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 as long as the components were positioned correctly, and I would ultimately opt for hip 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 then monitored their recovery. After following more than 50-60 “surface hippies” who returned to the U.S., I felt that the results were nothing short of miraculous.
Over subsequent years I traveled to numerous meetings, received training in the U.S., England and Belgium and studied and compared the resurfacing prostheses available globally at that time. The original concept and development of the metal on metal resurfacing prosthesis 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. There have been more than 120,000 implanted worldwide and greater than 16 years of well documented clinical experience with what appears to be the most successful performance among the various prostheses globally.
" There have been more than 120,000 [BHR prosthesis] implanted worldwide and greater than 16 years of well documented clinical experience with what appears to be the most successful performance among the various prostheses globally."
- Dr. John Rogerson, M.D. -
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 where it was ultimately approved for use in the United States.
Other companies have subsequently introduced their own resurfacing prostheses. The Wright Medical Conserve Plus had a reasonable design, but the metal was heat treated and the instrumentation not precise, so that is not an appealing option for me. DePuy and Zimmer introduced different designs with different metal formulations and tolerances and did not attain FDA approval. They subsequently were recalled off the market after performing poorly. The Stryker Corin prosthesis had a different metal coating treatment and has not flourished, and the Biomet prosthesis has yet to attain FDA approval.
I started implanting the BHR in 2006 and have now performed over 800 hip resurfacing procedures and have been extremely happy with the results in young, active patients with severe arthritis. They have routinely been able to resume unlimited activity of all types with a 98.6% success rate. We recently reported our results to the FDA and they compared favorably with Dr. McMinn and Treacy’s experience.
In summary, I was pleased that the Birmingham hip resurfacing was the first hip 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, and very pleased with our clinical results.
John S. Rogerson, M.D.