Smith and Nephew


BIRMINGHAM HIP (BHR) Resurfacing System

An alternative to total hip replacement


Younger active male patients who suffer from hip pain due to non-inflammatory arthritis (degenerative joint disease) such as osteoarthritis, traumatic arthritis, avascular necrosis, or dysplasia/DDH, or inflammatory arthritis such as rheumatoid arthritis, may benefit from the bone-conserving approach of the BIRMINGHAM HIP Resurfacing System (BHR).

Unlike total hip replacement, which removes all of the bone within your ball and socket hip joint, the BHR Hip resurfaces just a few centimeters of bone, preserving more of your original joint.

Candidates for Hip Resurfacing

Hip resurfacing is intended for younger active male patients in need of a hip replacement. The suitability of resurfacing as an appropriate treatment for you should be determined by your surgeon, including a review of your bone quality and the size of your femoral head. Please discuss your options with your surgeon.

The Implant

The BHR Hip was CE marked in January 1997 and has been implanted in hospitals in Europe since then. It was approved for use in the United States by the Food and Drug Administration in 2006.

The BHR Hip has two parts: the femoral head (the ball) and the acetabular component (the socket).

The benefits of the BHR technique and implant for appropriate patients may be significant. The implant's head size, its bearing surfaces and its bone-sparing technique could make it the right choice for active patients. In fact, the implant's rate of survivorship for men under the age of 65 is comparable to—and in many cases, better than—standard total hip replacements after ten years of use.1

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 helps to reduce the risk of dislocation of your implant after surgery.2

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 the natural femoral head, a well-placed BHR reduces concerns about post-operative leg length discrepancy. Also, should you need the implant to be replaced at some point in the future, you would be a candidate for a standard hip replacement stem as opposed to needing a longer “revision” stem-type, 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, by contrast, preserves both 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.

The femoral component is cemented over the top of the prepared femoral head like a tooth cap, and the acetabular component is pressed into place much like a typical hip replacement component would be.

Why BIRMINGHAM HIP Resurfacing?

Long-term successful outcomes around the globe:

  • The Australian Orthopaedic Association National Joint Replacement Registry Annual Report 20153 showed BHR survivorship of 90.2% at 14 years follow-up, the longest of any resurfacing device.
  • BHR continues to be the most implanted resurfacing device world-wide and is the only hip resurfacing device with 14 years of registry data.
  • Great Britain's Oswestry Outcomes Centre's patient registry revealed BHR 10-year survivorship of 95.4%, with 98.6% of patients rating their opinion of the experience as pleased or extremely pleased.4
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.


1Data on file, Smith & Nephew.

2S. S. Jameson, D. Lees, P. James, Serrano-Pedraza, P. F. Partington, S. D. Miller, R. M. D. Meek, M. R. Reed. Lower rates of dislocation with increased femoral head size after primary total hip replacement. J. Bone Joint Surg [Br] 2011;93-B:876-80.

3Australian Orthopaedic Association National Joint Replacement Registry Annual Report. Adelaide: AOA; 2015.


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.


BHR patient information