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How long do hip and knee joint replacements really last? It’s one of the first question I’m asked in clinic, usually from someone already doing the math in their head. The concern is real – “If the surgery happens at 60, does it need doing again at 80?”
Here is the honest answer: how long joint replacements last has significantly improved over the last twenty years as surgical techniques and implant materials and designs continue to advance.
After more than twenty years in practice and over 700 hip and knee replacements a year, this is what I tell patients across the desk.
How long do joint replacements last?
The rule of thumb I use in clinic is that a first-time hip or knee replacement wears at about one percent per year. Carry that out to twenty years and roughly 80 percent are still performing the way they did on day one.
That is a counseling figure, not a study result. It is easy to remember and it gets you close.
My own view is that today’s implants beat it. I expect closer to one in ten patients to need something done by the twenty year mark, and the registry numbers below support that.
What is a national joint registry?
A national joint registry is a country-level database that records every joint replacement performed and tracks whether it later needed another operation. Registries are the most honest source we have, because they follow hundreds of thousands of ordinary patients rather than one surgeon’s best cases.
Registry survival measures one specific thing: revision surgery. A joint that aches on a cold morning is not a failed joint. A joint that needs an operation again is.
How long does a hip replacement last?
With today’s bearing surfaces, about 94 percent of total hip replacements are still working at 20 years. That is a much better number than most patients have been told, and it is recent.
The older figure looked far worse. A pooled registry analysis of 215,676 total hip replacements reported 25-year survival of 57.9%, which suggested hips were substantially less durable than knees.
That conclusion no longer holds, and the reason sits in the bearing surface. Those older constructs used conventional polyethylene and early-generation ceramics that are no longer in routine use.
A 2026 analysis restricted to modern bearing surfaces covered 1,904,237 total hip replacements, including 1,899,034 drawn from eight national joint registries. It found survivorship of 93.6% at 20 years. The American Academy of Orthopaedic Surgeons patient guide to total hip replacement is a good plain-language companion to those numbers.
The same paper modeled longer horizons at 92.8% at 25 years and 92.1% at 30 years. Those two figures are extrapolated from a statistical model rather than observed in patients, so I quote the 20-year number and treat the rest as encouraging.
Same operation. Different materials. A materially different result.
How long does a knee replacement last?
Roughly 82 percent of total knee replacements are still in place 25 years after surgery. That comes from a systematic review in The Lancet pooling 14 national joint registries and 299,291 knees, which remains the largest look we have at knee implant survival.
Knees have been the more predictable of the two joints for a long time, and that has not changed. What changed is that hips caught up and then passed them once the bearing materials improved.
If you want the detail on age, weight, activity, and the five factors that move knee survival most, I covered knee replacement longevity in detail in a separate article.
Registry survival data at a glance
| Implant | What was studied | Survival |
|---|---|---|
| Total knee replacement | 299,291 knees, 14 national registries | 82.3% at 25 years |
| Total hip replacement, older bearings | 215,676 hips, conventional polyethylene and early ceramics | 57.9% at 25 years |
| Total hip replacement, modern bearings | 1,904,237 hips, including 1,899,034 from eight national registries | 93.6% at 20 years |
Survival here means the implant had not needed revision surgery. The 25-year and 30-year projections for modern hips (92.8% and 92.1%) are modeled estimates, not observed results.
Read across those rows and one point stands out: how long joint replacements last now depends heavily on which joint it is and which generation of parts went in.
Why do joint replacements fail?
Four reasons account for most failures. I have listed them in roughly the order I encounter them.
Loosening. The metal components gradually lose their grip on the bone. This is less common than it used to be, but it still happens, and it is the classic long-term failure.
Plastic wear. Between the metal surfaces sits a plastic liner, and that liner is effectively your new cartilage. Like tread on a tire, it wears with use. The plastics we implant now are far better than what we used in the 1990s, which is a large part of why the hip numbers moved.
Infection. Bacteria that settle on metal and plastic are hard to clear. In some cases the components have to come out, which can mean roughly three months without a working joint before it is rebuilt. Worth saying plainly: in that situation the infection caused the failure, not the implant. I have written separately on the warning signs of joint replacement infection.
Instability or dislocation. This is far more often a hip problem than a knee problem. If a replaced hip repeatedly comes out of joint, revision may be the way to fix the mechanics. The specifics are covered in my article on hip replacement dislocation.
What are the signs a joint replacement is wearing out?
Most implants warn you before they fail. Call your surgeon’s office if you notice any of these:
- Pain returning after years of quiet. New deep aching in a joint that had settled down is the most common first sign.
- A sense of looseness or giving way, particularly on stairs or uneven ground.
- Swelling that keeps coming back in a joint that had stopped swelling.
- New grinding or clunking. Some quiet clicking is normal in a replaced joint. A new grinding sensation is not.
- Fever, redness, or drainage. These need same-day attention, because infection is the one problem where hours matter.
None of these automatically means surgery. An x-ray and an examination usually sort it out, and plenty of these complaints turn out to be a tendon rather than the implant.
What happens in a revision joint replacement?
A revision is a second operation that removes some or all of a failing implant and rebuilds the joint with new parts. Not every revision is the same size of undertaking.
What is the difference between a partial and a full revision?
Sometimes only one element is exchanged, most often a plastic liner or a single component. That is a partial revision, and it is a considerably smaller operation with a shorter recovery.
A full revision is different. Every original part comes out, then new parts go in. Functionally that is two operations in one sitting, which is why it is fair to describe it as close to twice the surgery. For the knee-specific version of this, see my article on revision knee replacement.
Why is removing the old implant the hardest part?
Your bone grows into the surface of a modern implant. That is by design, and it is exactly what gives the replacement two decades of stability.
It also means removal is the demanding half of the job. Taking out a well-fixed component is slow, deliberate work, often careful chiseling with specialized instruments.
The pace is intentional. The goal is not simply to get the old part out; it is to protect the bone around it, because whatever bone remains is what the new implant has to attach to. Bone lost during removal narrows the options for the reconstruction. Knowing what each part of an implant does makes that trade-off easier to picture.
What is recovery like after revision surgery?
More involved than the first time, and patients deserve to hear that straight. A revision means working through muscle and tendon that has already been operated on once.
That tissue is less forgiving. Recovery takes longer, there is generally more soreness, and rehabilitation asks more of you.
Revision is a well-established operation and people do well with it. It is simply not a repeat of the first experience, and expecting it to be is the most common source of disappointment I see.
If you are facing one, the most useful thing you can do is find a surgeon who performs a significant number of them. Experience carries more weight here than almost anywhere else in joint replacement, because the judgment involved in removing a well-fixed implant without compromising bone is developed through repetition, not looked up. The American Association of Hip and Knee Surgeons is one place to start looking for a specialist.
How can you make a joint replacement last longer?
Several of the things that decide how long joint replacements last sit inside your control. These are the habits I see in patients whose joints are still quiet at year 20:
- Keep your weight steady. Every extra 20 pounds adds well over 100 pounds of force across the joint with each step, and that load lands on the plastic bearing.
- Finish your rehabilitation. Strong quadriceps and hip muscles absorb load that would otherwise reach the implant.
- Choose low-impact activity. Walking, cycling, swimming, and golf are friendly to an artificial joint. Distance running and repeated jumping are not.
- Treat infections anywhere in your body promptly. Bacteria from a tooth abscess or a urinary infection can travel through the bloodstream and settle on an implant.
- Keep your follow-up appointments. A quick x-ray every few years catches early loosening while it is still simple to address.
Timing matters too. Getting the first joint right, at the right time, is the best longevity strategy there is. Nonsurgical treatment can carry many patients comfortably for years before surgery becomes the better option.
Talking through joint replacement longevity in Franklin and Middle Tennessee
Registry data tells you how long joint replacements last across hundreds of thousands of people. It does not tell you how long yours will. Every patient who walks into my Franklin office arrives with a different set of numbers: age, arthritis, weight, work, and what they still want to do on a Saturday.
I see patients from Franklin, Nashville, Brentwood, Columbia, Spring Hill, Murfreesboro, and across Middle Tennessee at the Bone and Joint Institute of Tennessee, 3000 Edward Curd Lane, Franklin, TN 37067.
If you are weighing a first hip replacement or knee replacement, or you have a replaced joint that has started talking to you again, let’s take a look. Call (615) 791-2630 or request an appointment with Dr. Calendine online. No referral required.
Watch: what happens when a joint replacement wears out
In this video I walk through the same ground as this article: the one percent per year rule of thumb, what the registry numbers actually show, the four reasons replacements fail, and what a revision operation involves.
Cory Calendine, MD is a board-certified, fellowship-trained orthopedic surgeon at the Bone and Joint Institute of Tennessee and Chief of Orthopaedic Surgery at Williamson Medical Center. This article reflects his independent clinical perspective and is educational only. It is not medical advice and does not replace evaluation by your own surgeon. Implant survival statistics describe large groups of patients and cannot predict any one person’s result.
References
- Evans JT, Evans JP, Walker RW, Blom AW, Whitehouse MR, Sayers A. How long does a hip replacement last? A systematic review and meta-analysis of case series and national registry reports with more than 15 years of follow-up. Lancet. 2019;393(10172):647-654. PubMed
- Evans JT, Walker RW, Evans JP, Blom AW, Sayers A, Whitehouse MR. How long does a knee replacement last? A systematic review and meta-analysis of case series and national registry reports with more than 15 years of follow-up. Lancet. 2019;393(10172):655-663. Erratum in: Lancet. 2019;393(10174):876. PubMed
- Pentland V, Thompson Z, Dayimu A, et al. Survivorship of modern total hip replacement to 30 years: systematic review, meta-analysis, and extrapolation of global joint registry data. Lancet. 2026;407(10531):855-866. PubMed
The one-percent-per-year rule of thumb, the ordering of failure modes, and the descriptions of revision surgery reflect Dr. Calendine’s clinical practice and are not drawn from these studies.
