follow – up was performed on the Birmingham Mid Head Resection (BMHR) .. good surgical technique and a well proven resurfacing implant is vital for success . The novel Birmingham Mid-Head Resection (BMHR) device offers the option. We have illustrated the surgical technique to manage this rare. Surgery was conducted via a standard posterior approach to the hip joint using a 58 mm BHR acetabular component, a 52 mm BMHR femoral head implant and.

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Anteroposterior radiograph of the right hip after revision surgery. This was techniquee a high-energy mechanism and simply involved a fall from standing height with the patient landing directly onto the right hip.

This difference may represent the difference between laboratory tested axially loaded cadaveric femora techniqie real life when a fall is more likely to result in rotation forces caused by the femoral head-neck anteversion.

In these patients only a stemmed component was possible by removing bone stalk. In addition to receiving honours of distinction from several quarters, the University of Birmingham has conferred on him the degree of Doctor of Medicine Honoris Causa in recognition of his sterling contributions to the medical profession. This is unlike the usual fracture pattern seen in conventional hip resurfacing arthroplasty and that seen in cadaveric BMHR studies.

Copyright technjque The BHR procedure is typically unsuitable for patients with avascular necrosis AVNlarge femoral cysts, or surgica, with anatomical difficulties such as hip dysplasia or Perthes disease.

The fracture patterns in our case seem to be unusual compared with what has been documented in the literature. Femoral neck fracture is a known complication of standard resurfacing arthroplasty and is the most common reason for revision. No patients were omitted from this cohort.


Subsequent radiographs revealed an unusual periprosthetic fracture pattern around his right BMHR Fig. The fracture started high on the superior lateral side of the femoral neck and spiralled distally to the subtrochanteric region.

Birmingham Mid-Head Resection Periprosthetic Fracture

Alongside the development of these devices, he has perfected the surgical techniques for their safe implantation. Having performed over Metal-on-Metal Hip Resurfacings over the course of 20 years, he is the most experienced surgeon in this field. Testing shows that the conical stem replicates the physiological loading of the native femur, preventing any stress-shielding bone loss in the long term.

A recent cadaveric bhmr using the BMHR has actually found that valgus placement does not strengthen and varus placement does not weaken femora. This will be of great clinical significance as revision surgery will be more technically challenging and may result in longer operating times, greater blood loss, longer hospital stays and skrgical patient satisfaction outcomes although it should be emphasised that it is still too early to tell. This latest cadaveric study seems to imply that the BMHR may be a more forgiving implant to use in terms of its positioning compared to its resurfacing cousins.

No potential conflict of interest relevant to this article was reported. A clinicoradiologic study of the Birmingham Mid-Head Resection device.

The Birmingham Mid Head Resection prosthesis is a recently developed hip prosthesis for patients who are keen on having metal on metal hip resurfacing but do not have enough bone stock in their femoral head to accept a resurfacing implant. Femoral neck notching has been shown to be a significant contributor to subsequent fracture of resurfacing implants. This fracture pattern is different from published cadaveric studies, and clinicians using this implant should be aware of this as revision is likely to require a distally fitting, rather than a metaphyseal fitting stem.


Shimmin AJ, Back D. It was increasingly becoming obvious that some younger active patients were not candidates for resurfacing due to some technical issues.

© The McMinn Centre – Mr Derek McMinn MD FRCS Hip Resurfacing Birmingham UK

Open in a separate window. The BMHR stem is manufactured from Titanium Alloy which also has a long history of clinical success with orthopaedic devices. This device is a “Ceramic-on-Metal” CoM articulation.

However, due to its existing positive results in our patients, the device is being developed as part of future resurfacing device designs. During the BMHR operation, the femoral head ball joint is resected through the middle, thereby removing the diseased or necrotic bone. Gone are the days when young, active patients crippled from hip arthritis were told to shut up and put up with it.

Our current protocol for symptomatic early AVN. The valgus placement of the implant and radiographs suggest that reaming had thinned the medial calcar, potentially weakening the femur further.

The remaining femoral bone is then prepared into a conical shape and a matching stem is tapped into place without the need for cement or screws. Again, until recently there was no corroborating evidence to suggest that this was also the case.