Reference :

Articles The Lancet Volume 407, Issue 10531 p855-866February 28, 2026

Survivorship of modern total hip replacement to 30 years: systematic review,
meta-analysis, and extrapolation of global joint registry data

Veronica Pentland, BSc a,*  ∙  Zoe Thompson, MD b,*  ∙  Prof Alimu Dayimu, PhD c  ∙  Prof Nikos Dem
iris, PhD d  ∙  Prof Eric Bohm, MD e  ∙  David Campbell, MD f  ∙

Background
Total hip replacement is a successful operation that aims to restore function and quality of
life to millions of people globally. Knowing how long a total hip replacement might last is
important for patients, surgeons, and health-care institutions for planning and resource
allocation. Over the past 20 years, the use of contemporary bearing surfaces for total hip
replacement has substantially altered implant wear and, possibly, longevity. To date, there
has been no large-scale study that examines survivorship of these modern implants. We
aimed to determine the survivorship of contemporary total hip replacements and bearing
materials.

Methods
We focused solely on the assessment of modern bearing surfaces: highly cross-linked
polyethylene versus metal or third-generation and fourth-generation ceramic heads and
ceramic-on-ceramic primary total hip replacement in adult patients. We conducted a search
of MEDLINE and Embase from database inception to June 13, 2024, including articles that
reported a minimum of 10 years of survivorship, irrespective of fixation method or surgical
approach. We then conducted a meta-analysis combining data from eight national joint
registries assessing all-cause revision within the various bearing combinations. We
extrapolated the extracted data to estimate survivorship to 30 years, using the multivariable
random-effects model from the registry data. The primary outcome was survivorship of the
hip replacement, defined as time from primary total hip replacement to first all-cause
revision, expressed as a percentage of unrevised implants at specific timepoints. This study
is registered with PROSPERO (CRD42024572518).

Findings
We identified 1 904 237 total hip arthroplasties across 29 clinical studies (n=5203) and eight
national joint registries (n=1 899 034). Pooled analysis of the included studies showed an all-
cause implant survivorship of 0·97 (0·96–0·98) under the random-effects model.
Survivorship estimate based on joint registry data was at 93·6% (95% CI 92·3–94·7) at 20
years. Extrapolating these data indicates a predicted survivorship of 92·8% (91·2–94·2) at
25 years and 92·1% (90·1– 93·7) at 30 years.
Interpretation
The estimated 92% 30-year survivorship of contemporary total hip replacement
suggests that advances in bearing surface technology have greatly improved the long-term
durability of total hip replacements and might influence patient counselling, health-care
planning, and device regulation.