A recent international study investigated the long-term durability of modern hip replacements and showed that modern bearing surface solutions appear to significantly reduce the need for hip replacement revision surgery.
Hip replacement surgery, or arthroplasty, is one of the most successful surgical procedures in the world. Every year, it helps millions of people worldwide regain mobility and improve their quality of life. Knowing how long a prosthesis is likely to last is essential for patients, surgeons, and the healthcare system so that treatment, follow-up, and resources can be planned appropriately.
Over the past two decades, new, so-called modern bearing surfaces have been introduced in hip arthroplasties. These innovations have substantially altered implant wear and, possibly, longevity. However, no large-scale research has been conducted to evaluate the long-term durability of contemporary total hip replacements.
A recently published extensive study showed that modern bearing surface solutions appear to have significantly reduced the number of hip replacement revisions both in Finland and internationally.
The study began with a systematic literature review of modern bearing surface combinations for hip replacements, including ceramic-on-ceramic, ceramic-on-metal, and metal-on-metal combinations.
“Today's delta ceramics are no longer fragile and prone to chipping, as previous generations of products were. Plastics technology has also advanced, and today’s polyethylene plastics are highly cross-linked, improving their wear resistance,” says co-author of the study, Professor Keijo Mäkelä from the University of Turku, Finland.
The study utilized data from all currently operating Western national arthroplasty registries. This also included Finnish hip replacement surgeries from the Finnish Arthroplasty Register. Mäkelä has led the expert group for the registry maintained by the Finnish Institute for Health and Welfare since 2014. The study also includes national registry data from England, Australia, Sweden, Norway, and Denmark, as well as regional registries from the United States and Canada.
The study assessed the long-term durability of nearly 1,900,000 hip replacements with different bearing surface options based on the registries. The 20-year durability of all bearing surface options combined was excellent at 93.6 percent.
The analysis included 97,876 hip replacement surgeries from Finland. According to the study, the survivorship results of prostheses in Finland were at a good international level. Modern bearing surfaces seem to work well in the long term, and there were no significant differences in survivorship estimates between different bearing surfaces.
"Our research results can benefit both prosthetic orthopedists and general practitioners when patients ask how long their hip replacements will last before they have to undergo surgery again," Mäkelä explains.
The research article was published on 28 February 2026, in the flagship edition of The Lancet, one of the world's most prestigious medical journals.
