There is no single “best” hip implant. Two choices matter most: the bearing surface (what the ball and socket are made of) and how the implant is fixed to bone (cemented or uncemented). Modern evidence favours highly cross-linked polyethylene liners with either a ceramic or metal ball, and cemented fixation – at least of the stem – in older patients.
This guide from the hip team at Sports Orthopedics Institute, Bengaluru explains the options in plain language, what national joint registries show, and how your surgeon matches the implant to you.
Key takeaways
- Hip replacements last a long time: about 58% are still in place at 25 years in registry data, and modern materials are expected to do better.
- Highly cross-linked polyethylene roughly halved long-term revision rates compared with older polyethylene.
- Ceramic vs metal ball on cross-linked polyethylene: registries show similar results.
- Metal-on-metal is now largely abandoned because of metal-ion problems.
- Over about 65–75, cemented fixation has the lowest revision risk in most registries, especially in women.
- Your surgeon's experience with the implant matters as much as the implant itself.
Parts of a Hip Replacement
- Stem – fits into the thigh bone (femur)
- Ball (femoral head) – sits on top of the stem; made of metal or ceramic
- Cup (acetabular shell) – fixed into the pelvis
- Liner – sits inside the cup; usually polyethylene (a medical-grade plastic) or ceramic
The ball and liner rub against each other – this pair is called the bearing surface.
How Long Do Hip Replacements Last?
A Lancet meta-analysis of national registry data (more than 215,000 hips) found that about 58% of hip replacements were still in place at 25 years, while published case series suggested about 78% (Lancet, 2019). About 85% lasted 15 years (NIHR summary).
Many hips in these studies used older materials no longer in use, so implants put in today are expected to last longer.
Bearing Surfaces Compared
|
Bearing |
What it is |
Strengths |
Drawbacks |
|---|---|---|---|
|
Metal on highly cross-linked polyethylene |
Cobalt-chrome or stainless steel ball, cross-linked plastic liner |
Long track record, reliable, lower cost |
Small risk of corrosion where the ball meets the stem |
|
Ceramic on highly cross-linked polyethylene |
Ceramic ball, cross-linked plastic liner |
Very low wear; no metal ions from the ball; common choice for younger patients |
Higher cost; very rare ceramic head fracture |
|
Ceramic on ceramic |
Ceramic ball and liner |
Extremely low wear |
Rare squeaking or chipping; higher cost; positioning more critical |
|
Metal on metal |
Metal ball and metal cup |
– |
Metal-ion release and soft-tissue reactions; now largely abandoned |
What the registry evidence shows
- Cross-linked polyethylene changed outcomes: in the Australian registry (over 240,000 hips), revision at 16 years was 6.2% with highly cross-linked polyethylene versus 11.7% with conventional polyethylene (JBJS; Becker's summary).
- Ceramic vs metal ball on cross-linked polyethylene: a review of national registries found high survival with both and broadly similar results – the Australian registry showed a 15-year revision rate of 6.3% with ceramic heads and 5.1% with metal heads, while New Zealand showed no difference (Orthobullets summary).
- Newer antioxidant (vitamin E) cross-linked polyethylene was linked to a lower revision rate after 3 years in an Australian registry study of nearly 200,000 hips (Acta Orthop, 2026).
In practice: most patients do very well with a metal or ceramic ball on a highly cross-linked polyethylene liner. Ceramic heads are often chosen for younger, active patients to minimise wear and avoid metal at the bearing.
Fixation: Cemented, Uncemented or Hybrid?
|
Type |
How it's fixed |
Typical use |
|---|---|---|
|
Cemented |
Bone cement (PMMA) grips the implant immediately |
Older patients; weaker or osteoporotic bone |
|
Uncemented |
Textured or coated surfaces press-fit into bone, which then grows onto them |
Younger patients with good bone quality |
|
Hybrid |
Cemented stem, uncemented cup |
Common in older patients |
|
Reverse hybrid |
Uncemented stem, cemented cup |
Less common |
What the registry evidence shows
- Over 65: in Nordic registry data from nearly 348,000 hips, 10-year survival of cemented implants was higher than uncemented in patients aged 65–74 and 75 or older; in those aged 55–64 survival was similar (BMJ, 2014).
- Women: in the Norwegian registry, all-uncemented hips had a higher revision risk than cemented, mainly from fractures around the implant and dislocation. Women had about 12 times the risk of revision for fracture with uncemented stems; hybrid hips performed like cemented ones (Acta Orthop, 2020).
- Over 75: across national registries, cemented fixation was associated with the lowest revision risk (registry review, 2013).
In practice: for younger patients with good bone, uncemented and cemented fixation both perform well. For older patients – especially women – a cemented or hybrid hip (cemented stem) is usually preferred. Cemented hips also allow full weight-bearing immediately.
Other Implant Choices
- Head size: larger heads (typically 32–36 mm) reduce the risk of dislocation; modern cross-linked polyethylene makes them possible without excess wear.
- Dual-mobility cups: a ball inside a larger mobile liner, used for patients at high risk of dislocation – for example after a hip fracture, with neurological conditions, or in revision surgery.
- Short or bone-preserving stems: sometimes used in younger patients; long-term data are still emerging.
- Custom and 3D-printed implants: mainly for complex anatomy, severe bone loss, tumours or revision surgery – not routine first-time hip replacement.
- Robotic and navigation-assisted surgery: can improve the accuracy of component placement; whether this leads to better long-term function or survival than skilled conventional surgery is still being studied.
Matching the Implant to You
|
Factor |
How it shapes the choice |
|---|---|
|
Age and activity |
Younger, active patients: ceramic ball on cross-linked polyethylene is common; uncemented or cemented fixation |
|
Bone quality |
Osteoporosis or older age: cemented or hybrid fixation |
|
Sex |
Older women: cemented stem preferred because of fracture risk with uncemented stems |
|
Dislocation risk |
Larger heads or dual-mobility cups |
|
Anatomy |
Previous surgery, deformity or bone loss may need specialised implants |
|
Metal sensitivity |
Ceramic ball avoids metal at the bearing |
|
Cost |
Ceramic and specialised implants cost more; discuss coverage under your insurance or government scheme |
Above all, choose a well-proven implant with good registry data, used by a surgeon who is experienced with it.
Risks to Know About
- Dislocation – most common in the first few months
- Fracture around the implant – during or after surgery; more common with uncemented stems in older women
- Infection – uncommon but serious
- Loosening and wear over many years
- Leg-length difference
- Blood clots
- Bearing-specific issues – ceramic squeaking or chipping (rare), corrosion where the ball meets the stem (rare)
Protecting Your Hip Replacement
- Keep a healthy weight
- Stay active with walking, cycling, swimming and strength exercises; avoid high-impact sports
- Follow hip precautions in the early months if advised
- Treat infections anywhere in the body promptly
- Attend follow-up and report new pain, clicking or instability
How Sports Orthopedics Institute Can Help
Our hip team in HSR Layout, Bengaluru selects proven, registry-backed implants and fixation tailored to your age, bone quality and activity level – and explains the reasons for each choice.
Book at sportsorthopedics.in or call +91 6364538660 / +91 9008520831.
Frequently Asked Questions
Which type of hip implant lasts the longest?
Modern implants with highly cross-linked polyethylene liners – with either a ceramic or metal ball – have excellent long-term results in registries. Ceramic-on-ceramic also has very low wear. The quality of the implant's track record and the surgery matter more than the material alone.
Is a ceramic hip better than metal?
On cross-linked polyethylene, registry results are broadly similar. Ceramic balls avoid metal at the bearing and are often chosen for younger patients, but cost more.
Should my hip be cemented or uncemented?
If you are over about 65–75, especially if you are a woman, cemented or hybrid fixation has the lowest revision risk in most registries. In younger patients with good bone, both work well.
Are metal-on-metal hips still used?
Rarely. They were largely abandoned because metal debris caused problems in some patients.
How long will my hip replacement last?
In registry data, about 85% last 15 years and 58% last 25 years – and today's implants are expected to do better.
Is robotic hip replacement better?
It can improve the accuracy of implant positioning, but it hasn't yet been shown to give better long-term results than skilled conventional surgery.
Can I have an MRI with a hip replacement?
Yes, in most cases. Tell the radiology team so they can adjust the scan.
What are the signs my hip replacement is failing?
New groin or thigh pain, clicking or squeaking, a feeling of instability, or a change in leg length – see your surgeon.
References
- Evans JT, et al. How long does a hip replacement last? A systematic review and meta-analysis of case series and national registry reports. Lancet, 2019;393:647–654.
- Cross-linked polyethylene reduces the rate of revision of total hip arthroplasty at 16 years. Australian registry study, JBJS.
- Ceramic vs metal heads on highly cross-linked polyethylene: review of national registries.
- Antioxidant-added highly cross-linked polyethylene and revision risk: 198,073 hips from the Australian registry. Acta Orthop, 2026.
- Failure rate of cemented and uncemented total hip replacements: register study of combined Nordic database. BMJ, 2014.
- Dale H, et al. Fixation, sex, and age: highest risk of revision for uncemented stems in elderly women. Acta Orthop, 2020.
- Troelsen A, et al. A review of current fixation use and registry outcomes in total hip arthroplasty: the uncemented paradox, 2013.
Disclaimer: This article is for general information and does not replace advice from a qualified orthopedic surgeon.