Birmingham Hip Resurfacing

Why the Birmingham Hip Resurfacing System
A Personal Message from John S. Rogerson, MD

When I realized that I had hip arthritis several 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”. 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 and that when I subsequently would need a hip replacement, I would opt for a 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 to Dr. Stachnew in Galesburg, Illinois and then monitored their recovery. After following more than 50-60 “surface hippies” who have returned, I feel that the results are nothing short of miraculous. Over the last four years I have traveled to meetings, received training in the U.S., England and Belgium and studied and compared the resurfacing prostheses currently available globally. I performed my first very successful resurfacing under a special FDA “Compassionate Use Permit” a year and a half ago and have been eagerly awaiting FDA approval for this exciting new technology. There are a number of resurfacing prostheses currently on the market globally with three (Wright Medical, Corin, and Biomet) undergoing IDE clinical investigation in the U.S. The DePuy and Zimmer companies are soon going to be starting their investigational trials. The original concept and development of the metal on metal resurfacing replacement 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 (see the “history of hip resurfacing” section on my web page). There have been more than 65,000 implanted worldwide and greater than nine years of well documented clinical experience with what appears to be the most successful performance among the various prostheses globally.

By the Numbers: Dr. Rogerson’s Birmingham Hip Resurfacing Success as of August 31, 2008 Since June 2006, Dr. Rogerson has performed 324 Birmingham hip resurfacing procedures. Of these patients, 98.4% have classified themselves as highly satisfied. Of the 324 procedures, only five complications have arisen: One hip infection converted to metal-on-metal big femoral head with resolution. One hip dislocation at three weeks from a fall on a wet floor with repeat dislocation and resection of redundant posterior pouch and resolution. One hip dislocation at six weeks from a fall off a step with recurrent dislocation and conversion to a metal-on-metal big femoral head arthroplasty with resolution. One partial foot drop with incomplete resolution. One hip dislocation at a year and a half in a hyperlax female.

Since the current resurfacing prostheses undergoing FDA IDE clinical investigation are still considered experimental, most insurance companies are not reimbursing their use. Because the costs in Europe for resurfacing were approximately half those in the States, most patients I have referred for this procedure have chosen to go abroad up to this point. All of these implants have been the Birmingham and I’m extremely impressed with how they are performing. With the recent FDA approval of the Birmingham hip resurfacing prosthesis, insurance companies are now obligated to provide coverage for this particular prosthesis in the United States. They are not obligated, however, to pay for any other type of resurfacing procedure. Attempts to bill another type as a traditional total hip replacement are risky with the patient later getting stuck with the entire cost when the adjuster notices it is a resurfacing.

Aside from the Wright Medical prosthesis, I am not enthused about any of the other makes coming to market in the future in the U.S. There are various reasons I prefer the Birmingham that are related to the metallurgy, heat treatment, line to line fit, instrumentation, etc. but the largest factor is the fact that it is the only resurfacing prosthesis that has a well documented long term follow-up with the metal over a forty year span and a technique that has been successful globally over nine years. 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.

In summary, I am pleased that the Birmingham hip resurfacing replacement recently was the first 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.

Sincerely,

John S. Rogerson, M.D.
 

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9/16/2008

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