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.

髋部疼痛和行动不便会严重影响一个人的日常生活。 然而，医疗技术的进步带来了恢复髋関节功能和改善整体健康状况的创新解决方案。 伯明翰髋関节表面翻修（ BHR ）便是其中之一； 是一种专为了年轻或活跃的男性患者设计的保骨髋関节系统。

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，髋関节表面翻修术于亚洲国家尚未广泛使用，只有少数骨外科医生具备进行此类手术的技能。 即使如前所述，髋関节表面翻修仍然是全髋关节置换术（THR）的可行替代方案，尤其是当患者希望尽可能保留更多骨骼的情况下。

 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.

因为如今旅行已经变得非常便捷及实惠，即使患者不在香港居住，在香港接受BHR手术已经变成一个值得考虑的方案

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’.

髋関节翻修术系一种特殊形式嘅髋関节手术，适用于患有髋関节关节炎嘅年轻男性。 受损嘅软骨跟薄薄一层支撑软骨的骨将被移除，并用人造材料代替-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.

最常见的原因是网球和足球等踢腿和弓步运动所引起的骨关节炎（“磨损”），但幸运的是，大多数年轻人不需要更换髋关节，所以这并不常见。 于澳洲、英格兰和威尔士的联合登记处，所有髋関节手术，其中表面翻修手术占约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.

鑑于年轻男性的髋部会承受很大的负荷，因此与接受传统全髋关节置换术 （THR） 的老年人相比，他们的表现相对较不理想。伯明罕髋关节表面翻修术是为了解决这个问题而开发的，并且已经取得了成功，在英格兰和威尔士国家联合登记册中，伯明罕髋关节翻修术是所有类型的髋关节置换术中最成功的。普遍而言，髋关节表面翻修术提供了出色的功能恢复，患者能够重返竞技场，包括职业运动。安迪·穆雷（Andy Murray）通过伯明罕髋关节表面翻修术重返网球赛场。

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.

髋关节骨关节炎在亚洲并不常见，可能是因为在过去的日子里，大多数人不多运动，所以需求较低。 髋关节表面翻修术仅在少数亚洲国家有所提供：土耳其、印度、香港和日本。亦只有少数外科骨科医生具备进行此类手术的技术。即使如前所述，髋关节表面翻修仍然是 THR 的可行替代方案，尤其是当患者希望尽可能多地保留更多骨质时。

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.

如果您曾在接受一线治疗后仍患有疼痛的髋关节炎，那么无论您的年龄如何，都该进行髋关节置换术了。如果您是55岁以下患有骨关节炎的男性，髋关节表面翻修术可能是您最适合的选择。如果您是一个非常活跃的年长男性，您仍然可以考虑髋关节表面翻修术。如果你是一个年纪大、久坐不动的男性，或者你是一名女性，传统的THR可能是你最好的选择

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.