Hip Replacement in Young Patients

How young is too young for hip replacement surgery?

Hip replacement
A hip replacement surgery is performed for the treatment of severe hip arthritis.. Don Farrall / Getty Images

Hip replacement surgery has long been used to treat hip arthritis in elderly patients. However, concerns arise when a patient in his 40s, 50s, or younger, has severe hip arthritis that is not relieved with non-operative treatments. Once reserved for elderly patients, hip replacement surgery is becoming more common in the younger, active population.

How Young is Too Young?

No one can definitively answer this question, but what we do know is that the benefits of performing hip replacement surgery in younger patients may outweigh the risks of surgery.

The benefits are primarily quality of life, pain reduction, and maintaining proper fitness. By accomplishing these goals, patients may also reduce the risk of developing other problems associated with poor fitness such as cardiovascular disease.

The primary problem in performing hip replacement surgery in younger patients is the concern of wearing out the implant. Developments in manufacturing have sought to reduce the magnitude of this problem, but it is a concern. Furthermore, the amount of wear to a hip replacement is related to the activity level of the patient. As you might expect, the usual activities of the average 30 year old are different from the average 80 year old. Therefore, young patients with joint replacements should be cautious, and perform only suggested activities.

What Are the Results of Hip Replacement in Young Patients?

The results of hip replacement in patients younger than 50 years of age is clearly not as good as it is in older patients.

However, these studies show that almost 90% of implants are still functioning 10 years after surgery, and more than 60% are still working after 15 years. We know that the younger age you have a hip replacement, the more likely it is to wear out quickly.

What we do not know is how newer implants may affect the longevity of a hip replacement.

Most studies looking at how long hip implants last are evaluating traditional metal and plastic replacements. Newer implants made of all metal, or ceramic have shown better results in laboratory testing. It is important to understand, however, that lab results are not always predictive of how these implants will work in people, and we simply do not know if these newer implants are going to last longer.

Are Newer Implants Better?

Many new joint replacement implants are constantly being developed. The goal of any new implant is that it will be more reliable and more durable than preceding implants. While this is a terrific goal, the bottom line is that it is not always the case. Some new implants have been a tremendous success, while there are other stories of implants that have been recalled and even required surgical removal. Unfortunately, sometimes these problems don't show up until the implants have been used for years or even decades.

Implants can be tested in laboratory settings without exposing patients to any risk or harm, however, some implant problems only show up after they have been implanted in people.

Patients often want advice about which implant is best, or if newer implants are better. These a difficult questions to answer, and there is no perfect solution. While the prospect of a newly designed implant may be appealing, I think patients, even young patients, should use caution when trying anything without a proven track record. 

Young patients are rightfully concerned about how long their newly implanted joint replacement is likely to last. While there are no guarantees, there are good data to suggest that hip replacements often last 20 years or longer. Sticking to a proven implant that has a good track record can help to ensure that your replacement will last as long as possible.

Sources:

Daras M, Macaulay W. "Total Hip Arthroplasty in Young Patients With Osteoarthritis" Amer Journal Orthop. 2009 Mar;v38,n3:125-29.

McAuley JP, et al. "Total hip arthroplasty in patients 50 years and younger" Clin Orthop Relat Res. 2004 Jan;(418):119-25.

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