operative technique, eventually developing the Birmingham Hip Resurfacing (BHR). The first BHR was implanted in July 1997, in Birmingham, England. Over the next few years its success spurred surgeons all over the United Kingdom, Europe, Australia and many parts of Asia to start performing the procedure. On 9 May 2006, the FDA approved the BHR for medical use in the United States. Following thirteen years of usage McMinn reports 96% success with his BHRs in all patients and all diagnoses. These resurfacings are particularly successful in young patients who are the worst group for THRs. His success rate of the BHR in this age group is 98% at 13 years. Several other series and national registers also show similar results of around 95% currently with the BHR. The 2009 Australian National Joint Replacement Registry reported a 95% success rate for the BHR. From 2009 onwards MOM resurfacing came under a cloud, as DePuy marketed the ASR hip resurfacing and persuaded many of their user surgeons to implant it. It had a bearing clearance of 60microns, in comparison with the BHR's 200+microns, determined from the Ring explant and other retrievals. With a high early failure rate it was taken off the market within 3 years. More careful surveillance by the UK National Joint Registry indicated that resurfacings in women had a higher failure rate, as any head size of 46mm and less had. In 2004 John O'Hara worked with Finsbury Orthopaedics to develop the ADEPT hip resurfacing. The implant was very similar and was manufactured on the same machines as the BHR has been since 1997. The major developments were in the instrumentation which were so improved that it became much easier to implant the Adept in an optimal position. In the most recent UKNJR data, the failure rate for the Adept is slightly better than ceramic on cross linked polyethylene hip replacements and is half that of the BHR in the range of sizes still made. Short Stem Hip Replacement Birmingham Mid Head Resection In the early 2000s, McMinn found that the results of the BHR are excellent in all types of hip arthritis except one. In a condition called osteonecrosis, in which the ball part of the hip joint suffers a loss of blood supply and becomes non-viable, the results of hip resurfacing are not good (less than 90% success 10 years after their operation). Osteonecrosis can occur from