Dr Solomon Young Hip Arthritis / replacement
Hip replacement in the young patient. The Young Adult and Teenager.
General advice on hip arthritis and hip replacement is provided under the section Hip Replacement Recommendations.
Hip Replacement surgery has been well recognised as one of the best quality of life outcomes surgery for the past 100 years. Hip replacement was pioneered by Dr John Charnley in the late 1960's and now 50 years later technology has evolved significantly that has resulted in longer lasting implants and the ability to replace younger patients' hips.
Studies around the world have shown that well designed and tried and tested implants should last 30-35 years or possibly even longer. The Australian National Joint Register has contributed significantly to the reporting on success rates of young patients having hip replacement surgery.
Dr Solomon has extensive experience (over 27 years) in young adult and teenager hip problems that may need hip osteotomy surgery to preserve joint function or hip replacement surgery for end stage arthritis. He is recognised as one of the leaders in his field of hip surgery.
He was made a member of the prestigious International Hip Society in 2024
Dr Solomon has published on the results of hip replacement surgery in patients under 20 years of age (Solomon et al J Bone Joint Surg Am, 2014 Dec 17) This group of young patients often present with disabling and debilitating hip pain as an end result of major hip problems in childhood. An updated analysis is currently being performed and should be available in 2025
Dr Solomon's General Summary of the younger age hip replacement (under age 60).
In patients under the age of 60 there is a choice of bearing surfaces. There is also an option of a hip resurfacing of either metal on metal in males or ceramic on ceramic in males or females.
In general, I prefer a ceramic on ceramic bearing surface for patients under the age of 50.
The advantage of ceramic on ceramic bearings is that the reported wear rate is extremely low and in over 27 years of orthopaedics I am yet to see a worn-out ceramic bearing. The new highly cross linked polyethylene is also showing excellent outcomes at 25 years and may in time be the bearing of choice.
A small disadvantage of ceramic on ceramic is that in rare circumstances (around 1%) Ceramic on ceramic bearings may experience a squeak in certain extreme hip movements. Newer technology is now helping surgeons align implants more accurately to reduce this potential of squeaking. www.coringroup.com/au/solutions/optimized-positioning-system-ops/
Dr Solomon was one of the principal research and design surgeons of this new technology and uses this type of patient specific hip analysis in his preoperative work up.
The other exceedingly rare complication with ceramic is a ceramic fracture. The material however has improved so much that the ceramic manufactures report a 0.001% rate of fracture (1 in a 100 000).
Ceramic on highly cross-linked polyethylene is proving to be an exceptionally good bearing and the advantage of this bearing is that it does not squeak. I believe that when we have >25 year outcome data on this bearing, most replacements will likely use this "hard on soft" combination.
Male and Female under Age 55 outcomes
There are more than 50000 primary Hip Replacements performed every year in Australia. Fifteen percent (15%) are performed in patients under the age of 55. The data below is extrapolated from the Australian National Joint Register online publication.
There is a difference with respect to primary diagnosis in patients aged less than 55 years compared to older age groups. The proportion of procedures undertaken in young patients for standard primary osteoarthritis is 78.0% compared to 90.0% for those aged 55 years and older.
In the younger age group, there is an increased proportion of patients with the diagnoses of developmental dysplasia, perthes, slipped epiphyses, avascular necrosis, rheumatoid arthritis, ‘other inflammatory arthritis’ and tumour.
Young patients having a hip replacement for Osteoarthritis have a 9.5% revision rate at 20 years which means OVER 90% of patients are doing well more than 20 years post surgery.
The Figure above is taken from the Australian Joint Register
Bearing Surface:
The main bearing surfaces used in young patients are:
- ceramic on ceramic
- ceramic on highly crosslinked polyethylene
- metal on highly crosslinked polyethylene
There is NO statistical difference in revision rates for wear related problems using any of the above bearings at 23 years. The laboratory data suggests a ceramic on ceramic bearing may last longer however up to date this has not been seen in the clinical (real patient) follow up data. Ceramic on ceramic may have a 1% chance of a squeak at the extremes of hip motion and a 0.001% chance of fracture.
My general philosophy is to use a ceramic on ceramic bearing in the under 60 year age group (for the theoretical advantage of lower wear) however should registry data in the future still show no difference between bearings at 20-25 years then it is likely most surgeons will use the ceramic/polyethylene bearing in younger patients.
Birmingham / Adept Hip and Ceramic Resurfacing Replacement:
Hip Resurfacing has started to regain popularity as a result of newer materials that have recently been approved. In the past only young male patients (<60) were suitable for this type of replacement, however with newer non metal-on-metal resurfacing implants, young active females are now eligible for resurfacing replacements.
The advantage for the young adult is that it may allow the patient to do more robust type sports like regular jogging, touch football, social soccer and generally higher impact sports. It is still a replacement and patients need to be aware that it cannot behave and feel like a normal joint and rarely it may still result in complications due to metal on metal surfaces such as metal allergy, fluid build-up and in rare cases soft tissue damage. The new ceramic-on-ceramic resurfacing eliminates the concerns of metal ion issues.
The Birmingham hip resurfacing, BHR, is the gold standard of hip resurfacing implants. It is a metal on metal resurfacing. Recently the BHR manufacturer (Smith & Nephew) has stopped manufacturing however the Adept metal-on-metal resurfacing which is identical to the BHR, is still manufactured by a company called MattOrtho and has exactly the same results as the BHR.
Ceramic Hip Resurfacing
Hip resurfacing has been a very successful way of treating young active males with advanced hip osteoarthritis. The Birmingham Hip Resurfacing has a 25-year clinical follow up in the UK and 23 years in Australia. According to the Australian National Joint Registry, Males have a 7.9% revision rate at 23 yrs in Australia.
Hip Resurfacing allows higher impact sport activities and Andy Murray is one of the most well-known sportsmen who has had a metal-on-metal hip resurfacing.
The advantage of a resurfacing in appropriately selected patients compared to standard hip replacements is that a resurfacing replacement preserves femoral bone stock, allows repetitive high impact activities / contact sports and has a low risk of dislocation.
Metal on Metal Resurfacings have done poorly in women for a number of reasons including smaller bones not allowing adequate implant sizing creating issues with metal-on-metal wear particles.
Over the last 6.5 years a carefully controlled multicentre worldwide trial has been testing a ceramic-on-ceramic resurfacing implant. There is no metal involved in the bearing and the thought is that the metal-on-metal wear problems will therefore no longer exist. This will also allow women to have the ability to have a hip resurfacing.
The Recerf ceramic hip resurfacing (manufactured by MattOrtho https://www.matortho.com/recerf) has recently been approved in Australia and whilst it has been implanted in a trial over the past 6 years, the latest published data has an average 4 year follow up in 600 hips. The follow up data is showing excellent outcomes with 98% survival at 5 years.
So far, the results look very promising but long-term results (over 10 years) are needed to make a true comparison to metal resurfacings and conventional hip replacement.
My approach to ceramic hip resurfacing is to provide a patient with the latest data and allow patients to make an informed decision as to what they would like. The surgery is basically identical to a metal-on-metal resurfacing with the same posterior approach incision, same soft tissue releases and same post operative protocol.
Impact sports are not recommended for a minimum of 8 months after surgery.
Summary
Hip replacement in the younger patient is very successful however it is important to understand what implants and bearings are used and how long they may last. It is equally important to appreciate that it is an artificial joint that still may wear out in a young patient’s lifetime and therefore the joint needs "looking after".
Younger patients with hip arthritis may present more technical challenges in their surgery due to the original reason why the hip wore out at a younger age (such as severe dysplasia, perthes or previous trauma). It is important to choose a surgeon who has experience in operating on the young arthritic hip.
It is still better as a young patient to walk / run or play sports on an arthritic hip that is not causing significant discomfort than to have the hip replaced. The timing of hip replacement surgery (especially in the young patient) is when you are experiencing pain requiring regular analgesics and when you are experiencing pain at rest such as night pain. It is never too late to replace the arthritic hip and you are doing no harm by delaying surgery. Most patients know "when the time is right" for surgery.
Updated July 2025