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Man in his early 50's with arthritis affecting both his hips received hip resurfacing on both sides and has subsequently trekked round the Himalayas.

In the UK, Metal on Metal (MoM) bearings are enjoying a renaissance as the Birmingham Hip Resurfacing (BHR). This implant is engineered to trap a thin layer of the body's own fluid between the metal bearing surfaces, as oil is used in a car engine. This produces a very low friction bearing that has wears very slowly. Whilst blood metal levels are increased in those with MoM hip replacements, there seems to be no adverse consequences of this after many decades' experience with these bearings.

Resurfacing involves trimming of the femoral head to fit the implant rather than removing it and fixing the femoral component to the shaft. The amount of bone removed is therefore minimal. Because the shaft of the femur is not transgressed there is no thigh pain, less blood loss, and should revision ever be required complex revision implants are unnecessary.

The BHR has been in use in its current form since 1997. Despite relatively short follow up, the failure rate has already been shown to be lower than for conventional THR in patients under 55 years old. The commonest reason for re-operation is femoral neck fracture (0.5%), and it is now known that resurfacing is not suitable for patients with or at risk of osteoporosis.

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