter total hip replacement. Optimom combines the benefits of large diameter metal-on-metal resurfacing arthroplasty with those of a stemmed femoral prosthesis that does not depend on the bone quality of the femoral neck. 
Optimom represents a significant advance in hip replacement for the active patient, as well as providing improved stability for revision and DDH patients at risk of dislocation. Modular Optimom heads may be used with any Corin approved stem, providing a large diameter total hip replacement system with all the advantages of a metal-on-metal bearing surface and a large diameter articulation. Optimom Large Diameter Metal-on-Metal Total Hip Replacement System A new approach to stemmed total hip arthroplasty for patients in whom the condition of the femoral head or neck does not allow resurfacing, Corin has developed Optimom, a metal-on-metal stemmed large diameter total hip replacement. Optimom combines the benefits of large diameter metal-on-metal resurfacing arthroplasty with those of a stemmed femoral prosthesis that does not depend on the bone quality of the femoral neck.
Optimom represents a significant advance in hip replacement for the active patient, as well as providing improved stability for revision and DDH patients at risk of dislocation. Modular Optimom heads may be used with any Corin approved stem, providing a large diameter total hip replacement system with all the advantages of a metal-on-metal bearing surface and a large diameter articulation.
Stem Options
Optimom is available with a range of Corin and approved other hip stems for optimum flexibility and implant choice.
- Johnson and Johnson's DEPUY ASR Articular Surface Replacement.
The DEPUY ASR System brings together advanced hip bearing technology with a bone and soft tissue preserving surgical approach. Its rationale is to provide surgeons with an advanced resurfacing hip system with dramatically lower wear properties which can be introduced through a conventional or minimal incision. Both approaches may be used with Intelligent Surgery giving a new level of precision. For patients it's the more natural bone conserving solution for early intervention. - Biomet has ReCap Femoral Resurfacing Head , which is a metal (cobalt chromium) cap that resurfaces the head of the femur. This conservative procedure makes the technique less invasive than traditional hip replacement surgery. The ReCap Head may require a smaller incision and less bone removal, which can allow you to recover more quickly and with less pain. The implant can also help prolong or avoid the need for future total hip replacement. However, if you should need total hip replacement in the future, the ReCap Head allows your surgeon the ability to perform the procedure with a less-invasive approach.
- Zimmer UK's Durom - Hip Resurfacing.
Precision Swiss manufacturing combined with advanced design based on years of clinical experience have resulted in the Durom Hip Resurfacing which represents a substantial step forward in the field of hip resurfacing.
The principle design features are based around optimising the durability of both the bearing and the component fixation, combined with providing excellent range of motion. - Finsbury's ADEPT Resurfacing Hip.
Finsbury Orthopaedics has set the standards in metal-on-metal design and manufacturing technology since the early 1990s. The ADEPT Hip System is the accumulation of our experience and includes both resurfacing and total hip options.
Unique flexibility of sizing is provided with 2mm increments on the head which allows for 2 cup sizes for every head and 2 head sizes for every cup. Not only is this feature bone conserving, but it also assists with optimising the range of motion.
The critical features of the ADEPT system and technical rationale are based entirely on clinical history rather than short-term mechanical studies. The ADEPT metal-on-metal resurfacing system follows well established clinical history and has evolved from the Ring hip and Birmingham Hip Replacement.
The parallel stem inside the resurfacing head prevents cement migration into the femoral neck during impaction. The tapered section outside the head avoids intimate bone contact within the neck which reduces the risk of load transfer and stress shielding. For your FREE personalized quote, register here Glossary Arthroscopy
The use of a telescopic viewing device inserted into a joint via a small incision together with specialised surgical tools, enabling the surgeon to see inside of the joint on a television screen and identify and repair the defect. Also known as orthopaedic endoscopy.
Articular cartilage
Smooth cartilage which protects the inside of the joint.
Clearance
Clearance is the term used to describe the effective gap between the femoral head and acetabular cup in a Metal-on-Metal bearing. It is calculated by subtracting the radius of the femoral head from the radius of the acetabular cup. This difference in radii is used to describe the gap at the equatorial position on the bearing when the femoral head is in contact with the acetabular cup in a polar orientation. Polar bearings operate with a large apparent contact surface area. However the real contact surface area is very small. It is at this point where the articular surfaces interact creating friction and wear.
What is Optimal Clearance?
As well as a value of the difference between head and cup radii, clearance can be expressed as a ratio to head diameter. There is an optimal clearance associated with each head diameter. Although low clearances work well in laboratory conditions, there may be an issue in the clinical environment. Factors such as bone density, implant position and post surgery may all effect the ability of the bearing to generate a fluid film. With low clearances, there is reduced tolerance for correct function in less than perfect implantation or patient conditions. As a Metal-on-Metal bearing is not in continuous motion, it operates in a mixed lubrication regime and its longevity is linked to its ability to generate and sustain a fluid film. Laboratory evidence confirms the BHR generates fluid film lubrication. Small clearances increase friction and may cause micro motion in the cup. This may hamper bony ingrowth resulting in impaired fixation.
The Stribeck Curve is a graphical representation of the measured frictional forces occurring in a bearing. From the shape of the curve, deductions can be made concerning the lubrication operating conditions of the bearing. Results of friction testing of the BHR are shown below in Graph A. The friction tests suggest boundary lubrication pre-testing but at 1 million cycles, a mixed lubrication regime was evident. By 2 million cycles, the classical Stribeck curve had formed indicating a considerable contribution from fluid film, which continued to be evident at 3 millioncycles.
Endoscopy
The use of a telescopic viewing device inserted into a body cavity via a small incision together with specialised surgical tools, enabling the surgeon to see the inside of the body cavity on a television screen and identify and repair the defect.
External fracture fixation
Restoring of fractured limbs to the most anatomically correct alignment through use of constructs or frames which are attached externally to the body.
Hip Arthritis
Arthritis of the hip is a disease which wears away the cartilage between the femoral head and the acetabulum, causing the two bones to scrape against each other, raw bone on raw bone. When this happens, the joint becomes pitted, eroded, and uneven, resulting in pain, stiffness, and instability. In some cases, motion of the leg may be greatly restricted.
Osteoarthritis:
Osteoarthritis is the most common form of arthritis in the Western world. It is degenerative, and although it most often occurs in patients over the age of 50, it can occur at any age, especially if the joint is in some way damaged. It is usually confined to the large weight-bearing joints of the lower extremities, including the hips and knees, but may also affect the spine and upper extremity joints. Patients with osteoarthritis often develop large bone spurs, or osteophytes, around the joint, further limiting motion.
Causes:
Osteoarthritis of the hip is a condition commonly referred to as 'wear and tear' arthritis. Although the degenerative process may accelerate in persons with a previous hip injury, many cases of osteoarthritis occur when the hip simply wears out. Some experts believe there may exist a genetic predisposition in people who develop osteoarthritis of the hip. Abnormalities of the hip due to previous fractures or childhood disorders may also lead to a degenerative hip. Osteoarthritis of the hip is the most common cause for total hip replacement surgery.
Symptoms: The first and most common symptom of osteoarthritis is pain, usually occurring towards the groin area during weight-bearing activities such as walking.
To decrease hip arthritis pain people usually compensate by limping, which reduces the force across the arthritic hip. Hip osteoarthritis may also result in loss of motion of the hip joint, causing difficulty in doing daily living activities such as putting on socks and shoes. As a result of the cartilage degeneration, the hip loses its flexibility and strength, and may develop bone spurs. As the arthritis worsens, the pain may increase and may become constant, even during non weight-bearing activities.
Human tissue engineered
Tissue grown from a human cell source in the laboratory by simulating growth conditions occurring naturally in the human body.
Intermediate Compression Hip Screw System
A hip fracture reduction system using a plate which is designed for children.
Internal fracture fixation
Restoring of fractured limbs to the most anatomically correct alignment through use of internal implants such as plates, screws and nails.
Intramedullary nail
A nail used in the intramedullary canal which extends along the middle of a long bone like the femur or tibia.
Minimally invasive surgery (MIS)
Surgery not conducted through a large incision which thereby avoids serious tissue damage and long recuperation periods. Also known as 'keyhole surgery'.
Rheumatoid Arthritis
Unlike osteoarthritis which is a 'wear and tear' phenomenon, rheumatoid arthritis is a chronic inflammatory disease that results in joint pain, stiffness, and swelling. The disease process leads to severe, and at times rapid, deterioration of multiple joints, resulting in severe pain and loss of function.
Causes:
Although the exact cause of rheumatoid arthritis is unknown, some experts believe that a virus or bacteria may trigger the disease in people with a genetic predisposition to rheumatoid arthritis. Many doctors think rheumatoid arthritis is an autoimmune disease in which the synovial tissue of the joint has been attacked by the immune system. The onset of rheumatoid arthritis occurs most frequently in middle age and is more common among women.
Symptoms:
The primary symptoms of rheumatoid arthritis are similar to osteoarthritis and include pain, swelling, and the loss of motion. Other symptoms may include loss of appetite, fever, energy loss, anemia, and rheumatoid nodules (lumps of tissue under the skin). People suffering with rheumatoid arthritis commonly experience periods of exacerbation or 'flare up' involving pain and stiffness in multiple joints.
Treatment:
Treatment for pain associated with rheumatoid arthritis may involve medications such as non-steroidal anti-inflammatory drugs (NSAIDs), aspirin, and analgesics.
Supracondylar implant
An implant used above a condyle at the tip of a bone (eg the bottom of the femur, just above the knee joint).
Surgical drive systems
Motorised devices, controlled by the surgeon, that drive the cutting blade.
Tissue repair
The repair of damaged tissue (ie skin, bones, joints and soft tissue) irrespective of whether the damage is induced by trauma, disease or the aging process.
Healthbase is the trusted source for global medical choices, connecting patients to leading healthcare facilities overseas. Healthbase's state-of-the-art, easy to use, information rich web-based system helps you research and arrange your medical care including necessary travel and accommodation, all at one place. We arrange first class services for patients at major internationally accredited hospitals in Singapore, Thailand, India, Mexico, Panama and expanding to Costa Rica, Argentina, Brazil, Malaysia and Turkey. The cost of surgical care at our ever growing network of affiliated institutions is typically a fraction of the cost of care in the U.S. with equal or superior outcomes. Our primary concern at Healthbase has always been quality of care. We have carefully screened overseas hospitals based on the quality of care, procedural availability, pricing, and overall patient experience. We only work with the hospitals that maintain best practice standards of care, such as ISO, JCI/JCAHO accreditation and provide direct access to elite US, UK and internationally trained physicians, docotors and surgeons. Click here to access our hospitals page. Over two hundred medical, dental and cosmetic procedures are available in various categories: Orthopedic procedures such as hip replacement, Birmingham hip resurfacing, artificial knee replacement, knee surgery, cosmetic procedures such as breast augmentation, face lift, rhinoplasty (nose surgery), liposuction, dental procedures such as bridges, implants, crowns, and procedures in categories such as cardiac, vascular, spinal, obesity, eye, LASIK, urology, general surgery, plastic surgery, weight-loss surgery, wellness and much more. The savings are up to 80% from typical USA prices. Medical Tourism is the act of traveling abroad to receive medical, dental and cosmetic care. Medical Tourism is also called as Medical Travel, Health Tourism, Health Travel and Medical Value Travel. Significantly lower costs for best practice care is usually the primary motivation although some medical tourists go abroad for immediate availability of procedures and unavailable treatments. Patients frequently take advantage of the opportunity to vacation and tour inexpensively in the country they are visiting. Click here to hear more about medical or dental tourism. Looking for FREE cost estimate? Register. | Like to look at our extensive hospital profiles and doctor profiles? Register now. | | |
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