Younger Adults Getting Hip Replacements On The Rise

According to the American College of Rheumatology, nearly half a million people in the United States get a hip replacement each year. And that number is only going to increase as our population ages.

But total hip replacements aren’t just for those adults in their 60s or 70s anymore or for older adults suffering from osteoarthritis. An increasing number of adults under the age of 50 are undergoing this procedure. James Hartson, MD, an orthopedic surgeon at Franciscan Health Michigan City, explained another growing population of hip replacement patients: people in their 40s and 50s.

Why Are Younger Adults Getting Hip Replacements?

The number of hip replacements among younger adults has been rising steadily over the past few decades. In adults younger than 55 years old, total hip arthroplasty procedures increased by 177 percent between 2000 and 2019. 

This rise is attributed to several factors, including higher rates of early-onset osteoarthritis, obesity, and sports-related injuries. Younger adults often experience hip degeneration due to repetitive stress, congenital conditions such as hip dysplasia, or avascular necrosis, which leads to bone death and necessitates joint replacement. Younger adults are often involved in high-impact sports or physically demanding jobs, which can speed up the wear and tear on joints.

In addition, new and improved imaging technology can identify joint issues earlier, leading to quicker interventions.

"We are seeing a significant increase in younger patients, many of whom are highly active and eager to regain full mobility," Dr. Hartson said. "This shift poses unique challenges, particularly regarding implant longevity and the higher likelihood of revision surgery due to increased wear and tear over time."

There are several reasons that lead people to consider a hip replacement.

Arthritis

The top reason that people in their 40s and 50s are getting hip replacements is due to arthritis, specifically osteoarthritis. Injuries from sports or motor vehicle accidents can commonly lead to arthritis.

Hip dysplasia

For people in their 20s and 30s, having a condition called hip dysplasia can lead to needing a hip replacement earlier. In people with this fairly rare condition, their hips may not have developed quite right during infancy or childhood. This malformation can then lead to arthritis at a moderately young age.

Avascular necrosis

In people with this condition, the blood supply to the hip dies out. Avascular necrosis leads to early failure of the hip. In some cases, the cause of this condition is unknown. However, it sometimes occurs in people with:

• Diabetes
• History of drug or alcohol use
• History of smoking

Long-term steroid use

The other group that might require a hip replacement at an earlier age are those who have been on long-term (chronic) steroid medication to treat a health condition such as asthma or a rheumatoid condition.

Other health conditions

Other medical conditions that might lead to a total hip replacement among younger adults include avascular necrosis, congenital hip disorders and sports-related injuries. 

Should I Consider Hip Replacement?

Healthcare professionals generally consider a hip replacement an elective procedure. If you need a hip replacement, you’ll have a detailed discussion with your healthcare provider to weigh the advantages and disadvantages. In most cases, you’ll explore less invasive therapeutic alternatives before considering surgery.

If the hip pain is affecting quality of life, your surgeon may consider hip replacement as a treatment option.

What Are Challenges Of Hip Replacement In Younger Adults?

Common challenges among younger adults having hips replacements are the possible need for a second hip surgery later in life, activity levels and mental health, Dr. Hartson said.

"While hip replacement can provide significant pain relief and improved mobility, younger patients must carefully consider the challenges, including implant longevity and lifestyle modifications," he said. 

Potential of a later hip surgery

One of the biggest concerns for younger adults having a hip replacement is the lifespan of the prosthetic joint, Dr. Hartson said. Traditional hip implants typically last between 15 and 20 years, meaning that younger adults may require revision surgery later in life.  So, if a person in their 40s or 50s undergoes a joint replacement, it’s very likely they’ll have to undergo at least one more procedure to replace that same joint again in their lifetime.According to a study published in The Journal of Bone and Joint Surgery, patients under the age of 50 have nearly double the risk of requiring a revision surgery compared to those ages 65 or older.

Revision hip replacement surgeries are often more complex, with increased risks of complications such as bone loss and infection.  

Physical activity wearing the hip joint

Another major challenge is the activity level of younger patients. Unlike older adults, who are generally less active, younger individuals often wish to resume high-impact activities such as running, sports or heavy lifting. These activities can accelerate implant wear, leading to early failure of the prosthetic hip. Younger adults who have had hip replacement need to be mindful of their activity levels post-surgery, as high-impact activities can significantly reduce the lifespan of their hip implant, Dr. Hartson said.

Mental health factors

Finally, psychological and emotional factors play a role. Many younger patients struggle with the idea of undergoing a major joint replacement, particularly because they anticipate needing further surgeries later in life. They also face the challenge of adapting to potential lifestyle changes, including avoiding certain activities that could compromise the hip implant’s longevity.

Advancements in Hip Replacement Technology

To address the concerns of younger patients, advancements in hip replacement technology have focused on improving the lifespan of implant materials and surgical techniques. One major development is the use of highly cross-linked polyethylene and ceramic implants, which have significantly reduced wear rates compared to traditional metal-on-polyethylene implants. Ceramic hip implants demonstrated superior wear resistance, with a projected lifespan exceeding 25 years, making them a promising option for younger patients.

Another innovation is the use of minimally invasive surgical techniques, which result in smaller incisions, reduced muscle damage and faster recovery times. The anterior approach, for example, has gained popularity because it allows for a quicker return to normal activities. Additionally, robotic-assisted hip replacement surgery is becoming more common, improving precision, implant alignment and long-term outcomes.

The combination of advanced biomaterials, robotic-assisted surgery and the anterior approach has revolutionized hip replacement procedures, offering younger patients a longer-lasting and more natural-feeling joint.

"Fortunately, new materials and surgical innovations are helping to extend the life of hip implants, reducing the need for multiple revision surgeries," Dr. Hartson said. "As technology continues to evolve, younger patients undergoing hip replacement can look forward to better long-term outcomes and an improved quality of life."

What Can I Expect With Hip Replacement?

The hip is a ball-and-socket joint. In hip replacement surgery, the surgeon removes the ball and socket and replaces them with an implant made from metal (titanium, most often) or high-grade plastic.

The procedure itself typically takes about an hour. For younger and generally healthy people, surgery will likely be an outpatient procedure and most can return home the same day as surgery. Many can resume low-impact exercise, such as walking, biking or swimming, soon after surgery. And those with office jobs can get back to work within a few days.

How Can I Protect My Hips?

Recovering from hip replacement surgery can take time. Follow these tips to protect your hip health — now and for years to come:

• Avoid injury as much as possible.
• Exercise regularly — preferably low-impact activities such as walking, swimming or biking.
• Maintain flexibility through regular stretching or activities such as yoga.
• Reach and maintain a healthy weight.