{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T14:48:23Z","timestamp":1787755703598,"version":"build-2784847793"},"reference-count":28,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"14","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2021,7,21]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>The BIRMINGHAM HIP Resurfacing (BHR) system is a metal-on-metal hip implant system approved by the U.S. Food and Drug Administration in 2006. The approval required a multicenter, prospective, post-market-approval study. Our purpose is to report the current results at 10 years of follow-up.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>\n                      Between October 2006 and December 2009, 280 primary BHR procedures were performed at 5 sites. Outcome measures included Kaplan-Meier survivorship, reasons for revision, radiographic component stability and osteolysis, Harris hip scores, and metal levels including cobalt and chromium. The mean age at the time of the procedure was 51.3 \u00b1 7.1 years, 74% (206) of 280 BHRs were implanted in male patients, the mean body mass index was 27.8 \u00b1 4.4 kg\/m\n                      <jats:sup>2<\/jats:sup>\n                      , and 95% (265) of 280 hips had a primary diagnosis of osteoarthritis. The mean follow-up among all 280 hips was 9.0 \u00b1 2.5 years. Prior to 10-year follow-up, 20 hips were revised and 5 patients representing 5 hips had died. Among the remaining 255 hips, 218 (85%) met the minimum follow-up of 10 years.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>The 10-year survival free from all-cause component revision was 92.9% (95% confidence interval [CI], 89.8% to 96.1%) for all hips and 96.0% (95% CI, 93.1% to 98.9%) among male patients &lt;65 years old at the time of the procedure. Reasons for revision included femoral loosening (n = 5), femoral neck fracture (n = 3), pseudotumor (n = 3), osteolysis (n = 2), and acetabular loosening (n = 1), as well as 6 revisions for a combination of pain, noise, or metal levels. Among unrevised hips, the median Harris hip score improved from preoperatively (59) to 1 year postoperatively (99; p &lt; 0.001) and remained stable through 10 years postoperatively (99; p = 0.08). Radiographically, 5% (10) of 218 unrevised hips had osteolysis with no component migration. Median metal levels had increased at 1 year postoperatively (cobalt: from 0.12 ppb preoperatively to 1.5 ppb at 1 year postoperatively, p &lt; 0.001; chromium: from 0.6 ppb preoperatively to 1.7 ppb at 1 year postoperatively, p &lt; 0.001), then remained stable through 5 years before slightly decreasing at 10 years postoperatively (cobalt: 1.3 ppb, p &lt; 0.001; chromium: 1.4 ppb, p &lt; 0.001).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>This prospective, multicenter, post-market-approval study demonstrated that the BHR implant system is safe and effective through 10 years of follow-up, particularly among young male patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence:<\/jats:title>\n                    <jats:p>\n                      Therapeutic\n                      <jats:underline>Level IV<\/jats:underline>\n                      . See Instructions for Authors for a complete description of levels of evidence.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.2106\/jbjs.20.01886","type":"journal-article","created":{"date-parts":[[2021,5,17]],"date-time":"2021-05-17T14:08:58Z","timestamp":1621260538000},"page":"1303-1311","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":19,"title":["Results of the First U.S. FDA-Approved Hip Resurfacing Device at 10-Year Follow-up"],"prefix":"10.2106","volume":"103","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5260-1463","authenticated-orcid":false,"given":"Edwin P.","family":"Su","sequence":"first","affiliation":[{"name":"Hospital for Special Surgery, New York, NY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9697-7796","authenticated-orcid":false,"given":"Henry","family":"Ho","sequence":"additional","affiliation":[{"name":"Anderson Orthopaedic Research Institute, Alexandria, Virginia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0134-9215","authenticated-orcid":false,"given":"Vinay","family":"Bhal","sequence":"additional","affiliation":[{"name":"Smith & Nephew, Memphis, Tennessee"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9851-9975","authenticated-orcid":false,"given":"Lawrence R.","family":"Housman","sequence":"additional","affiliation":[{"name":"Tucson Orthopedic Institute, Tucson, Arizona"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9827-2968","authenticated-orcid":false,"given":"John L.","family":"Masonis","sequence":"additional","affiliation":[{"name":"OrthoCarolina Hip and Knee Center, Charlotte, North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3822-2306","authenticated-orcid":false,"given":"John W.","family":"Noble","sequence":"additional","affiliation":[{"name":"Center for Orthopedics, Lake Charles, Louisiana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5998-9461","authenticated-orcid":false,"given":"Robert H.","family":"Hopper","sequence":"additional","affiliation":[{"name":"Anderson Orthopaedic Research Institute, Alexandria, Virginia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7303-4776","authenticated-orcid":false,"given":"C. Anderson","family":"Engh","sequence":"additional","affiliation":[{"name":"Anderson Orthopaedic Clinic and Inova Mount Vernon Joint Replacement Center, Alexandria, Virginia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2021,5,17]]},"reference":[{"issue":"12","key":"bib1-20250430","doi-asserted-by":"crossref","first-page":"3712","DOI":"10.1016\/j.arth.2018.08.019","article-title":"Conventional polyethylene in total hip arthroplasty in young patients: survivorship, wear analysis, and clinical outcomes between 15 and 20 years","volume":"33","author":"Stambough","year":"2018","journal-title":"J Arthroplasty."},{"issue":"1","key":"bib2-20250430","doi-asserted-by":"crossref","first-page":"74","DOI":"10.1016\/j.arth.2011.03.022","article-title":"Periacetabular osteolysis is the problem in contemporary total hip arthroplasty in young patients","volume":"27","author":"Kim","year":"2012","journal-title":"J Arthroplasty."},{"issue":"4","key":"bib3-20250430","doi-asserted-by":"crossref","first-page":"330","DOI":"10.5301\/hipint.5000268","article-title":"Hip resurfacing: history, current status, and future","volume":"25","author":"Amstutz","year":"2015","journal-title":"Hip Int."},{"issue":"12","key":"bib4-20250430","doi-asserted-by":"crossref","first-page":"3803","DOI":"10.1007\/s11999-013-2915-9","article-title":"Do young, active patients perceive advantages after surface replacement compared to cementless total hip arthroplasty?","volume":"471","author":"Barrack","year":"2013","journal-title":"Clin Orthop Relat Res."},{"issue":"1","key":"bib5-20250430","doi-asserted-by":"crossref","first-page":"56","DOI":"10.1007\/s11999-008-0558-z","article-title":"Is patient selection important for hip resurfacing?","volume":"467","author":"Nunley","year":"2009","journal-title":"Clin Orthop Relat Res."},{"issue":"6","key":"bib6-20250430","doi-asserted-by":"crossref","first-page":"92","DOI":"10.1016\/j.arth.2011.03.038","article-title":"Do patients return to work after hip arthroplasty surgery","volume":"26","author":"Nunley","year":"2011","journal-title":"J Arthroplasty."},{"issue":"2","key":"bib7-20250430","doi-asserted-by":"crossref","first-page":"382","DOI":"10.1007\/s11999-009-1106-1","article-title":"The learning curve for adopting hip resurfacing among hip specialists","volume":"468","author":"Nunley","year":"2010","journal-title":"Clin Orthop Relat Res."},{"issue":"1","key":"bib8-20250430","doi-asserted-by":"crossref","first-page":"28","DOI":"10.2106\/00004623-200501000-00006","article-title":"Metal-on-metal bearings and hypersensitivity in patients with artificial hip joints. 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