Smith and Nephew


BIRMINGHAM HIP (BHR) Resurfacing System

An alternative to total hip replacement


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

The Implant

The BHR Hip was approved for use in the United States by the Food and Drug Administration in 2006, but has been implanted in hospitals around the world since 1997.

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

The benefits to patients of the BHR technique and implant 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.

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 reduces the risk of dislocation of your implant after surgery.

The 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 your femoral head, a well-placed BHR Hip reduces concerns about 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, 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 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 resurfacing 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 20141 showed BHR survivorship of 91.6% at 13 years follow-up, the longest of any resurfacing device.
  • BHR is the only resurfacing device with more than 10 years of registry data and continues to be the most implanted resurfacing device world-wide.
  • Great Britain's Oswestry Outcomes Centre's patient registry revealed BHR Hip's 10-year survivorship of 95.4%, with 98.6% of patients rating their opinion of the experience as pleased or extremely pleased.2
  • A study presented at the American Academy of Orthopaedic Surgeons 2010 Annual Meeting discussed importance of several factors in successful outcomes of resurfacing hip replacements. One factor was prosthesis selection, and it showed that BHR Hip had a significantly lower risk of revision than other hip resurfacing options.
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. Females should not have the BHR device. 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 recommendations 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 if you experience impact 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.


1Australian Orthopaedic Association National Joint Replacement Registry Annual Report. Adelaide: AOA; 2014.


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

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Not every orthopaedic surgeon is trained to use the BHR Hip. Find the surgeons in your area who use the BHR Hip by entering your ZIP code or city and state below.