BHR vs THR

Hi LJay – I have a BHR and a THR and I have done a lot of research over the last 4 years. My first recommendation is to explore the website “Surfacehippy.com” and look at Mr McMinn’s own website because he invented the procedure. For me, BHR was a no-brainer but I was about at the limit of the envelope for age and bone quality. Since then (nearly 3 years ago) the BHR device has been limited to males and with a minimum size of 48mm (me) by the manufacturer. This has not meant the end of resurfacing, though, as other devices are available and small women can still be treated by experienced surgeons, of which there are a couple of handfuls in the US and somewhat fewer in the UK.
In practice, there is little difference in the short-term results as far as I can see. My BHR was only a couple of months old when I started jogging carefully but it took about a year to feel completely confident running fast. My THR is only 5 months old and jogging recommended at 6 weeks because I had no femoral head to worry about breaking off (the operation saw to that, unfortunately) and I have already done lots of running, walking, cycling and climbing as my recent post shows. There is still some pain in this leg though, but a THR from scratch, rather than a failed BHR op, would be an easier operation with less soft-tissue disturbance.
Technology: BHR is metal on metal, newer devices are metal on polyethylene. There is a risk of reaction to the chrome or cobalt contained in the steel, but a very small risk. Lifespan of the bearing is at least 20 years if fitted properly ie Dr Gross at Cleveland Clinic or Derek McMinn/Ronan Treacy in Birmingham, UK. Modern resurfacing using polythene can have the polythene liner replaced if it wears (Dr Pritchett). THR is based on ceramic, mine is ceramic on ceramic but the trend is for ceramic on polythene, again the liner should be replaceable if it wears. Ceramic will not wear but used to shatter, apparently this has been overcome with new materials.
Disadvantages: THR involves a metal stem inside the femur, normal loading of the femur encourages bone growth but the load/stress is shielded by the stem so bone will tend to lose density (the opposite happens with resurfacing) and to me this is the biggest disadvantage to THR, and must be a significant concern to younger people faced with the decision.
Resurfacing will always be more expensive and less likely to be accepted by insurance companies, and MoM currently has a very bad press due to previous faulty devices and poorly trained surgeons.

Hope this helps,

Pete

I Just had the BHR installed via Dr, Pritchett 7 weeks ago, I couldn’t be happier! It’s hard to imagine a faster recovery. The Procedure was done as out patient procedure (only took a few hours and I was sent home). This reduced the cost considerably. There was no extra charge for the BHR over THR it’s universally coded on the insurance form as Joint angioplasty. I had no problems with my insurance (united health care) I now am running a 10k distance slowly, ( your actual mileage will vary, I’m not normal , a little insane and a card carrying member of the Marathon Maniacs Club currently I run 5 – 6 miles 3-4 times a week, I am not fully recovered by any means, but it does get easier each week . PT Helps a lot. I believe the key to a fast recovery is the BHR advantage; which as Pete describes, is the capping of the Femur, The superior approach that Dr Pritchett used and the way he sets and sutures the tendon length, or something like this, not sure I am describing it correctly . I also ran before surgery … a10k everyday The, Boston, Eugene and Seattle rock and roll marathons. Three months prior.
My recovery goal is to run the Boston marathon one more time ..I have to qualify by running a marathon at BQ pace by Sept 15 2018 ..about 11 months out, I am working towards this. I would definitely give a BHR consideration , suggest you consult with one of the expert resurfacing surgeons who specialize in the procedure and see if it’s a good fit for you.
I am a 62 year old male, running fool, who just didn’t want to give it up

I enjoy this question and the answers.
I am an active 52 year old male 5 weeks post op of RTHR (biomet dual articulation E1).
I saw three OS and none of them recommended resurfacing but did suggest I see Dr. Pritchett if I wanted to learn more. I now somewhat regret I didn’t follow up but also believe I would have had ongoing concerns about the metal on metal wear and if I would be one of the unlucky ones impacted. Other concerns were the potential bone loss on the acetabular side from excessive reaming or having to accomodate a bigger cup. Bone saving on the femoral side is a plus but potential bone loss on the acetabular side is rarely mentioned.
I think I understand how a metal/metal hip resurfacing allows higher impact activities but if resurfacing is now trending towards metal on poly then I would think the benefits/differences between resurfacing and replacement would be negligible. Does that make sense?