In the treatment of hip degeneration with the BHR (Birmingham Hip Resurfacing) method, only articular surfaces are replaced. This is a bone-saving procedure, because the femoral head is completely preserved, and it is just covered by a special cap. The second component of the prosthesis is an artificial acetabulum. There is no large stem that is drilled into the femoral canal, like in case of traditional endoprosthesis.
This method is known as resurfacing arthroplasty or overlay prosthesis. The differences in both approaches (hip replacement and hip resurfacing) are simply reflected in their terms – hip replacement involves replacing all hip joint structures (acetabulum of pelvis and a part of femur bone), while hip resurfacing means that only surfaces of hip joint structures will be secured by special overlays.
Resurfacing components are made of a chrome-cobalt alloy, which is subjected to extremely precise machining for a high-quality, smooth surface that allows low friction and wear.
Why hip resurfacing?
Birmingham Hip Resurfacing has been the best implant for physically active people for 20 years now.
- The BHR prosthesis is the least invasive of currently available methods of hip arthroplasty, yet the most effective when it comes to bring back the patient to the same physical fitness as before the disease.
- In the production process of this prosthesis, no heat treatment is used, as in the case of most prosthesis. It causes the evaporation of carbon crystals in the alloy, and consequently a significant increase in abrasion and a decrease in endoprosthesis durability.
- As a result of the unique production process, BHR prosthesis durability is very high. Unfortunately, the technology of “cold” processing is more expensive, which affects the price of the prosthesis.
- The advantage of the BHR method is maintaining the anatomical position of the head and neck of the femur in the acetabulum and high durability of the friction surfaces, which allows to avoid replacing the prosthesis (revision) due to its wear.
- An additional advantage of the BHR prosthesis is the fact that it is not the final solution. If for any reason there is a need for revision, the head and neck of the femur may be removed and the appropriate head stem (as in a full prosthesis) may be implanted, leaving the acetabulum of the BHR prosthesis.
- Based on studies of the state of health of patients who underwent hip arthroplasty by the BHR method, it can be concluded without doubt that this is a proven and effective method. There is a very small risk of serious complications related to infection, endoprosthesis dislocation or loosening, leading to the need for re-surgery (0.8% complications according to McMinn).
- The most common complication is a hip fracture under the cap caused by an incision of the neck during surgery or bone weakness, due to e.g. osteoporosis.
What patients is the BHR method for?
BHR prosthesis is designed for active people for whom ordinary prosthesis is not enough.
It is the only implant that guarantees a full return to sports activity. With it, a patient can practice not only “low impact” disciplines (e.g. swimming or cycling), but also those from the “high impact” group, i.e. martial arts, playing tennis, golf or cycling, without the risk of dislocation or loosening of the implant.
In patients under the age of 55, taking into account statistical life expectancy, there is a high probability that typical hip replacement will wear and will need to be replaced. Therefore, in this age group, surgery involving only the exchange of joint surfaces is the most advantageous solution.
Surgery and recovering after hip resurfacing BHR
Before surgery
During medical consultation the doctor decides whether BHR is suitable for a patient. The date of surgery is also set (approx. 4 weeks in advance), as well as consultations with anesthesiologist and general practitioner.
Necessary tests:
- X-rays of the hip joints (they can be performed on-site at the Carolina Medical Center),
- certificate from a dentist confirming the good health of teeth (certificate of sanation of oral cavity)
- laboratory tests,
- two blood group tests performed at interval.
Blood transfusion after surgery
Some patients require blood transfusions after surgery, therefore the condition for starting the procedure is to prepare blood for each patient. The best solution is autotransfusion, especially for some rarer blood groups. The patient donates blood at a blood donation station in the amount of 1 unit three weeks before surgery. The patient’s own blood prepared by the station is transfused after surgery if necessary.
Blood can be donated at a Blood Donation Station in Warsaw or, after consultation with the Carolina Medical Center medical staff, at other stations in Poland.
If it is impossible for a patient to undergo blood transfusion (for example due to religious beliefs), we offer other solutions – please discuss them with doctor upon consultation.
The patient’s overall health
Before undergoing the surgery, the patient should ensure that there are no inflammatory foci – e.g. sinuses, tonsils or teeth that could be a source of infection.
Surgery
The surgeon begins the operation by making access to the hip joint. Bone surface treatment is part of the surgery in which specialized tools and implants are used.
The femoral head is prepared for seating the component with the articular surface. In turn, the acetabulum of the pelvis is treated to seat the acetabular prosthesis. After performing these activities, the acetabulum prosthesis is inserted into the prepared cradle in a position ensuring stability of the hip joint and the possibility of growing around the bone tissue.
Afterwards, with the help of bone cement, a joint surface component of the femoral head is deposited. After careful evaluation of all elements, the surgeon closes the previously created surgical access, and finally stitches the skin with surgical threads or metal staples.
A day after surgery
Rehabilitation and verticalization begins already on the first postoperative day. Many patients a day after surgery take a few steps with the help of crutches or orthopedic walking frame, without exceeding the pain limit.
The operating surgeon determines to what extent a new hip joint can be loaded. In some cases, where due to the advancement of the hip disease, the procedure was more difficult technically, the surgeon may advise against walking and some rehabilitation for some time. It can also mean walking with the help of two crutches for a period of several weeks in order to allow complete healing and stabilization of the joint.
During the first six months after surgery extreme caution should be exercised – avoiding any collisions and injuries, because bone reconstruction is still underway, as a result of which the implant is “gripped” by bone tissue.
A few days after surgery
A discharge from the hospital usually occurs after four or five days. After returning home, the patient reports to the clinic for a change of dressings every 2 days, and after healing the wound for removal of stitches. For patients from outside Warsaw, dressing changes and stitches removal may be performed at the place of residence by qualified medical staff. The rehabilitation process should be controlled by a physiotherapist.
Recommendations after leaving the hospital
During the first months after the operation, the patient must carefully follow all medical recommendations, in particular regarding the degree of burden. In the weeks following the procedure, it is important to continue walking to further strengthen the muscles surrounding the hip joint.
Exercises are helpful in postoperative improvement and make typical daily activities easier to perform. Driving a car may be started after 3-5 weeks after the operation, although it is recommended to refrain from driving until the consent is given by a doctor, depending on the progress of rehabilitation.
Depending on patient’s condition, sex life can be started approximately 4-6 weeks after surgery. However, the patient should be careful not to do excessive hip movements during the first three months.
Prevention of postoperative complications
As with any surgery, there may be postoperative complications after hip resurfacing surgery.
In the postoperative period, the patient should:
- walk regularly,
- continue the exercises and physiotherapy according to the instructions received,
- lie flat for an hour a day to stretch muscles and ligaments within hip area.
The course of rehabilitation
An extremely important element of achieving fitness after hip prosthesis implantation is properly conducted and systematic rehabilitation. Carolina Medical Center patients have contact with a physiotherapist in the hospital ward, right after the surgery.
After leaving the clinic, the patient should continue rehabilitation according to the physiotherapeutic procedure protocol prepared by our specialists.
| Rehabilitation schedule | |
|---|
| 0-4 day / IN HOSPITAL WARD / | - gradual verticalization
- anti-edema, analgesic (elevation of the limb, cooling)
- exercises in ranges without pain
- learning how to walk on crutches with partial load on the operated leg
|
| 2-6 weeks / RETURN TO EVERYDAY ACTIVITY AND PROFESSIONAL ACTIVITY / | - increasing range of motion in the hip joint (flexion above 90 degrees)
- stretching, coordination, stabilizing, strength exercises
- increasing the load on the operated leg and walking distance
|
| 6-12 weeks / RETURN TO EVERYDAY ACTIVITY AND PROFESSIONAL ACTIVITY / | - exercises in full ranges of motion
- walking without crutches
- strength and endurance training (bike, swimming, jogging)
- starting sports exercises
|
| from 12th week/ FULL SPORTS ACTIVITY / | - football, tennis, jogging, skies
|
Complications
BHR implants have been in use since 1998. The Carolina Medical Center has performed more than 500 resurfacing operations and 9 revisions – implant replacements – since 2003, which is 1.8%. According to the largest database in the world, the Australian Registry, the percentage of complications after BHR in the 15-year period after surgery is 10.2% against 8.8% after total hip replacement.
A contraindication to implanting a BHR prosthesis is allergy to metal, which is recognized by changes in the skin in contact with a watch or other metal.
Implant wear
Each implant is subject to wear due to friction. In the case of polyethylene implants, polyethylene is rubbed off, ceramic – ceramics, and metal – metal. Usually it is a slow process, lasting many years. The cause of premature wear may be a defect in the material or incorrect positioning of the implant.
