How the Birmingham Hip Resurfacing System Works

The Birmingham Hip Resurfacing System was the first FDA-approved hip resurfacing system available for use in the United States. Hip resurfacing is an alternative to traditional total hip replacement for some arthritis patients. It was approved by the U.S. FDA on May 9, 2006.

What Is the Birmingham Hip?

Birmingham hip resurfacing system

Smith & Nephew

First introduced in 1997 in the United Kingdom, the Birmingham Hip has been used in 26 other countries and has been implanted in thousands of patients. Smith & Nephew is the manufacturer of the Birmingham Hip Resurfacing System.

How the Birmingham System Works

The Birmingham Hip Resurfacing System relieves hip pain and improves hip function by replacing parts of the damaged hip. The hip may have been damaged by osteoarthritis, rheumatoid arthritis, traumatic arthritis, dysplasia, or avascular necrosis.

The Birmingham Hip Resurfacing System is designed to conserve more bone than a traditional hip replacement. By conserving more bone, younger patients preserve future surgery options, including a traditional hip replacement, if later needed.

The Birmingham Hip is a two-part system. A metal cap is placed over the resurfaced femoral ball. A metal cup fits into the pelvic socket or acetabulum. The Birmingham Hip is a metal-on-metal joint.

The ball of the femur (as illustrated) is resurfaced before the metal cap is fit over it. Essentially, the Birmingham Hip smooths the worn areas of the ball-and-socket joint with durable high-carbide cobalt chrome, eliminating pain and returning a natural motion to the hip.

Is the Birmingham Hip Right for You?

A metal-on-metal joint, such as the Birmingham Hip, eliminates problems caused by polyethylene wear in traditional hip replacements which have a plastic liner in the acetabular component. Polyethylene wear is recognized as a cause of loosening of hip prostheses.

The Birmingham Hip is designed for young, active patients. It is not recommended for the elderly or inactive patients. The resurfacing system is also not appropriate in the following situations:

  • Patient has an infection in the body or blood.
  • Patient has bones that are not full grown.
  • Patient has a blood vessel-related disease, muscle-related disease, or nerve-and-muscle-related disease that will prevent stability of the Birmingham Hip or may interfere with the recovery phase.
  • Patient's bones are not healthy or strong enough due to osteoporosis, or there is a family history of bone loss; or if there are multiple fluid-filled cavities (cysts) greater than 1 centimeter in the femoral head.
  • Patient is female and of child-bearing age since it is unknown whether metal ions released by the device could harm an unborn child.
  • Patient has a kidney with significantly impaired function.
  • Patient has metal sensitivity.
  • Patient has a suppressed immune system due to diseases such as AIDS or receives high doses of corticosteroids.
  • Patient is obese or severely overweight.

Bottom Line

Not all arthritis patients who need a hip replacement will be an ideal candidate for the Birmingham Hip Resurfacing System. It is best for you to know your options and to discuss them with your healthcare provider. Based on your medical history, your practitioner will advise you and make a recommendation with regard to the best procedure for you.

Frequently Asked Questions

  • What's the difference between hip resurfacing and hip replacement?

    With hip resurfacing, the surgeon first trims away damaged cartilage and bone, then covers the hip socket and thigh bone with medal shells. In a hip replacement, the surgeon removes and replaces the entire head of the thigh bone and hip socket.

  • Who is a good candidate for hip resurfacing?

    In general, hip resurfacing is recommended for people with hip osteoarthritis who are younger, fit, and active with strong healthy bones. It is more commonly performed in men in their early 50s and should not be done in people over 65. That said, recommendations depend on the person and method of resurfacing.


  • How long does a Birmingham Hip Resurfacing surgery take?

    The surgery will take between one and a half and three hours to complete. After the surgery, you will likely stay overnight in the hospital for one to four days. 

  • How long will a Birmingham hip resurfacing last?

    At least 10 years and possibly even 15. A 2021 study found that 92.9% of BHR joints were still working properly after 10 years. Another study reported that 97.4% of BHR joints were still good at 10 years and 95.8% were still going strong at 15 years. 

  • What are the benefits of hip resurfacing?

    There is a decreased risk of hip dislocation because the resurfacing ball is larger and closer to the size of a natural femur ball. Walking patterns are also more natural after a hip resurfacing than a hip replacement. Hip resurfacing is also easier to revise, if needed.

  • How long will it take to recover after hip resurfacing?

    It will take at least six weeks after Birmingham Hip Resurfacing surgery to recover to the point of doing daily activities without pain. Your orthopedic surgeon will likely recommend physical therapy to regain hip strength, range of motion, and functioning.

  • Why were Birmingham hip resurfacing systems recalled?

    In 2015, manufacturer Smith & Nephew voluntarily recalled femoral heads that were 46 millimeters (mm) in diameter and smaller due to a greater risk of dislocation and a need for revision surgery. Patients do not need to take any action unless the artificial joint is causing them problems or pain. 


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4 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Su EP, Ho H, Bhal V, et al. Results of the first U.S. FDA-approved hip resurfacing device at 10-year follow-up. J Bone Joint Surg Am. 2021;103(14):1303–11. doi:10.2106/JBJS.20.01886

  2. Daniel J, Pradhan C, Ziaee H, Pynsent PB, McMinn DJ. Results of Birmingham hip resurfacing at 12 to 15 years: a single-surgeon series. Bone Joint J. 2014;96-B(10):1298–306. doi:10.1302/0301-620X.96B10.33695

  3. American Academy of Orthopaedic Surgeons: OrthoInfo. Hip resurfacing.

  4. Smith and Nephew. Statement regarding BHR system.

Additional Reading
  • Medical Devices. FDA. Birmingham Hip Resurfacing (BHR) System - P040033. Updated 09/05/2013.
  • Smith & Nephew Receives FDA Approval For Birmingham Hip Resurfacing System, May 10, 2006