Outcome of Birmingham hip resurfacing at ten years: role of routine whole blood metal ion measurements in screening for pseudotumours

Int Orthop. 2014 Nov;38(11):2251-7. doi: 10.1007/s00264-014-2429-4. Epub 2014 Jul 17.


Purpose: Emerging concern has arisen because of recent papers reporting a high prevalence of pseudotumours (PTs), even in patients with surface arthroplasties with a good clinical track record. The aim of our study was to establish the ten year survivorship of Birmingham hip resurfacing (BHR), to investigate whole blood (WB) metal ion levels and prevalence of adverse reactions to metal debris (ARMeD) and to determine the association of blood metal ion levels and symptoms with ARMeD in patients operated on with BHR at our institution.

Methods: Between May 2001 and May 2004, 261 consecutive BHRs were implanted in 219 patients. All living, nonrevised patients underwent a systematic screening programme consisting of clinical examination, WB cobalt and chromium measurements and targeted cross-sectional imaging.

Results: The ten year survival for the entire cohort was 91% (89-93%), with any revision as the endpoint. Prevalence of ARMeD was 6.9% in male and 8.8% in female patients. Symptomatic patients with elevated metal ion levels evinced highest prevalence (63%) of PTs compared with asymptomatic patients with elevated metal ion levels (42%) and symptomatic patients with nonelevated metal ions (11%).

Conclusions: Contradicting the current international guidelines, our results suggest that it seems beneficial to combine routine metal ion measurement with clinical assessment, even in patients with well-functioning BHRs. Further follow-up will reveal whether new PTs will develop in these patients and BHR survivorship in the longer term.

MeSH terms

  • Aged
  • Arthroplasty, Replacement, Hip / methods*
  • Cobalt / blood
  • Female
  • Granuloma, Plasma Cell / blood*
  • Hip Prosthesis / adverse effects
  • Humans
  • Ions / blood
  • Male
  • Metal-on-Metal Joint Prostheses
  • Metals / blood
  • Middle Aged
  • Prevalence
  • Prosthesis Design


  • Ions
  • Metals
  • Cobalt