Birmingham Hip Resurfacing in Hong Kong

A Bone-Conserving Total Hip Solution for Enhanced Mobility

Introduction

 Hip pain and limited mobility can significantly impact one's quality of life. However, advances in medical technology have led to innovative solutions that aim to restore hip function and improve overall well-being. One such solution is the BIRMINGHAM HIP Resurfacing System (BHR), a bone-conserving total hip system designed for younger or more active male patients.

髖部疼痛和行動不便會嚴重影響一個人的日常生活。 然而，醫療技術的進步带来了恢復髖関節功能和改善整體健康狀況的創新解決方案。 伯明翰髖関節表面翻修（ BHR ）便是其中之一； 是一種專為了年輕或活躍的男性患者設計的保骨髖関節系統。

Hip resurfacing is not widely available in Asian countries, and only a few surgeons possess the skill to do such a procedure. Even as said, Hip resurfacing is still a viable alternative to THR especially when the patient would like to preserve as much of the bone as possible.

目前，髖関節表面翻修術於亞洲國家尚未廣泛使用，只有少數骨外科醫生具備進行此類手術的技能。 即使如前所述，髖関節表面翻修仍然是全髖關節置換術（THR）的可行替代方案，尤其是当患者希望儘可能保留更多骨骼的情況下。

 Though being said, even if you don't reside in HK, you might still want to consider to have a BHR in Hong Kong as travel nowadays is very convenient and affordable.

因為如今旅行已經變得非常便捷及實惠，即使患者不在香港居住，在香港接受BHR手術已經變成一個值得考慮的方案

What is the HIP Resurfacing?

Hip resurfacing is a special form of hip replacement for young men with arthritis of their hips. The damaged cartilage and only a thin layer of bone supporting the cartilage are removed, and replaced with artificial material - hence the name ‘resurfacing’.

髖関節翻修術係一種特殊形式嘅髖関節手術，適用於患有髖関節關節炎嘅年輕男性。 受損嘅軟骨跟薄薄一層支撐軟骨的骨將被移除，並用人造材料代替-因此得名“表面翻修”

Why would a young man need hip replacement?

The commonest reason is osteoarthritis (‘wear & tear’) from kicking and lunging sports like tennis and football, but fortunately, most young men don’t need their hips replaced, so it’s not very common. In the joint registries for both Australia and for England & Wales, resurfacings make up about 3% of all hip replacements.

最常見的原因是網球和足球等踢腿和弓步運動所引起的骨關節炎（“磨損”），但幸運的是，大多數年輕人不需要更換髖關節，所以這並不常見。 於澳洲、英格蘭和威尔士的聯合登記处，所有髖関節手術，其中表面翻修手術佔約3%。

What’s so special about hip resurfacing?

Young men put a lot of bearing on their hips and they have thus done relatively poorly compared with elderly with conventional total hip replacement (THR). Resurfacing was developed to tackle this problem - and it has been successful - in men 55 years and under with osteoarthritis the Birmingham Hip Resurfacing is the most successful of all types of hip replacement in the National Joint Register for England and Wales. Generally, hip resurfacings provide excellent function and patients are able to return to competitive sport, including professional sport. Andy Murray has returned to tennis with a Birmingham Hip Resurfacing.

鑑於年輕男性的髖部會承受很大的負荷，因此與接受傳統全髖關節置換術 （THR） 的老年人相比，他們的表現相對較不理想。伯明罕髖關節表面翻修術是為了解決這個問題而開發的，並且已經取得了成功，在英格蘭和威爾士國家聯合登記冊中，伯明罕髖關節翻修術是所有類型的髖關節置換術中最成功的。普遍而言，髖關節表面翻修術提供了出色的功能恢復，患者能夠重返競技場，包括職業運動。安迪·穆雷（Andy Murray）通過伯明罕髖關節表面翻修術重返網球賽場。

Is Hip Resurfacing available in Asia?

Osteoarthritis of the hip is not very common in Asia, probably because most people don’t play much sport in the past days, so demand is low.

Hip resurfacing is only available in a few Asian countries: Turkey; India; Hong Kong, and Japan. and only a few surgeons possess the skill to do such procedure. Even as said, Hip resurfacing is still a viable alternative to THR especially when the patient would like to preserve as much of the bone as possible.

髖關節骨關節炎在亞洲並不常見，可能是因為在過去的日子裡，大多數人不多運動，所以需求較低。 髖關節表面翻修術僅在少數亞洲國家有所提供：土耳其、印度、香港和日本。亦只有少數外科骨科醫生具備進行此類手術的技術。即使如前所述，髖關節表面翻修仍然是 THR 的可行替代方案，尤其是當患者希望盡可能多地保留更多骨質時。

I’ve been told I’m too young for a hip replacement?

If you have painful arthritis of your hip despite first line treatment, it’s time for hip replacement, regardless of your age. If you are a man aged up to 55 with osteoarthritis, hip resurfacing is probably the best choice. If you are a very active older man, you may still consider hip resurfacing. If you are an older more sedentary man, or if you are a woman, conventional THR might be your best option.

如果您曾在接受一線治療后仍患有疼痛的髖關節炎，那麼無論您的年齡如何，都該進行髖關節置換術了。如果您是55歲以下患有骨關節炎的男性，髖關節表面翻修術可能是您最適合的選擇。如果您是一個非常活躍的年長男性，您仍然可以考慮髖關節表面翻修術。如果你是一個年紀大、久坐不動的男性，或者你是一名女性，傳統的THR可能是你最好的選擇

How long do hip resurfacings last?

The first successful modern hip resurfacing, the ‘Birmingham Hip Resurfacing’ (BHR), was introduced in 1996, FDA approved in 2006, and remains the most successful and popular type of resurfacing with excellent results reported at 20 years (1).

首个成功的现代髋关节重建手术是“伯明翰髋关节翻修术”（Birmingham Hip Resurfacing，简称为BHR），于1996年首次引入， 2006年获得美国食品药品监督管理局（FDA）的批准，并且在20年的时间里一直被认为是最成功和最受欢迎的髋关节重建类型之一，具有出色的效果（1）。

What is the BIRMINGHAM HIP Resurfacing System?

The BIRMINGHAM HIP Resurfacing System is a total hip solution has been available in HK since 2003, and FDA approved in 2006,

It is meticulously designed based on insights gained from earlier generation metal-on-metal total hips and a deep understanding of hip resurfacing principles. This system is specifically tailored to meet the needs of younger or more active male patients who desire a long-lasting, bone-conserving solution for hip-related issues such as osteoporosis.

Key Features of BHR:

1. Metallurgy: The BIRMINGHAM HIP Resurfacing System is produced using the investment casting process from high-carbon cobalt chrome. This material provides exceptional strength and durability, allowing for long-term performance.
2. Wear Testing: Rigorous wear testing has been conducted on the system, demonstrating its ability to withstand millions of cycles. This testing confirms the system's reliable performance and its contribution to the fluid film, which helps reduce wear and tear over time.

Benefits of the BIRMINGHAM HIP Resurfacing System:

1. Bone Conservation: Unlike traditional total hip replacements, the BIRMINGHAM HIP Resurfacing System preserves more of the patient's natural bone. This bone-conserving approach can be advantageous for younger or more active patients, as it allows for potential future surgeries, if necessary.
2. Enhanced Mobility: By restoring the natural anatomy and function of the hip joint, the BIRMINGHAM HIP Resurfacing System aims to improve overall hip mobility. This can result in enhanced range of motion, enabling patients to return to their active lifestyles and engage in activities they enjoy.
3. Long-Term Survivorship: Clinical studies have shown promising long-term survivorship rates for the BIRMINGHAM HIP Resurfacing System. This indicates that the system is designed to provide durable and reliable performance over an extended period, offering patients the potential for sustained relief and improved function.

Considerations and Patient Information:

Before considering the BIRMINGHAM HIP Resurfacing System, it is essential for patients to consult with their orthopedic surgeon. The suitability of this system depends on various factors, including the patient's age, activity level, bone quality, and overall health. A thorough evaluation by a qualified healthcare professional will help determine if this system is the right choice for the individual patient.

How is BHR different from THR ( total hip replacement)?

Both surgical procedures are used to address hip joint problems. The goals are to alleviate pain, improve mobility, and restore function in patients with hip conditions such as osteoarthritis, rheumatoid arthritis, avascular necrosis, or hip fracture.  And the postoperative rehabilitation process of both BHR and THR is similar, which involves physiotherapy, exercises to strengthen the hip muscles and gradual progression of weight-bearing activities under the guidance of a healthcare professional.

Following is a simple table that illustrates the differences of both surgeries:

I have osteonecrosis, not osteoarthritis. Can I still have hip resurfacing?

If there is not too much bone loss (maximum about 30%) the results of the BHR are as good in osteonecrosis (also known as ‘avascular necrosis’ or ‘AVN’) as in osteoarthritis - in other words - the results are excellent. In borderline cases it may not be able to tell from X-ray or MRI whether the hip will be resurfaceable, so starts the operation by preparing the femoral head for resurfacing. If the head is suitable for resurfacing he continues with the resurfacing. If not, he switches immediately to conventional THR. This only adds about 10 minutes to the operation time.

Is Hong Kong a good place for a hip resurfacing?

The BHR was introduced to Hong Kong in 2003, at Matilda International Hospital by Dr Jason Brockwell, who has performed over 500 BHRs since.  Many patients are from Hong Kong and many come from the region. Visitors usually come to Hong Kong the day before their operation, and then go directly from the hospital to the airport to fly home 2 - 3 days after the operation.

Booking a BHR surgery in HK

If you're considering booking a Birmingham Hip Resurfacing (BHR) surgery in Hong Kong, Asia Medical specialists have made the process as seamless as possible. Follow these simple steps to secure your appointment:

1. Enquiry: .  Simply email us your X-ray and any medical reports to hipresurfacing@asiamedical.hk and doctor will able tell you if your hip is likely to be suitable for resurfacing.
2. Consultation and Assessment: Once we receive your inquiry, we will schedule a Tele-consultation with Dr Brockwell (Either a face to face consultation or teleconsultation for initial screening) . During this consultation, the surgeon will evaluate your condition, answer any questions you may have, and discuss the potential benefits and risks of the BHR surgery.  Dr Brockwell will send you a medical report for your insurance company.
3. Pre-operative Preparation: If you decided to proceed with the BHR surgery, our team will guide you through the pre-operative preparation process. This may include medical tests, imaging scans, and necessary paperwork. Our aim is to ensure that you are physically and mentally prepared for the procedure.
4. Surgery Scheduling: Based on the availability of our surgical team and taking into consideration your preferences, we will work together to schedule a convenient date for your BHR surgery. Our goal is to accommodate your needs while maintaining a high standard of surgical care.
5. Logistics and Accommodation: You have an option to choose to either book the hotel and tickets by yourself or you can entrust our Customer Service team to arrange everything for you.
6. Surgical Day: On the day or the day before surgery, you will be admitted to the hospital, our team will guide you through the process.
7. Postoperative Care: Following the surgery, our dedicated medical staff will provide comprehensive postoperative care and guidance. We will monitor your recovery progress, prescribe necessary medications, and schedule follow-up appointments to ensure optimal healing and rehabilitation.  If needed, we will also collaborate with your local physicians to help you to continue your rehabilitation process at your own place.

Can I have both hips resurfaced in one operation?

Yes. It’s safe and saves time and money. Most patients are delighted with the results. Surprisingly, patients are not particularly disabled after having both hips operated - they can walk with crutches and climb stairs and get to the bathroom independently.

Can I have both hips resurfaced in one operation?

Currently we are partnering with Matilda International Hospital to provide a ‘total care package’ with a fixed price of around HK$240K for one hip and less thanHK$430K for both hips, staying in a multi-occupant room. Twin and private rooms are more expensive. Most insurers reimburse hip resurfacing.

*Note* above price doesn't include hotel accommodation and travel expenses

References:

1. Dhawan, R., et al., Birmingham Hip Resurfacing at 20 years. Bone Joint J, 2023. 105- B(9): p. 946-952.