Comparative analysis of Birmingham hip resurfacing: Minimum 2-year follow-up clinical outcomes in obese vs. non-obese populations
Author(s):Quesada-Jimenez R, Walsh EG, Kahana-Rojkind AH, Kuhns BD, Schab AR, Domb BG.
DOI Link: 10.1016/j.jos.2025.07.012
Background
Birmingham hip resurfacing (HR) is an alternative to total hip replacement, particularly in younger or more active patients. Obesity can increase the risk of osteoarthritis earlier in life, but it may also affect surgical outcomes. This study compared outcomes of hip resurfacing in obese versus non-obese patients.
Methods
This retrospective Level 3 study evaluated patients who underwent hip resurfacing between 2010 and 2021 with at least 2-year follow-up or documented endpoint. Patients with BMI ≥30 were included and propensity matched 1:1 with non-obese controls based on age, surgical approach, and follow-up duration. Outcomes included validated PROs (mHHS, HOOS-JR, FJS, VAS), patient satisfaction, return to sport, complication rates, revision surgery, and implant positioning.
Key Findings
A total of 70 patients were analyzed.
- Both obese and non-obese patients showed significant improvement in all PROs
- Patient-reported outcomes and satisfaction were comparable between groups
- Similar rates of return to sport and achievement of clinical outcome thresholds
- Obese patients with BMI >35 had higher complication and revision rates
- Increased risk of conversion to total hip arthroplasty in higher BMI subgroup
Conclusion
Hip resurfacing provides strong short-term functional improvement in both obese and non-obese patients, with comparable outcomes overall. However, higher BMI—particularly morbid obesity—is associated with increased risk of complications and revision surgery.
What Does This Mean for Providers?
Hip resurfacing can be considered in appropriately selected obese patients, but risk stratification is important. Patients with higher BMI, especially >35, should be counseled on increased complication and revision risk despite similar functional improvements.