Smith and Nephew


BIRMINGHAM HIP (BHR) Resurfacing System

A high-performance alternative to total hip replacement


Active patients who suffer from hip pain due to arthritis, dysplasia or avascular necrosis may benefit from the bone-conserving approach of the BIRMINGHAM HIP Resurfacing System (BHR Hip), the world's leading hip resurfacing system.

Unlike total hip replacement, the BHR hip resurfaces just a few centimeters of bone, preserving your original joint. The BHR hip is not unlike a cap for a tooth.

Because this technologically advanced surgical procedure resurfaces, rather than replaces, the end of your femur (thighbone), you may participate in physical activity with an implant that is potentially longer-lasting and more stable than total hip replacements.

For a more detailed explanation, please review the BIRMINGHAM HIP (BHR) Resurfacing System Patient Information PDF.

Candidates for Hip Resurfacing

Hip resurfacing is intended for active patients who are under 60 years of age and in need of a hip replacement. Adults over 60 who are living non-sedentary lifestyles may also be considered for this procedure. However, this can only be further determined by a review of bone quality. As with all treatments, please discuss with your options with your doctor to find out if hip resurfacing is appropriate for you.

The Implant

The BHR Hip was approved for use in the United States by the Food and Drug Administration in 2006, but has been implanted around the world more than 125,000 times since 1997. Surgeons who offer this implant to patients have undergone specialized training.

The benefits to patients of the BHR Hip technique and implant are significant. The implant's head size, its bearing surfaces and its bone-sparing technique make it a preferred choice for active patients.

While the implant's rate of survivorship is comparable to standard total hip replacements after five years, these three key advantages set the resurfacing technique and implant apart from its total hip replacement counterparts.

Head Size

While the implant closely matches the size of your natural femoral head (hip ball), it is substantially larger than the femoral head of most total hip replacements. This increased size translates to smaller chance of dislocation of your implant after surgery.

The Bone Conservation

The BHR Hip implant conserves substantially more bone than a total hip replacement. Since it preserves your natural femoral neck and most of your femoral head, concerns about leg length discrepancy are dramatically reduced. Also, should you need the implant replaced at some point in the future, you are a candidate for regular total hip replacement surgery as opposed to needing a more traumatic and complex revision surgery as is often the case when a traditional hip replacement needs to be replaced.

The Procedure

Total hip replacement requires the removal of the femoral head and the insertion of a hip stem down the shaft of the femur. Hip resurfacing preserves the femoral head and the femoral neck. During the procedure, your surgeon will only remove a few centimeters of bone around the femoral head, shaping it to fit tightly inside the BHR Hip implant.

Your surgeon will also prepare the acetabulum for the metal cup that will form the socket portion of the ball-and-socket joint. While the resurfacing component slides over the top of the femoral head like a tooth cap, the acetabular component is pressed into place much like a total hip replacement component would be.

Why BIRMINGHAM HIP Resurfacing?

Long-term successful outcomes around the globe.

  • 2013 Australian Registry's results showed BHR Hip's survivorship at 10 years (92.9%) is better than all other resurfacing implants' survivorship after just their 7th year.
  • BHR is the only resurfacing device with more than 10 years of registry data and continues to be the most implanted resurfacing device world-wide.
  • Great Britain's Oswestry Outcomes Centre's patient registry revealed BHR Hip's 10-year survivorship of 95.4%, with 98.6% of patients rating their opinion of the experience as pleased or extremely pleased.
  • A study presented at the American Academy of Orthopaedic Surgeons 2010 Annual Meeting discussed importance of several factors in successful outcomes of resurfacing hip replacements. One factor was prosthesis selection, and it showed that BHR Hip had a significantly lower risk of revision than other hip resurfacing options.
Not every surgeon has been trained to perform BIRMINGHAM Hip Resurfacing. To find a surgeon trained in BIRMINGHAM Hip Resurfacing near you, use our Find a Physician locator.

Important Notes

There are potential risks with hip resurfacing surgery such as fracture, infection, loosening, dislocation and wear that may result in the need for additional surgery. The results and physical activities of this patient may not be representative of the results and physical activities that you may experience following surgery. Females of child-bearing age should not have the BHR device. It is unknown whether metal ions released by the device could harm an unborn child. Do not perform high impact activities such as running and jumping during the first post operative year while the bone is healing. Early device failure, breakage or loosening may occur if you do not follow your surgeon's limitations on activity level. Early failure can happen if you do not guard your hip joint from overloading due to activity level, failure to control body weight, or accidents such as falls. Hip resurfacing surgery is intended to relieve hip pain and improve hip function. Talk to your doctor to determine what treatment may be best for you.


  • Barrack R,. The Case for Hip Resurfacing: A Bigger Picture. Current Concepts in Joint Replacement Meeting. December 2010.
  • Australian Orthopaedic Association National Joint Replacement Registry Annual Report. Adelaide: AOA; 2013.

The information listed on this site is for informational and educational purposes and is not meant as medical advice. Every patient's case is unique and each patient should follow his or her doctor's specific instructions. Please discuss nutrition, medication and treatment options with your doctor to make sure you are getting the proper care for your particular situation.


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