Birmingham Hip Resurfacing in Nashville, TN: Dr. Damon H. Petty
If hip pain has started to limit the activities that define your life, running, lifting, hockey, basketball, martial arts, or anything that loads the joint hard, and you have been told a total hip replacement is your only option, the conversation should not end there. Birmingham Hip Resurfacing (BHR) is a bone-conserving alternative designed for active patients who want lasting pain relief without giving up high-impact return to sport. It is not for everyone, and the right surgeon matters as much as the right procedure.
Dr. Damon H. Petty is one of the few orthopedic surgeons in the United States who has been performing BHR for over 25 years. He trained directly under Dr. Peter Brooks at the Cleveland Clinic, one of the American pioneers in advanced hip reconstruction and Birmingham Hip Resurfacing. Dr. Petty is board-certified in Orthopedic Surgery and Sports Medicine, fellowship-trained under Drs. James Andrews and William Clancy, and served as Head Orthopedic Team Physician for the Tennessee Titans from 2018 to 2026. He is the only surgeon in Middle Tennessee performing the BHR procedure.
A few things to know up front. BHR is FDA-approved in the United States for male patients only. Smith & Nephew, the BHR manufacturer, is winding down production of the implant, so candidate evaluation matters more now than ever. Dr. Petty is actively monitoring next-generation hip resurfacing implants as the BHR system supply tightens.
What Is Birmingham Hip Resurfacing?
Birmingham Hip Resurfacing is a bone-conserving alternative to total hip replacement. Instead of removing the femoral head (the ball of your hip) and inserting a long stem down your thighbone, BHR resurfaces just a few centimeters of bone on the femoral head with a smooth metal cap. The acetabulum (the socket) is fitted with a matching metal cup. The result is a metal-on-metal articulation that closely replicates the natural anatomy of your own hip.
The implant has two parts. The femoral component is a rounded cap that overlays the prepared femoral head, much like a crown on a tooth. It is cemented in place. The acetabular component is a press-fit metal cup with a porous outer surface that allows the patient’s bone to grow into it. Both components are made from a high-carbon cobalt-chromium alloy, one of the most durable metals used in artificial implants.
The Birmingham Hip Resurfacing system was designed by Derek McMinn and Ronan Treacy in Birmingham, England, and first implanted in 1997. It was approved by the U.S. Food and Drug Administration in 2006 for male patients. Today the BHR is manufactured by Smith & Nephew and remains the most widely implanted hip resurfacing device in the world, with the longest published follow-up data of any resurfacing implant.
How BHR Differs From Total Hip Replacement
Total hip replacement and Birmingham Hip Resurfacing solve the same problem, severe hip arthritis, but the approach is fundamentally different. Total hip replacement removes the entire femoral head and the femoral neck, then inserts a long titanium stem down the shaft of the femur to support a smaller artificial ball. BHR removes only a few centimeters of damaged bone from the femoral head and resurfaces what remains, preserving the natural neck and most of the original anatomy.
That preservation matters. The larger ball of a BHR implant approximates your native femoral head size, which substantially reduces dislocation risk compared with total hip replacement. The intact femoral neck means leg-length discrepancy after surgery is rare. And because the bone is preserved, future revision surgery, if ever needed, is a more straightforward conversion to a standard total hip replacement rather than a complex revision.
Birmingham Hip Resurfacing
A few centimeters of femoral head only
Metal cap on resurfaced bone, metal socket
Lower (large ball, anatomic match)
Rare
Yes, when properly healed
Convert to standard THR
Male patients only
Total Hip Replacement
Entire femoral head and neck
Titanium stem in femur, smaller artificial ball
Higher (smaller artificial ball)
Possible
Limited, typically discouraged
More complex revision required
All eligible adults
Bone removed
Implant
Dislocation risk
Leg-length change
High-impact sport return
Future revision
FDA approval
If you are not a BHR candidate, total hip replacement remains an excellent option with greater than 95% patient satisfaction. Learn more about Total Hip Replacement with Dr. Petty.
Dr. Petty has performed BHR procedures for 25 years across a patient population that includes athletes, firefighters, military service members, weightlifters, skilled tradesmen, and active executives in their 40s and 50s. He has also treated professional baseball players from the Yankees, Pittsburgh Pirates, Tampa Bay Rays, and Kansas City Royals organizations across his sports medicine practice. The protocols he uses for an active 52-year-old in Brentwood are the same protocols he has used for elite athletes.
Why Active Men Travel for Birmingham Hip Resurfacing
The reason patients seek BHR specifically, often traveling significant distances to find a surgeon who still performs it, comes down to one thing: the option to return to high-impact activity. Total hip replacement is a remarkable procedure for restoring quality of life, but most surgeons restrict patients from running, contact sports, heavy lifting, and other activities that load the joint at high force. The artificial stem-and-ball construct is engineered for durability, not for impact loading.
BHR loads the femur the way your natural hip does, because the femur is largely intact. With proper healing and a properly selected patient, BHR can support a return to activities that are typically off the table after total hip replacement.
Patients with BHR have returned to professional careers in:
The NBA (basketball at the highest level)
The NHL (hockey at the highest level)
Olympic-level fencing
Professional tennis (Andy Murray returned to the ATP tour after BHR)
Professional baseball (multiple MLB players)
Are You a Candidate for Birmingham Hip Resurfacing?
You may be a strong candidate for BHR if you are:
Male and under approximately 65 years old
Highly active and want to maintain or return to high-impact activity (running, basketball, hockey, weightlifting, martial arts, court sports, skilled labor)
Suffering from non-inflammatory hip arthritis (osteoarthritis, traumatic arthritis, avascular necrosis, hip dysplasia) or inflammatory arthritis such as rheumatoid arthritis
In good general health with a femoral head large enough and bone strong enough to support the implant
Willing to commit to annual follow-up imaging and bloodwork for the first five years after surgery, then again at the 10-year mark
BHR is generally not appropriate if you have:
Severe osteoporosis or weakened bone that cannot support the resurfacing cap
Chronic kidney disease, dialysis history, or a prior kidney transplant (because metal ions are cleared by the kidneys)
Known metal sensitivities
Smaller or weaker femoral head anatomy
Inability to follow post-operative restrictions
If you are not a BHR candidate, that is a legitimate finding, not the end of the conversation. Dr. Petty offers Total Hip Replacement, Hip Arthroscopy, and Stem Cell Therapy and Regenerative Medicine as alternatives, all from the same provider with the same standard of care.
The BHR Procedure:
What to Expect
The Birmingham Hip Resurfacing procedure typically takes 90 to 120 minutes and is performed at one of the Tennessee Orthopaedic Alliance surgical centers in the Nashville area. Most patients spend one night in the hospital, though some are appropriate for outpatient discharge.
Most patients are walking with assistance the same day of surgery and discharge home with crutches and a structured recovery plan.
Birmingham Hip Resurfacing Recovery Timeline
Recovery from BHR is structured around protecting the femoral neck while the bone heals around the implant. The protocol is more cautious than total hip replacement recovery for the first six months, then opens up considerably.
The single biggest predictor of femoral neck fracture after BHR is doing too much too early. Dr. Petty’s protocol is conservative for the first six months for a reason.
Long-Term Outcomes and Survivorship
The long-term data on Birmingham Hip Resurfacing in properly selected male patients is among the best in joint replacement. Published studies, including registry data from the Australian Orthopaedic Association National Joint Replacement Registry and the United Kingdom’s national joint registry, demonstrate greater than 98% survivorship at 20 years in properly selected male patients under the age of 65 at the time of surgery.
A separate 25-year follow-up study from the Royal Orthopaedic Hospital in Birmingham, where the BHR was developed, reported an 89.5% male implant survival rate at 25 years and a 95.4% to 99.5% patient satisfaction rate across published cohorts. These results are comparable to or better than total hip replacement outcomes in the same demographic, which is remarkable given that BHR patients are typically younger and more demanding on the implant.
Dr. Petty’s outcomes track to the published literature. Across 25 years of performing BHR, his patients have included athletes who have returned to professional careers, active professionals who have maintained their preferred sports without ongoing hip pain, and laborers who have returned to physically demanding work. The combination of careful patient selection, anatomic implant placement, and structured surveillance is what produces these results, and it is what separates a surgeon with deep BHR experience from one who performs the procedure occasionally.
BHR Implant Phase-Out:
What Patients Need to Know
Smith & Nephew, the manufacturer of the Birmingham Hip Resurfacing implant, is winding down production of the BHR system. Supply is limited and the window for patients who want a BHR specifically is narrowing. This is one of the reasons early consultation matters: candidate evaluation, scheduling, and implant procurement all take time, and surgeons performing BHR are working with finite implant inventory.
Dr. Petty is actively monitoring the next generation of hip resurfacing implants as they progress through development and regulatory review. Several promising next-generation systems are in advanced stages, including ceramic-on-ceramic resurfacing alternatives and refined metal-on-metal designs that address some of the limitations of the original BHR. As these systems become clinically available, Dr. Petty will offer them when they are appropriate and when the long-term data supports their use. For now, the BHR remains the gold standard for hip resurfacing in eligible male patients, and Dr. Petty has implant access for properly selected candidates.
Why Choose Dr. Petty for Birmingham Hip Resurfacing in Nashville
25 Years of BHR Experience, Trained by an American BHR Pioneer.
Dr. Petty completed specialized BHR training at the Cleveland Clinic under Dr. Peter Brooks, one of the American pioneers in advanced hip reconstruction and Birmingham Hip Resurfacing. He has been performing BHR for over 25 years across a patient population that ranges from professional athletes to active executives to skilled tradesmen. His outcomes include patients who have returned to careers in the NBA, the NHL, and Olympic-level fencing, outcomes that traditional total hip replacement cannot deliver.
Dual Board Certification and Andrews-Clancy Fellowship Training
Dr. Petty is board-certified in both Orthopedic Surgery and Sports Medicine. He graduated from Harvard University with honors and the University of Virginia School of Medicine, completed his orthopedic residency at the Cleveland Clinic (consistently ranked among the top orthopedic programs in the country), and finished a highly selective sports medicine fellowship under Drs. James R. Andrews and William Clancy in Birmingham, Alabama. He is a member of the American Academy of Orthopaedic Surgeons (AAOS), the American Orthopaedic Society for Sports Medicine (AOSSM), and the invitation-only American Sports Medicine Fellowship Society.
NFL and Professional Athlete Care
Dr. Petty served as Head Orthopedic Team Physician for the Tennessee Titans from 2018 to 2026 and has been team physician for Tennessee State University for the last 15 years. He has treated professional baseball players across multiple MLB organizations, including the New York Yankees, Pittsburgh Pirates, Tampa Bay Rays, and Kansas City Royals. The diagnostic precision and protocols he developed at the highest level of professional sport are the same protocols he brings to every BHR patient at TOA.
Surgeon-Performed Care, Not Delegated
Every step of your evaluation, surgical planning, BHR procedure, and postoperative surveillance is performed by Dr. Petty personally. Bone marrow surveillance bloodwork review, x-ray interpretation, and follow-up clinical visits are not delegated to a physician assistant or nurse practitioner.
Cost of Birmingham Hip Resurfacing in Nashville
Birmingham Hip Resurfacing is generally considered medically necessary when performed for hip arthritis, avascular necrosis, or other indicated conditions, and most insurance plans cover the procedure.
National total procedure costs for BHR in the United States generally range from
$20,000 to $50,000
Including hospital fees, surgeon fees, anesthesia, and standard follow-up care. Your out-of-pocket expense depends on your plan, your deductible, and your co-insurance.
Dr. Petty practices through Tennessee Orthopaedic Alliance, which accepts most major insurance plans. Self-pay options are available for patients without coverage or who prefer to pay directly.
Patient Reviews
“As a hard working father of 4, who absolutely doesn’t like going to the doctor, Dr. Petty doesn’t waste time or resources and is straight to the point. I am a returning patient. I am very pleased with my first hip resurfacing operation and look forward to my second, and I wouldn’t want anyone else to perform that surgery but Dr. Petty.”
— Ashley Locke, Sept 2025
“I’ve been a patient of Dr. Petty’s for 8 years. I’ve had 3 surgeries and scheduling a 4th with him, as well. He cuts to the chase, explains why surgery is indicated, what to expect, the risks, all of it. If he thinks more conservative measures are indicated, he’ll make that suggestion.”
— Nancy S., Oct 2025
From the moment I walked in, I felt welcomed and well cared for. Dr. Petty was thorough, patient, and took the time to listen to my concerns.”
Roberto C., Aug 2025
Great expertise and knowledge on where the medicine should be applied and why.
- Healthgrades
Frequently Asked Questions About Birmingham Hip Resurfacing
Schedule a Birmingham Hip Resurfacing Consultation in Nashville
Dr. Petty sees patients at his Nashville office through Tennessee Orthopaedic Alliance (TOA) at 8 City Blvd, Nashville, TN 37209. Phone: (615) 329-6600. Hours: Monday through Friday, 8:00 AM to 5:00 PM.
We see BHR candidates from Nashville, Brentwood, Franklin, Murfreesboro, Hendersonville, Gallatin, Lebanon, and communities throughout Middle Tennessee. We also see patients who travel to Nashville from many states throughout the Eastern United States specifically for Dr. Petty’s expertise with Birmingham Hip Resurfacing, which is one of the few procedures in orthopedics where finding the right surgeon often means crossing state lines.