4 December, 2025

Total Hip Replacement for Childhood Hip Problems: When, Why, and What to Expect

Hip pain that begins in childhood can follow a person into adulthood and, in some cases, lead to the need for total hip replacement much earlier than most people expect. Conditions that start in infancy or the teenage years change how the hip joint develops. Over time those abnormal forces and shapes can wear out the hip. The decision to go for a total hip replacement in a young adult is complex and must balance current function, future implant longevity, and available joint-preserving options.

Which childhood hip conditions can eventually require a total hip replacement?

A few patterns of disease that begin in childhood commonly progress to advanced hip arthritis by young adulthood. The most important to recognize are:

Developmental dysplasia of the hip (DDH) or congenital dislocation. The ball and socket can be misformed or the socket may be shallow so the femoral head sits partially or completely out of the cup.
Avascular necrosis (AVN) of the femoral head. When blood supply to the growing femoral head is interrupted, the bone collapses and the shape changes, often during crucial growth years.
Perthes disease and slipped capital femoral epiphysis (SCFE). These pediatric disorders distort the ball shape or joint congruency and predispose to early wear.
Juvenile idiopathic arthritis or other inflammatory disorders. Chronic inflammation damages cartilage and bone, progressing to end stage arthritis in some patients despite medical therapy.
Significant childhood trauma that damaged the hip joint or its blood supply.

When these problems are identified early there are often hip-preserving treatments available. But if the joint is already severely damaged, the most reliable way to restore pain-free mobility is a total hip replacement.

Why is treating childhood-onset hip disease challenging?

Childhood hip disorders produce a set of specific challenges that make later hip replacement different from the common adult case:

Bone and socket deformity. A shallow or dysplastic socket may not be a nice round cup. The ball may be flattened, misshapen, or located in an abnormal position.
Soft tissue contractures and limb shortening. Muscles, tendons, and nerves may be shorter because the limb did not grow normally. Correcting length too quickly risks nerve stretch or soft tissue failure.
Abnormal biomechanics. The altered alignment produces uneven joint loading and can reduce the success of a standard implant unless specialized techniques are used.
Patient age and implant lifespan. Younger patients will likely outlive an implant and face revision surgeries in the future. Implant selection and surgical planning must account for long-term revision strategies.

Addressing these issues often requires more complex reconstruction: femoral osteotomies to correct alignment, complex acetabular reconstruction to create a stable socket, or the use of specialized implants. Precision during component placement is critical to restore limb length, offset, and stability.

When should total hip replacement be performed in a young adult with childhood hip disease?

There is no single age threshold. The decision to perform a total hip replacement is driven by symptoms, function, and failure of all reasonable joint-preserving options:

Severe pain that limits daily activities. If a patient cannot attend school, work, or perform routine tasks despite conservative care, replacement becomes a strong consideration.
Progressive loss of mobility or function. Declining ability to walk, climb stairs, or participate in life is an indication.
Exhaustion of joint-preserving measures. This includes physiotherapy, activity modification, guided medications, containment surgeries in childhood, or corrective osteotomies that have already failed.

Because implants have a limited lifespan, surgeons try to delay total hip replacement when possible. Modern implants often last around 20 to 25 years in many patients. That means implanting one at age 20 may require revision in middle age. But delaying replacement at the cost of prolonged disability is not always the best strategy. If a 20- or 30-year-old cannot live an active life because of hip pain, a well-planned total hip replacement can restore function and quality of life.

How long do implants last and what does that mean for younger patients?

Contemporary implants using high-quality ceramics and highly cross-linked polyethylene have significantly improved longevity. In large series, many patients have good function at 20 years, with roughly 90 percent still doing well at that point. Nevertheless, a younger person who receives a total hip replacement will likely need at least one revision later. Planning for this eventuality is part of the initial surgical decision.

Surgeons take this into account by selecting implant systems that make future revisions easier, preserving bone when possible, and using materials with proven wear characteristics. The goal is to maximize the time to first revision and to keep revision surgery technically feasible.

Surgical techniques and technologies that help in childhood-onset hips

Because of deformity and shallow sockets, surgeons use specialized techniques for these hips:

Acetabular reconstruction to build a stable, correctly oriented socket. This may include bone grafts or augmented components.
Femoral osteotomy to correct deformity and help restore leg length and offset.
Soft tissue releases and staged lengthening to avoid nerve stretch when significant lengthening is required.
Robotic-assisted or computer-guided placement improves accuracy when the hip anatomy is not standard. Robotic tools are particularly valuable for precise cup orientation in dysplastic or migrated sockets.
Selection of implant materials such as ceramic heads on highly cross-linked polyethylene to reduce wear and improve longevity.

These approaches increase the chance of a well-functioning, durable reconstruction even in hips with complex childhood origin.

How much lengthening is safe?

Lengthening a shortened limb is not just a mechanical act. Muscles, nerves, and soft tissues have to tolerate the change. There is a limit to how much immediate lengthening a nerve can safely handle. To reduce the risk of nerve injury, surgeons:

Plan realistic goals for leg length equality rather than trying to obtain perfect symmetry in a single stage.
Use staged procedures or osteotomies if large corrections are needed.
Monitor nerve function during surgery and release tight soft tissues.

The extent of safe lengthening depends on individual anatomy. Surgical judgment balances improved function against the risk of nerve complications.

When can other treatments delay total hip replacement?

Not every child with a hip disorder will need a total hip replacement. Options that can postpone or avoid replacement include:

Early detection and containment procedures for DDH in infancy such as harnessing or closed reduction.
Corrective osteotomies in childhood or adolescence to improve joint congruency and reduce wear.
Pediatric rheumatology treatments for juvenile arthritis to control inflammation and slow joint damage.
Physiotherapy, activity modification, and pain management to maintain mobility and function for as long as possible.

Where these measures succeed, replacement can be delayed into older adulthood. But if the joint is irreparably damaged, these measures serve only to buy time and reduce symptoms temporarily.

Case example that illustrates the challenge

A 24-year-old woman from a neighboring country presented with a lifelong left hip problem. Her left femoral head sat high and outside the true socket because the hip had been dysplastic since birth. Her right hip was normal. She could not walk easily and had significant functional limitation. After careful planning, a reconstructive total hip replacement was performed. Because the socket was shallow and the anatomy abnormal, robotic guidance was used for precise cup placement and custom-sized components were chosen. Within months she was walking and functioning independently—an outcome that conservative therapy could not have delivered at that stage.

Rehabilitation and long-term expectations

Rehabilitation after a total hip replacement aims to restore mobility, strengthen muscles, and retrain gait. For patients whose muscles were short or weak for years, physiotherapy may take longer. However, most patients notice dramatic pain relief and improved activity levels once soft tissue healing and rehabilitation proceed.

Long-term expectations include:

Improved daily function and reduced pain.
Possible need for future revision surgery, especially in younger patients.
Regular follow-up with clinical and radiographic checks to monitor implant wear and position.

How to decide: timing and threshold for replacement

Surgical timing is individualized. The threshold for proceeding to a total hip replacement is higher in younger patients because of implant lifespan concerns, but the key guiding principle is function. If a patient cannot perform daily activities, educational tasks, or work due to hip pain, replacement becomes the best solution. In older patients with similar symptoms, the threshold may be lower because the expected implant lifespan is likely to exceed the patient’s remaining decades of activity.

What parents and young patients should know

If a hip problem began in childhood, ask these questions:

Has the underlying condition been optimized with pediatric or adolescent orthopedics?
Are there reasonable joint-preserving options left to try?
How will surgery affect future revision options and what materials or techniques will the surgeon use to maximize longevity?
What rehabilitation program will be needed after surgery?

Open discussion with your orthopedic team about the tradeoffs between delaying surgery and improving current quality of life is essential.

Summary

Childhood hip disorders such as DDH, AVN, Perthes, SCFE, and juvenile arthritis can lead to early joint degeneration. A total hip replacement is a reliable way to restore pain-free mobility when joint-preserving treatments fail or the hip is irreparably damaged. These cases require careful planning because of deformity, limb shortening, and soft tissue issues. Modern implants and surgical technologies, including robotic assistance and advanced materials, have improved outcomes, but younger patients must understand the likelihood of future revisions. Ultimately, the decision revolves around restoring function and quality of life while planning responsibly for the long term.

Which childhood hip conditions commonly lead to early replacement?

Developmental dysplasia of the hip, avascular necrosis of the femoral head, Perthes disease, slipped capital femoral epiphysis, juvenile idiopathic arthritis, and severe childhood trauma are among the conditions that can progress to end stage arthritis requiring total hip replacement.

Can total hip replacement be performed in a 20-something?

Yes. Total hip replacement can be performed in young adults when pain and functional limitation cannot be controlled by conservative measures. The decision considers implant longevity and the likelihood of future revisions, but improving quality of life often justifies surgery.

How long do modern hip implants last?

Modern implants using ceramic and highly cross-linked polyethylene often demonstrate excellent function at 20 to 25 years in many patients. Longevity depends on activity level, implant selection, surgical technique, and patient factors.

What special techniques are used when the hip is dysplastic or deformed?

Techniques include acetabular reconstruction, femoral osteotomy, soft tissue releases, staged lengthening, and the use of computer-assisted or robotic guidance to improve component positioning. Specialized implants and bone grafting may also be necessary.

Can conservative treatments delay the need for total hip replacement?

Yes. Early detection and joint-preserving surgeries, targeted physiotherapy, activity modification, and disease-specific medical treatments for conditions like juvenile arthritis can delay or sometimes avoid replacement. However, they may not prevent the need for replacement if the joint is already severely damaged.

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