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 patients. It was approved by the FDA on May 9, 2006.

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.

This article looks at the Birmingham System, how it works, and what some of its pros and cons are.

Birmingham hip resurfacing system

Smith & Nephew

How the Birmingham System Works

The Birmingham Hip Resurfacing System is used to replace parts of a damaged hip. Hip resurfacing may be considered if your hip has 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. In younger patients, this helps make it possible to perform additional surgeries later in life, including total hip replacement.

The Birmingham Hip is a two-part system. First, the ball at the end of the femur bone is resurfaced so a metal cap can be placed over it. Then, the surgeon fits a metal cup into the pelvic socket (acetabulum).

The Birmingham Hip is a metal-on-metal joint. Essentially, the procedure smooths the worn areas of the ball-and-socket joint with durable high-carbide cobalt chrome. This eliminates pain and returns natural motion to the hip.

The hip resurfacing procedure has a high reported success rate of more than 94%.

Pros and Cons of Hip Resurfacing

Hip resurfacing may be a good choice for people who are young and active. The surgery does have certain disadvantages, however, along with its potential advantages.

Pros of Hip Resurfacing

  • The recovery time tends to be shorter, with less time spent in the hospital and less time before normal activities can be resumed.
  • The joint may be better able to withstand higher-impact activities like running.
  • It may last longer than a traditional hip replacement.
  • The larger ball is more stable and at less risk for dislocating.
  • The surgery preserves bone so revision surgery can be done in the future, if necessary.

Cons of Hip Resurfacing

  • The potential health impacts of metal debris that may result from a metal-on-metal joint is not well understood.
  • There is a small risk of nerve injury and associated muscle weakness in the leg.
  • There is also a small risk of fracture, especially in older females.
  • The surgery is much more difficult than traditional hip replacement so it may be harder to find a qualified surgeon.

Is the Birmingham Hip Right for You?

A metal-on-metal joint, such as the Birmingham Hip, eliminates problems with wear typically seen in traditional hip replacements. Wear is recognized as a cause of loosening of the hip prostheses.

The Birmingham Hip is not usually recommended for older people or for those who are not active. The resurfacing system is also not appropriate for people who have:

  • An infection in the body or blood
  • Bones that are not fully grown
  • 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 recovery
  • Bones that are not healthy or strong enough due to osteoporosis
  • A family history of bone loss
  • Multiple fluid-filled cavities (cysts) greater than 1 centimeter (cm) in the femoral head
  • Significantly impaired kidney function
  • Metal sensitivity
  • A suppressed immune system due to diseases such as AIDS 

It's also not recommended for:

  • Female of child-bearing age, since it is unknown whether metal ions released by the device could harm an unborn child
  • People who receive high doses of corticosteroids
  • Those who are obese or severely overweight

Most health insurers, including Medicare, will cover hip resurfacing. You may need to meet certain criteria, however, such as being under 65 years of age and trying non-surgical treatments first.

Costs vary widely according to the location where the surgery is performed, but the overall cost of hip resurfacing tends to be lower than hip replacement. One study found that the average cost of hip resurfacing was $26,000, while hip replacement cost an average of $50,000.


The Birmingham Hip Resurfacing System is an alternative to traditional hip replacement. It is usually done in younger, more active people. The major advantage of the surgery is that it preserves bone so additional surgeries can be done in the future, if necessary. It may also last longer and be less likely to dislocate than a traditional hip replacement.

Some people aren't good candidates for hip resurfacing. These include people with certain medical problems such as osteoporosis, kidney problems, or a suppressed immune system.

A Word From Verywell

Not all people who need a hip replacement will be good candidates 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 metal implants. 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 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. 

13 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.
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By Carol Eustice
Carol Eustice is a writer covering arthritis and chronic illness, who herself has been diagnosed with both rheumatoid arthritis and osteoarthritis.