Metal to Metal Hip resurfacing : LUSENET : About Joints : One Thread

I am interested in any information about metal to metal Hip resurfacing as a conservitive alternative to Total Hip Replacement. I have information from the Joint Replacement Institute, in LA, Calif., but would like information from any surgeon nearer Florida. I would also like to receive information from anyone that has had this proceedure. Thank you

-- Fred G. SMITH (, October 23, 1999


We have also been trying to get more information about this procedure, and were curious if you've received any good information. My husband is 39, very active, and needs replacements on both hips. Thanks for any insight. Thank you, Bobbi * We've also received all the information from Dr.Amstadt, but local surgeons are not very positive about his procedure.

-- Bobbi Kay (, February 18, 2000.

I underwent a hip resurfacing procedure, in Birmingham, England on 21 June, 2001. Early days but so far, so good.

-- Peter Lewin (, August 07, 2001.

I, too, am interested in hip surface replacement (hip resurfacing). I live in Houston, Texas, USA, but am unable to find anyone my area. I am willing to travel for surgery, but would like to limit to states not too far to travel post surgery. Jim Haynes

-- Jim Haynes (, August 21, 2001.

I am 47 years old living in Colorado (orginally UK) and my doctor considers this too young for a full replacement.

My sister is 2 years older and just had this Birmingham resurfacing procedure on both hips in the UK over the last year and thinks the result is perfect.

I too am looking for someone in the Western US (with good track record)who will do this procedure.

Would appreciate any leads from y'all who have obviously been already investigating....

-- Mark Suddaby (, October 11, 2002.

I am doing some research on joint replacement (for myself) as I am a canidate in the near future. The UK seems to have lots of information and they are doing operations there. Also some information from the autralian health car was found. I have found some good information from NICE - gov't agency in the UK

-- Gary Biagioni (, October 27, 2002.

I live in Cheltenham England and had a hip resurfacing operation on October 16th 2002. Although still recouperating the hip feels great and the pain has gone The surgeon still tells me i will be back on the golf course by Christmas. I am walking a mile or two each day and every day gets better. I am 58 and very active. Obviously I was apprehensive before the op. but would recommend it to anyone.

-- Alan Whittaker (, December 01, 2002.

My wife had both hips resurfaced at the Nuffield hospital in Birmingham england. As a person in the medical field, I have sent many people to England for the Birmingham hip. There is an orthopedic surgeon in Englewood, NJ who was trained in England to do hip resurfacing. His name is Dr.David Feldman and he does hip resurfacing at the Englewood Hospital. Do not have a total hip if you qualify for hip resurfacing. Robert Maines

-- Robert Maines (, December 07, 2002.

Also looking for a Surgeon in the Southern area of the US. I am British now residing in Florida. I am a 46 year old male who wishes to remain active. The full replacement surgery is scary to me. The resurfaceing seems to make more sense especially with the low wear metals they are using today.

Does anyone have info and testimonial relating to the resurfacing procedure. 1/ Surgeons, USA and in England. 2/ Any problems that have arisen. 3/ Insurance coverage. ( has anyone suceeded in obtaining coverage for this procedure?) 4/ Any other info would be really appreciated.

Thank You

Dave Cavill 2/

-- David Cavill (dcavill @, December 10, 2002.

Just do an internet search for biremingham hip. You'll find plenty of information.

-- John R Edwards (, February 18, 2003.

Well, after extensive research and all sorts of do diligence, I'm flying over to Enlgand mid-march to get the BHR done. I'm a very active 44 year old with severe osteo-arthritis in my left hip. Very nervous, but really, is there any choice after you check out the limitations of THR and how invasive it is?

-- carol p (, February 27, 2003.

I am 77 years old and very active. I thought that I had a groin problem two years ago after a masters badminton tournament and was advised to get the total hip replacement. I wanted to do the less intrusive and more user friendly hip resurfacing and fortunately it was available in Calgary in December of 1992 if bone density was adequate. It has been a wonderful success and I am now hitting tennis balls with my wife and hoping to get back to some badminton by April.

-- Ernie McCullough (, February 28, 2003.

There is plenty of information available on this procedure and surgery appropriate for young, active patients at

There are many hip resurfacing patient stories and interaction with resurfacing patients in the following e-group:

Good luck to all looking for answers for painful hips.

-- Keith Brewster (, June 08, 2003.

I am an orthopaedic surgeon. I practice in the UK (HAving trained in UK,South Africa, Ireland and Canada). I specialise in shoulder surgery and have not performed hip surface replacements. My observations are made purely on the development of this product as I personally have little to gain from promoting the concept. My father in-law recently had a surface replacement (Aged 73 - a very active man.) This is some of the information I provided him and hopefully it will help any other readers to come to an objective and informed decision.

The concept of having a metal on metal bearing surface is highly attractive. The reason that total hip replacements fail is that the polyethylene (Plastic) that the cup is made of wears out with time. The wearing out produces a fine powder which stimulates an inflammatory reaction from the patient. This inflammatory process eats away the bone at the interface between the cement and bone (in a cemented prosthesis) and the metal and bone (in an uncemented prosthesis.)

The net result is that the hip ultimately fails and the revision surgeon has to address ways of "replacing" this lost bone. A metal on metal implant eliminates the polyethylene debri formation and therefore potentially eliminates the greatest cause of failure.

Metal debri that might result, forms particles that are too large to trigger the same inflamamtory response. In the very early days of hip arthroplasty surgery there were metal on metal implants that failed because of the inability to produce two perfectly congruent surfaces such that "spot welds" resulted between the two surfaces and then the hip fused, or the resulting sheer forces caused the implant to fail between the bone and metal interface. There were however some of these implants that went on to last for very long periods that easily matched the traditional "Charnley" hip. We assume that in these cases the technicians were fortunate enough to have achieved a much better congruency of the surface, but they were unable to reliably reproduce this for the majority.

The other attraction about the surface replacement is that the majority of the bone is left behind on the femoral side (Ball)such that if the hip should require revision at some point in the future the revising surgeon should not face the same problems of having to "rebuild" the bone.

On the down side, because you are resurfacing the femoral head, the "ball" is very big and the "Cup" will need to be even bigger. Therefore the amount of bone that needs to be taken on the acetabular side (Cup side)will be more than the traditional cup requires. This is only a theoretic problem especially as revision surgeons are much more easily able to rebuild bone on the acetabular side.

The fundamental issues however lie with the fact that most of the arguements for or against are theoretical. It is an unfortunate fact that the only way to prove that this hip will be as successful as most people believe it should be is to wait and see if those people who have the surgery will need revisions in 10 or 15 years or not at all. You therefore have to wait 10 years or longer to get these answers.

The Birmingham hip has been around for some years now and the results thus far have been very impressive. There are now at least 2 other manufacturers in the UK that are producing their own versions.

There are two issues that hinder the whole decision making process. The first is a commercial one. Those promoting the product have a vested interest in promoting it, and those apposing it often seem to me to be apposing it because they percieve it to be a threat to their current practices. (Ie if you are a total hip replacement specialist you may have to re-train in this new procedure and loose potential "clients" in the niterim)

This debate is particularly relevant across the Atlantic. The UK National Health has a commission called the National Institute for Clinical Excellence (see their Web page This institute has produced very thorough recommendations on hip resurfacing. Personally I thought this was premature when it was published but I make that statement purely on Gut feel rather than a thorough knowledge of the entire subject.

In the US the product has not yet been given the all clear where the approach tends to be a lot more conservative becasue of possible litigation issues. Personally I was more in the US camp.

The second issue is that if this product is as good in like for like patients (Ie versus the standard total Hip replacement (THR)) will it necessarily be as good in pateints that traditionally have not been suitable for THR.

There is a danger that (As has been the case in may other products in the past) it starts off looking very promising, therefore the indcations for who would be appropriate for this surgery expand faster than the research and we end up putting this implant in 50 year olds, 40 years olds and even 20 year olds. As the age comes down so the expectations of the patients increase. We may find ourselves in 5 years with hundreds of very unhappy young patients.

The implant then gets a bad name, most people stop using it and everyone goes back to the drawing board to actually work out who is really suitable for a surface replacement. The difference then will be that we are 10 or 15 years down the line and the wait I was talking about would have passed and we will have reams of literature available to then make a more informed decision.

So we have a product that theoretically is brilliant, we have two schools of thought as to whether it is good or bad, both arguably have vested interests in forcing their point and most of us are sitting somewhere in the middle waiting for the dust to settle, hoping we dont develop arthritis in our own hips while we are waiting.

I advised my 73 year old father-in-law that it was a good idea. Would I advise my 46 year old brother the same. It is a personal decision at the end of the day. As long as you know where the issues lie you can match the risks with the limitations your own hip places on your existance. Do as much research as you can, speak to people that have no vested interests, and at the end of the day you have to make your own call.

David Selvey

-- David Selvey (, August 15, 2003.

I have great pleasure in replying to this ongoing discussion as a Physical Therapist who ultimately has the job of returning patients back to functional "normality". The NICE document is found at so if you cut & paste this link into your browser it will take you straight there. Graduating back in 1995, it was nearly 2 years before I had the pleasure of treating Mr Ronan Treacey's patients at the Royal Orthopaedic Hospital in Birmingham and my only concern was a large proportion (30%) of patients reporting painful and limited hip flexion (knee to chest movement) in the early phases of recoevry. Unfortunately I rotated out of the ROH so I did not get to follow-up the longitudinal results. However even today (14.Oct.2003) in a different part of the UK I have just reviewed a patient who only has 60 degrees of hip flexion at week 7. This was a metal on metal but not performed at ROH. A paper by Smet et al (2002) Hip Int;12(2) pp.158-162) confirms my reservations and reassures me! Average hip flexion is 120.36 degrees (range of the subjects was 90-140). Thankfully the passage of times shows continued hip flexion range even when (like my patients) the early results seem poor. So further info & research papers via OR for patients So if it was my hip on the way out & showing early arthritic change I have no doubt I would opt for the Metal on Metal but surgical skill and geometry of the hip are CRUCIAL factors. Regards, Owen Moore

-- Mr Owen Moore - Clinical Specialist PT (, October 14, 2003.

I have had problems with my left hip since early child hood and now having just turned 39 had my left hip joint resurfaced. I have been seeing a specilist at one hospital in Lanarkshire Scotland for the last 13 years. The problems with constant pain 24/7 drove me to near depression and a very stressfull life, but after complaining to my doctor and then my specialist again, asking for a second opinion I waited another 9 months and finaly got my operation as i was nearly at the crippled stage of being unable to walk any great distance without being exhausted and in great pain. The thought of the operation was stressfoull enough but actually turned out O.K and was very happy with the result. Five weeks after the operation I can move my leg quite well and can now keep my foot straight in front of me when I walk as I could not do this before as this was very painful to do so. So to ant one out there needing this operation "Don't worry bescause the idea of not having to suffer extreme pain is fantastic and feels like a large load being taken of my shoulders".After many years of missusing my leg mucels I only have pain in the precess of building these wasted mucels back to their usual condition

-- Alex Crothers (, February 11, 2004.

You should visit this website:

-- Robert Toussie (, March 15, 2004.

I am an orthopaedic surgeon in Colombia, with a field of job in hip surgery. I had a training in UK, with Resurfacing hip surgery and now in my country, I am doing the surgery. I have experience with the Corin prostesis, Cormet 2000, made of crome-cobalt, and by the time I have had more than 60 patients that are very confortable with their new hip. I am very pleased with this surgery. You can take more information at the web in,, and I know, there is a group of Corin in USA.

-- Mauricio Páez (, May 29, 2004.

After walking around with a gimp for 2 years and researching hip surgury, I chose to go with the resurfacing,chromium cobalt.The hip was done in Feb. 2000 by Michael Mont in Baltimore,MD.My worse fear was having one leg shorter like I see in many of the full hip l surgeries. I am 58,back to playing softball, tennis, raquetball, and biking. No one knows I had a surgury unless I tell them...That's how good it is.

-- gerry smelson (, July 02, 2004.

I am 25 and am having a resurfacing operation on my right hip on 21st July. I was born with a dislocated hip but it went undetected until I was 18 months old. Surgeons reunited my ball and socket during 8 operations and it enabled me to live a normal childhood and adolescence.

Now, age 25, the joint is incredibly painful. Because it grew for 18 months whilst apart, the ball is not round, it is flat and irregular and the socket is more like a saucer than a niece round cup. An arthroscopy operation carried out in January showed my surgeon that there is no more cartilage protecting the joint and the surfaces are rough like the surface of the moon. I cannot walk for more than 5 minutes without being in severe pain, I have a very obvious limp and over the last month have been woken many times every night from the pain.

I am very nervous about the operation and feel reassured having read people's answers here. Obviously starting at such a young age is frightening but my life is limited by my hip and my twenties are going all too fast without me living the life of a young girl in her twenties! I have tried cod liver oil tablets, glucosamine tablets, cutting out foods that aggrevate arthritis and this is the last resort before the full hip replacement. I will write again after my op and let you know how it went. My surgeon is Professor Griffin in the UK.

A great site for info on this procedure is:

-- Jacqui Ballard (, July 11, 2004.

I am an active 60 year old who just had his hip resurfaced by Dr David Feldman in Englewood N.J. USA. The procedure was done June 23, 04. So far so good. 4 weeks past walking with a cane, the old paine gone, healing pain is ok.

-- Bob Kirschbaum (, July 23, 2004.

I have osteoarthritis in both hips which is making mw limp and walk stooped. This is now affecting my back, calves, shins and knees! I am waiting for an appointment to undergo Hip resurfacing in both hips. What I am trying to decide is whether to have them both done at the same time or to do one at a time. Any advise or experiences would be helpful to make my decision.

Stephen Taylor ( 25 July 2004

-- Stephen Taylor (, July 25, 2004.

I have osteoarthritis in both hips which is making mw limp and walk stooped. This is now affecting my back, calves, shins and knees! I am waiting for an appointment to undergo Hip resurfacing in both hips. What I am trying to decide is whether to have them both done at the same time or to do one at a time. Any advise or experiences would be helpful to make my decision.

Stephen Taylor ( 25 July 2004

-- Stephen Taylor (, July 25, 2004.

Hola. Tengo 38 años y hace 10 me detectaron una artrosis en ambas caderas. La izquierda està en un estado de desgaste muy avanzado y me duele mucho. hace poco oí hablar de las prótesis de re-surfacing pero tengo poca información de los resultados a largo plazo (de los 12-13 años que hace que se estan implantando). desearia informacion de alguien que lleve esta prótesis hace años, que tipo de vida ha llevado, si es verdad que puedes hacer todo tipo de deporte, si no ha habido demasiado desgaste,... Gracias

-- Jaume March (, September 22, 2004.

With reference having two hip replacements (Stephen Taylor). I am 3 weeks post left M on M hip resurfacing and 1 week post right resurfacing. My background: I am a 42 year old NHS patient with a 20+ history of idiopathic bilat OA and I am a GP by profession. My Surgery: This was my first experience of an operation. My surgeon, Mr Skinner, at the Royal National Orthopaedic Hosptial, Stanmore, was happy to consider performing the procedure 1 week apart but not at the same time. However, I was happy when he decided to defer my second operation for a second week. I lost about 800ml blood in total (during op and in drain) per operation and my haemaglobin after the second op was 9.5 having been 14 pre the first op. I have not felt too bad with a low count but a little more tired. This is rapidly resolving now without iron tablets or transfusion. The first 24 hours after both operations was tough as it was difficult to control nausea and pain. I did not have an epidural as I wanted to reduce the risk of bladder catheterisation. (My next door neighbour on the ward had stayed awake for his second hip procedure - 5 week gap - different surgeon)with the aid of an epidural and wished he hadn't - he felt rotten afterwards!) My scars are about 25 cm long and were clipped. They have healed excellently. The clips are removed 12-14 d post op and the drain was removed after 24 hours. My Rehab: I was on my feet after both operations within 24 hours of both operations and my rehab is progressing well and my analgesia requirement is reducing fast. My physio's pre- and post- op measurements have already shown that the range of movement in both joints is already demonstrating considerable improvement. I will remain on two crutches for the full 6 weeks post the second operation but I am happy to do this knowing that I only have one episode of rehab to contend with. It is early days I know and I am conscious of the temptation to overdo things. One guy bust his newly resurfaced hip after walking 9 miles on it for three days in a row 2 weeks after surgery!!! Please let me know if you would find any further news of help. Best wishes to whoever you all are! Tim

-- Dr Tim Fooks (, November 11, 2004.

2 years ago - 6th December 2002, i had my first BHR followed six weeks later by a second BHR performed by Mr Jeremy Latham in Southanpton.I am now 52 years old and part of my life was spent as a professional footballer where cortisone injections many years ago were the norm for ankle and knee ligament injuries which i suspect contributed to the problems. From day one after the operation, i felt elated that i had waited as advised by my GP to have this form of operation. Similrly, after the 2nd operation. i have never looked back. Though i am careful to avoid trips and falls, i regularly(3 times per week) attend a local health and fitness centre where i exercise on a rowing machine, stepper and cross trainer for a combined hour each time. I have knowledge of three friends of mine who simialrly have had both hips replaced by Jeremy Latham and who are evangelical in their praise for him and the BHR - one of which spends 5 days a week at the golf course walking 6 miles per day. My recovery was good - almost a giant step every three months when i looked back and "measured" how far i had "travelled" each period. i feel more flexible than i have for many years, fit and thankful that i am confident that i will not have to suffer further replacemnt surgery in time to come as those who have had THR will i woudl be happy to offer you further information if you would like to contact me

thank you

Paul Bennett

-- Paul Bennett (, December 11, 2004.

I aked my orthopedic surgeon yesterday about hip resurfacing. The list of disadvantages he gave me were as follows: i) In hip resurfacing they have to ream out more of the acetabular side (Cup side)will be more than the traditional cup requires ii) There is a high risk of fracture of the femur bone approx 5% iii) There is a larger scar needed to perform the operation therefore it is questionable if the healing time is any quicker iv)The joint is cemented. We all have seen what has happened in the past with cemented joints is that they do not wear well. I'm in a quandry myself as to which way to go. His advise was to go with a thr ceramic on ceramic uncemented and if I wanted all the advantages a Hip resurfacing offered I should go with a titanium hip because of the larger ball though he had no guarantee what harm the ions in the implant would have in your body. I will be asking more professional opions before I make my decision.

-- lynne kagan (, February 08, 2005.

I had a Birmingham resurfacing op (titanium)within the NHS system in the UK in April 2001 at the age of 52. This was totally successful, as far as I was concerned at the time,and I recovered very quickly to return to work and my other activities - teaching ballroom dancing and sailing. However, after about 2 years I again started to experience problems with flexing the knee upwards and with bending down. This continued and became gradually worse. My GP thought the various pain I was experiencing was due to a trapped nerve. I did however return to the hospital where I had the operation to have further X-rays. They could find nothing, but followed up with further X-rays over a period of some 4 months, still with no further problem showing. By December 2004 the pain was significantly worse and I decided to return for further x-rays after the Christmas and New Year holidays. However, circumstances intervened and in early January, having attended a sailing exhibition in East London and sat on a coffee bar stool, the pain was so excrutiating I couldn't put any weight at all on the joint. Extensive x-rays showed the cup had slipped out to one side. This did not show up on a flat x-ray - only on an angled one. I have now had a full ceramic/metal hip replacement as the surgeon decided that revision of the resurfacing was not a viable option. There was no evidence of infection in my joint.I have been told that the bone is supposed to bond to the metal cup and mine hadn't ever done so. Apparently this has not been a problem with anyone else! I am very interested to hear about anyone who may have had a similar problem and also from anyone who has experienced a ceramic/metal FHR. (I know two other people who had the resurfacing op after me, they have not had any similar discomfort to me and are carrying on a full life - so I do not wish to put anyone off having that particular operation)

-- Jackie Bignell (, March 14, 2005.

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