Dr Matthew BroadheadOrthopaedic Surgeon · Sydney & Coffs Harbour

Journal Club · November 2026

How long does a hip replacement last?

In the Australian registry's 2026 report, about 92% of hip replacements done with implants still in use had not been revised at 20 years. An earlier Lancet review of older implants found 58% lasting 25 years.

How long will it last? It is asked before almost every hip replacement. Two sources answer it: a 2019 review in The Lancet that pooled the long-term evidence from around the world, and the 2026 report of the Australian joint replacement registry, which has the most recent figures and covers the implants used today.

What the studies looked at

A hip replacement is counted as having lasted for as long as no part of it has needed a further operation to replace it. That second operation is called a revision.

The Lancet review (2019). Researchers in Bristol gathered every report they could find of hip replacements followed for more than 15 years. The most reliable of these came from national registries, which record nearly every operation done in a country. The Australian and Finnish registries supplied long-term data on 215,676 hip replacements. The figures at 20 and 25 years came from Finland alone, from hips put in before 2003.

The Australian registry (2026). The Australian Orthopaedic Association National Joint Replacement Registry has recorded more than 98% of joint replacements done in Australia since 1999. Its 2026 report covers operations up to the end of 2025, and for hip replacement done for osteoarthritis it reports on 496,964 operations. It limits most of its analyses to implants that were still being used in 2025, which it calls modern prostheses. This year it also estimated, for the first time, the chance of needing a revision over the rest of a person’s life.

What they found

In Australia, with implants in current use:

  • At 10 years, about 4 in 100 had been revised (4.1%).
  • At 15 years, about 6 in 100 (5.9%).
  • At 20 years, about 8 in 100 (7.7%). Put the other way, about 92% had not needed a revision 20 years on.
  • Age made a modest difference. At 20 years, 9.6% of hips in people who were under 55 at the time of surgery had been revised, against 6.3% in people who were 75 or older.

In the Lancet review, with older implants:

  • About 89% were still in place at 15 years, 70% at 20 years and 58% at 25 years.

Why the two differ. The Lancet figures describe hips implanted a generation ago, many with parts that are no longer made. The registry figures describe implants that are still in use. One change stands out in the registry’s data: the plastic liner of the socket. A newer plastic, cross-linked polyethylene, wears more slowly than the plastic it replaced, and almost all plastic liners used in Australia are now made of it.

Over a lifetime. The registry’s new estimate is that the younger a person is at the time of surgery, the greater the chance of needing a revision at some point, simply because there are more years ahead. Its modelled lifetime risk was about 28% for people aged 46 to 50 at surgery, about 16% for people aged 66 to 70, and about 3% for people 86 and over. It was a little higher in men than in women, and higher in people who are obese.

What it means for you

For most people, a hip replacement done today can be expected to last a long time. On the Australian figures, about 9 in 10 are still in place 20 years later.

Age is the main thing that changes the picture. For someone in their seventies, the practical question is whether the hip will outlast them, and for most it will. For someone in their fifties, a second operation at some point in life is a real possibility, and it is fair to weigh that when deciding on timing. It is rarely a good reason to put up with years of severe pain and disability.

When a hip replacement does need to be redone, the most common reason now is infection, followed by a fracture around the implant, dislocation and loosening. A revision is a bigger operation than the first, which is why the aim is always for the first one to last.

None of this tells you what will happen to your own hip. That depends on your age, your weight, your general health, your bone quality and the implant used, and it is a conversation to have with your surgeon.

A caveat worth knowing

The registry’s figures are for implants still in use in 2025. Designs that were withdrawn along the way, often because they did not perform well, are left out. The registry says openly that this makes the results look better. With every implant and every reason for surgery included, about 11 in 100 hip replacements had been revised at 20 years, against 8 in 100.

The registry does not yet report a figure at 25 years, and its lifetime estimates are projections from a model, less certain the further ahead they look. They are not predictions for any one person.

Both sources count only revision. A hip that is still in place but painful counts as a success, and so does one that would have been revised had the person been well enough for surgery.

Assessing this studyA standardised appraisal for clinicians and registrars: study design, strength and validity.
Study design
Two sources read together. Evans 2019 is a systematic review with separate meta-analyses of case series and of national registry reports with more than 15 years of follow-up (PROSPERO CRD42018085642); the endpoint is all-cause revision. The AOANJRR 2026 Annual Report is a national registry cohort recording over 98% of joint replacements in Australia from September 1999 to December 2025, reporting cumulative percent revision by Kaplan-Meier estimate, and, new this year, a modelled lifetime risk of revision.
Level of evidence
OCEBM Level 2 (prognosis) for both: a systematic review of observational registry data, and a very large inception cohort. Neither is randomised. The lifetime risk figures are modelled projections and sit below the observed 20-year figures in certainty.
Are the results valid?
Evans 2019: sound methods, but the 20-year and 25-year registry estimates come from Finland alone, from hips implanted before 2003, pooled without accounting for death and unadjusted for age. AOANJRR 2026: near-complete national capture, linked to death records, with narrow confidence intervals. Its main limitation is deliberate: nearly all analyses are restricted to "modern prostheses", meaning those still in use in 2025. Designs that were withdrawn, often because they performed poorly, are left out, so the figures describe current implants and are better than the experience of everyone who had a hip replaced in that period. With all prostheses and diagnoses included, 20-year revision is 10.6% against 7.7%. The Kaplan-Meier estimates are unadjusted and weighted towards older patients. Metal on metal hips are excluded.
What are the results?
AOANJRR 2026, primary total conventional hip replacement for osteoarthritis, modern prostheses, 496,964 procedures (Table HT14): cumulative percent revision 4.1% (95% CI 4.0–4.2) at 10 years, 5.9% (5.8–6.0) at 15 years and 7.7% (7.4–7.9) at 20 years. By age at operation, 20-year revision was 9.6% under 55, 7.9% at 55 to 64, 7.2% at 65 to 74 and 6.3% at 75 and over (Table HT17). Modelled lifetime risk of revision fell from 28.3% for patients aged 46 to 50 to 16.2% at 66 to 70 and 3.3% at 86 and over (Table N4). Evans 2019, registry series: survival 89.4% (89.2–89.6) at 15 years, 70.2% (69.7–70.7) at 20 years and 57.9% (57.1–58.7) at 25 years.
Do they apply to our patients?
The AOANJRR figures are Australian, current, and directly applicable to counselling here. They answer a slightly different question from Evans: how implants in use today have performed so far, not how all hips implanted a generation ago fared. No 25-year figure is presented in the 2026 report. Revision is a narrow definition of failure; a painful hip that has not been revised counts as surviving. Lifetime risk is strongly age-dependent and is higher in men and in patients who are obese.
Bottom line
With implants in current use, about 92% of hip replacements done for osteoarthritis in Australia had not been revised at 20 years (AOANJRR 2026); the 58% at 25 years from the 2019 Lancet review describes older implants and is best read as a historical floor. Quote the registry figure with its two qualifiers: implants still in use, and age at operation.

Framework: study design graded with the Oxford Centre for Evidence-Based Medicine (OCEBM) Levels of Evidence; validity and applicability appraised in the CASP tradition.

This is a plain-language summary of published research, provided for general education. It is not medical advice and does not describe Dr Broadhead's own results. Whether any finding applies to you depends on your individual circumstances, so please discuss your care with your treating team.

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