Birmingham Mid-Head Resection Prosthesis and Its Implantation

Abstract

It is always a difficult consultation with young patients who come specifically wanting a hip resurfacing to have to tell them that their femoral head bone is of suspect quality. This poor-quality bone classically occurs in avascular necrosis (AVN) but can also be seen in osteopenia or osteoporosis or when large femoral head cysts are present (usually provoked by long-term anti-inflammatory medication). Other conditions such as severe slipped femoral capital epiphysis or Perthes disease can render the bony anatomy unsuitable for hip resurfacing. When I see poor-quality bone, I warn the patient that a hip resurfacing may not be a wise procedure. If they still insist on having the highest chance of a resurfacing, then we leave the decision on which procedure to perform to intraoperative findings. In these patients, I obtain consent for either a Birmingham Hip Resurfacing (BHR), a Birmingham Mid-Head Resection (BMHR) prosthesis, or a stemmed total hip replacement. The BMHR prosthesis was developed because moving from a hip resurfacing to a stemmed total hip replacement is a major leap in aggressiveness with respect to (a) femoral shaft invasion, (b) proximal femoral stress shielding, and (c) the ease of subsequent revision surgery if it should be required. We started developing our BMHR prosthesis some years ago with first implantation approximately 4.5 years ago.