Survivorship and risk factors for revision after total hip arthroplasty in patients 30 years and younger - a cohort study from the German arthroplasty register

Sep 29, 2026

Total hip arthroplasty in patients aged 30 years or younger is uncommon yet increasing, making revision risk assessment essential for long-term outcomes. This cohort study analyzed German Arthroplasty Registry data to quantify implant survivorship and identify factors linked to first revision after THA. Kaplan–Meier and Cox models were applied to 1,622 primary THAs. At 8 years, the cumulative revision rate was 4.6%, with pediatric hip disease showing the highest revision risk.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages7

Reading Time18 min

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Background and purpose

Methods

Results

Conclusion

Study design and data source

Survivorship and risk factors for revision after total hip arthroplasty in patients 30 years and younger: a cohort study from the German arthroplasty register Johanna ELLIOTT 1,2, Yinan WU 1, Arnd STEINBRÜCK 1,3, and Alexander W GRIMBERG 1 1 German Arthroplasty Registry (EPRD Deutsche Endoprothesenregister gGmbH), Berlin, Germany; 2 University of Newcastle, Hunter New England Health District, NSW, Australia; 3 Department of Orthopaedic Surgery, Physical Medicine and Rehabilitation, University Hospital of Munich (LMU), Munich, Germany Correspondence: [jellyott@gmail.com](jellyott@gmail.com) [Submitted 2025-06-12. Accepted 2025-11-10.](Submitted 2025-06-12. Accepted 2025-11-10.) This study was presented during the ISAR Congress 2025, Christchurch, New Zealand. ISAR Background and purpose — Total hip arthroplasty (THA) in young patients is rare but increasingly performed. We aimed to analyze implant survivorship and risk factors for revision in patients aged 30 years or less after THA based on the German Arthroplasty Registry (EPRD) . Methods — Kaplan–Meier survival analysis and Cox proportional hazard models were used to analyze the EPRD dataset from 2013 to 2023 for factors associated with increased risk of revision. The primary outcome was first revision operation. Results — 1,622 primary THAs in 1,452 patients were analyzed. The mean age was 26 years (range 11–30), 908 (56%) of whom were male. The most frequent diagnosis was secondary osteoarthritis (1,146, 72%), followed by osteonecrosis (357, 22%), and hip dysplasia (53, 3.2%). Of all THAs, 1,601 (99%) were uncemented, and 1,574 (97%) received ceramic heads. The average follow-up period was 3.7 years (range 0–10.6) . 47 hips were revised with a cumulative revision rate (CRR) at 8 years of 4.6%(95% confidence interval [CI] 2.8–7.3) . The most frequent revision cause was infection in 11 cases (0 .7%) . Increased revision risk was associated with pediatric hip disease for those with prior surgery for Perthes, HR 4.3 (CI 1.9–9.6), pelvic osteotomy HR 2.8 (CI 1.1–7.5), and a primary diagnosis of hip dysplasia, HR 3.4 (CI 1.3–8.5) . Conclusion — Uncemented THA in young patients demonstrated a revision rate of 4.6%(CI 2.8–7. 3), which we believe is a satisfactory mid-term survival. Patients with pediatric hip disease present the highest risk of revision. Total hip arthroplasty (THA) [1] is the last option for endstage hip osteoarthritis (OA) in younger patients [2]. It is postponed as long as possible as higher activity levels observed amongst these patients [3] may predispose to implant loosening and early revision [4] . The pathogenesis of end-stage hip pathology in patients aged 30 years or less differs significantly from that of the typical THA cohort [5-7] . Unlike idiopathic degenerative OA of the hip affecting the elderly population, congenital, metabolic, inflammatory, and neoplastic pathologies contribute more frequently to end-stage hip joint pathology in juveniles [2,8] . Improved quality of life is reported by young patients undergoing THA [5] . Advances in materials, fixation techniques, and tribology have coincided with improved survivorship from childhood hip disease, contributing to an expansion of the indication for THA in younger age groups [8,9] . This is reflected in the stable projected THA incidence rate reported for those aged 45 or less in Germany [10], despite reticence from those indicating the surgery. Because of the scarcity of THAin young populations, previously published registry studies describe implant survivorship in cohorts over several decades [5,8,11-13] . Over these long observation periods, implants, fixation methods, and tribology vary significantly, such that the time frame during which the surgery was performed becomes an independent factor influencing revision risk [5,11,12,14]. The advantage of the German Arthroplasty Registry (EPRD) database, one of the largest in Europe [15], is that the substantial size of the

FAQs

What was the primary outcome in the study?

The primary outcome was the first revision operation after total hip arthroplasty in patients aged 30 years or less.

What was the 8-year cumulative revision rate reported?

The cumulative revision rate at 8 years was 4.6% (95% confidence interval 2.8–7.3).

Which factors were associated with increased revision risk?

Higher revision risk was associated with pediatric hip disease with prior surgery for Perthes (HR 4.3), pelvic osteotomy (HR 2.8), and a primary diagnosis of hip dysplasia (HR 3.4).

Sep 29, 2026

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