Just a few decades ago, artificial joint replacement was considered a medical procedure reserved exclusively for older people - typically those over 65 suffering from advanced osteoarthritis. However, this perspective has changed dramatically. Increasingly, young patients, i.e., people under 55 or even under 40 years old, are opting for hip replacement, knee replacement or partial knee replacement because the pain, mobility restrictions, and daily limitations leave no other options.

In an active society where physical mobility, sport, occupation and quality of life are central values, the call for permanent joint replacement at a younger age is getting louder . Many wonder: When is the right time? And when is it too early? This blog provides a well-founded, medically up-to-date and understandable answer to these questions.

Chapter 1: Definition – What is an artificial joint?

An artificial joint, also called an endoprosthesis , permanently replaces the function of a diseased natural joint. It is usually made of metal alloys, ceramic or highly cross-linked plastic (polyethylene) and is firmly anchored in the bone - either cement-free (press-fit), cemented or hybrid.

The most commonly used endoprostheses in Germany are:

• The total hip replacement (hip arthroplasty)
• The total knee arthroplasty (TKA)
• The partial joint replacement, e.g., the sledge prosthesis in isolated osteoarthritis of a knee compartment

The goal of joint replacement is to alleviate pain, restore joint function, and improve quality of life in the long term – regardless of age.

Structure of an endoprosthesis

Using the example of hip replacement, the basic design can be well explained:

• Acetabulum: Inserted into the pelvis, often made of titanium, sometimes with ceramic insert
• Femoral stem: Anchored in the femur, carries the head
• Head component: Made of ceramic or metal, glides in the socket

In knee prosthesis a distinction is made:

• Monocondylar prosthesis (sledge prosthesis) – replaces only one joint compartment
• Bicondylar prosthesis (total knee replacement) - replaces the entire joint (usually femorotibial on both sides)
• Patellofemoral prosthesis – only for patellofemoral joint, rare

Chapter 2: Who is considered 'young' in joint replacement?

The term "young" in endoprosthetics is not a fixed age limit, but a relative concept. In medical literature and clinical practice, the following classifications usually apply:

• < 40 years – very young
• 40–55 years – young
• 55–65 years – middle age
• > 65 years – classic joint replacement area

A artificial joint under 50 years is considered particularly critical – not because it's technically infeasible, but because in this age group the risk of premature loosening, later revision surgery (revision) and higher mechanical stress are particularly high.

However, there are exceptions: Those who suffer from chronic pain, can no longer cope with everyday life, and have exhausted conservative therapies – they can also receive a hip or knee replacement at 30 or 40 years of age, if the indication is correctly made.

Chapter 3: Figures & Trends – Why more and more young people are receiving an artificial joint

The number of artificial joints implanted in Germany has been rising continuously for years – and the increase is particularly noticeable among younger patients. While in the past, classic joint replacement was usually performed in people over 65, today more and more people under 60, sometimes even under 40 years old, opt for a total hip replacement (THR), total knee replacement (TKR) , or unicompartmental knee arthroplasty (UKA).

Current Statistics: Knee and Hip Prostheses by Age Group

According to the Federal Association for Medical Technology (BVMed) and the Endoprosthesis Registry Germany (EPRD), it is shown:

• Around 450,000 joint replacement surgeries annually in Germany
• Of these, over 240,000 are hip TEPs, over 190,000 are knee TEPs
• The proportion of patients under 60 years is continuously increasing – for hip replacements, it is already over 15 %
• In knee prostheses, patients under 65 years old even make up around a third of the cases

In the USA, a particularly significant trend was observed: Between 2000 and 2017, the number of knee replacements in 45- to 64-year-olds increased by 188%, and hip replacements by 123% – and this trend is seen in a similar way in Europe.

Why this increase?

Several factors explain why more and more young people are opting for joint replacement:

1. More Active Lifestyle
   Many people remain physically active for longer today - jogging, tennis, hiking or CrossFit lead to higher stress and thus also earlier joint wear.
2. Earlier Diagnosis
   Thanks to MRI, arthroscopy and improved imaging, joint damage is now detected and documented earlier.
3. Increasing expectations for quality of life
   Young patients are not willing to live with pain and functional limitations for decades. The desire for unrestricted quality of life is greater than ever.
4. Improved Implants and Techniques
   Modern prostheses last significantly longer today. Studies show survival rates of over 90% after 20 years - making them more attractive for younger patient groups.
5. Specialization of centers
   Highly specialized endoprosthetics centers like the ENDOPROTHETICUM Mainz also enable complex care in young years with individually adapted implants.

Typical scenarios

A sporty active man, 42 years old, has been suffering from post-traumatic knee osteoarthritis since an accident in his youth. Conservative treatments no longer bring relief. A unicompartmental knee arthroplasty (UKA) or partial knee replacement offers him a chance to live largely pain-free again – without having to give up sports. The decision is not easy, but for him, it's the right step.

Anna, 34 years old, employed, physically active, mother of a toddler, suffers from bilateral hip dysplasia since her youth. Despite previous joint-preserving surgeries and years of conservative therapy (physiotherapy, infiltrations, painkillers), her condition significantly deteriorated: the pain increased, mobility decreased, and limping became noticeable. After just a few minutes of walking, she had to stop, nocturnal pain disrupted her sleep. Jogging, yoga, or sitting for long periods were hardly possible anymore. Also a very difficult decision, but treatment with short-stem prostheses brought the patient back to life.

Chapter 4: When is joint replacement in young age medically reasonable?

The decision for an artificial joint in young age is always a weighing between medical necessity, individual life circumstances and the long-term consequences of a surgical intervention. While age was previously almost automatically considered a counterargument, modern orthopedic guidelines now consider the suffering and functional capacity as decisive for the indication.

Important criteria for indication in young people

A joint replacement – be it a hip TEP, knee TEP or a unicompartmental knee arthroplasty – can be medically reasonable in younger patients if:

1. Conservative therapy is exhausted:
   Physiotherapy, pain medication, injections (e.g. hyaluronic acid, cortisone), orthotics, weight reduction and other measures have been applied for at least 6 months – without lasting success.
2. Severe limitations exist in everyday life:
   The joint causes such severe pain that everyday movements like walking, climbing stairs, or sitting are no longer possible – or only possible with medication.
3. Painful rest pain occurs:
   Pain that occurs at night or during rest periods is considered a serious warning sign for a serious joint pathology.
4. Imaging shows advanced destruction:
   X-ray or MRI images show severe osteoarthritis (stage III–IV according to Kellgren and Lawrence), joint deformities, or axial deviations.
5. The quality of life is severely impaired:
   Social, family, or professional life is significantly limited by the damaged joint.

Typical underlying conditions that require an endoprosthesis at a young age

The cause of premature joint wear is often not age-related, but lies in certain pre-existing conditions. These include:

• Rheumatoid arthritis or other autoimmune diseases
• Congenital malformations (e.g. hip dysplasia)
• Perthes disease or slipped capital femoral epiphysis in childhood
• Avascular bone necrosis (e.g., AVN of the femoral head during cortisone therapy or alcohol abuse)
• Post-traumatic arthrosis after accidents or sports injuries
• Early meniscus or cartilage operations that lead to instability
• Misalignment due to axial deviations (e.g. X-leg or O-leg)
• Chronic joint infections

These conditions can lead to joint replacement in patients as young as 30 to 40 years old – often initially a partial joint replacement such as a sledge prosthesis – being medically necessary.

Beware of misdiagnosis or hasty decisions!

Especially in young patients, there is a risk of premature indication or misjudging the cause of pain. It is essential to consider the following points:

• Not every pain means osteoarthritis – soft tissue problems, such as patellar tip syndrome, runner's knee, trochanteric bursitis or sacroiliac joint blockages, can cause severe symptoms.
• An accurate clinical examination is essential. The clinical correlation to imaging must always be given.
• Patients should always seek a second opinion at a specialized center like ENDOPROTHETICUM in Mainz before an endoprosthesis is implanted.
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A joint replacement at a young age is not a wrong decision – if the indication is correct. For many patients, it can even be a turning point to more quality of life, mobility, and future prospects. However, a careful consideration, a specialized diagnosis and treatment by experienced endoprosthetic experts.

Chapter 5: Which prosthesis is the right one for young people?

The choice of the appropriate implant is particularly critical in younger patients. While in older people, long-term pain relief and rapid rehabilitation are often the primary focus, in young patients, additional aspects such as durability, activity level, bone preservation, and revision options are also important.

The goal must be to preserve the natural joint for as long as possible, and if replacement is unavoidable, to operate as tissue-friendly and modular as possible. This requires precise individual indication, sound experience and modern implant technology.

Total endoprosthesis vs. partial joint replacement – When is what sensible?

1. Total joint replacement (knee TEP, hip TEP)

• Complete replacement of the joint
• For hip: replacement of the femoral head and acetabulum
• For the knee: Replacement of the upper and lower leg joint surface
• Advantages: long durability, proven technology, also suitable for pronounced osteoarthritis
• Disadvantages: higher bone loss, possibly limitation in very athletic stress

Suitable for:
Younger patients with multiple joint compartment arthritis (e.g. femoropatellar and medial gonarthrosis simultaneously) or in rheumatic diseases

2. Unicompartmental knee arthroplasty (UKA)

• Replacement of only the medial or lateral joint compartment in the knee
• The healthy bone, ligament apparatus, and cartilage in the remaining joint are preserved
• Advantages: Bone- and soft tissue-friendly, faster rehabilitation potential, more natural movement guidance
• Disadvantages: Not suitable for inflammatory diseases or advanced arthritis in several joint compartments

Suitable for:
Younger patients with isolated medial or lateral gonarthrosis – often as a result of malalignment or meniscal loss

3. Patellofemoral joint replacement

• Special form of partial prosthesis for isolated arthrosis of the kneecap
• Often used in cases of dysplasia or patellar malalignment in young age

Hip prostheses: cementless, short stem or surface replacement?

a) Cementless hip TEP

• Today's standard for younger people
• Enables good ingrowth of the prosthesis into the bone (so-called "press-fit" technique)
• Particularly suitable for patients with good bone quality
• Advantages: better later revision options

b) Short stem prosthesis

• Specifically developed for younger patients
• Saves bone substance at the femoral neck
• Better proprioception and biomechanically more favorable
• Particularly suitable for hip dysplasias or after Perthes

c) Surface replacement (resurfacing)

• Rare, but indicated in special cases (especially in young athletic men with good bone quality)
• Advantage: maximum bone preservation
• Disadvantage: Metal-metal connection and possible abrasion problems

Factors influencing prosthesis selection in young patients

• Bone substance and bone quality
• Axis ratios and malalignments
• Type of disease (e.g., degenerative vs. inflammatory)
• Professional requirements
• Sports ambitions
• Body weight and mobility
• Individual anatomy (e.g. in case of dysplasia or leg length differences)

Why choosing the right implant is crucial

Especially in younger patients, the probability of a revision surgery during their lifetime is significantly increased. Therefore, individual, forward-looking planning is crucial. In specialized centers like the ENDOPROTHETICUM in Mainz , not only the suitable prosthesis is selected, but also the surgical technique and long-term strategy are individually tailored.

Chapter 6: What young patients need to consider after surgery

A joint replacement in young age represents a significant intervention – but also a great opportunity for a new sense of well-being, painlessness, and mobility. However, to ensure the implant lasts as long as possible and complications are avoided, it is crucial what happens after the surgery. Young patients often have different requirements for their lifestyle than older people – and this makes holistic aftercare all the more important.

The first phase after surgery: rehabilitation and mobilization

After a hip TEP, knee TEP or sledge prosthesis rehabilitation usually begins on the day of surgery or the next day. At the curaparc-clinic in Mainz under the direction of Prof. Dr. med. Karl Philipp Kutzner special emphasis is placed on rapid, structured mobilization – adapted to the individual resilience and type of prosthesis.

Typical procedure:

• Day 1: first mobilization with physiotherapy, first steps with walking aids, full weight-bearing usually allowed from the start
• Week 1–2: Training of mobility, coordination, gait pattern
• Week 3–6: Load increase, muscle strength building
• Week 6–12: Transition to normality, return to everyday ability

Goal: to be mobile again as early as possible without overloading the implant. The right measure is crucial – and close coordination between surgeon, physiotherapist and rehabilitation team.

Special requirements for young patients with artificial joints

Unlike seniors, many young people want to return to their normal activities after surgery:

• Do sports
• professionally active being
• Care for or lift children
• Going on vacation, traveling, or driving a car
• partially even competitive sports or physically demanding activities (e.g. crafts, agriculture) practice

Therefore, differentiated aftercare is crucial. As a rule, the following sports activities can be resumed after 3–6.

The INDIVIDUAL sports clearance must always be done by the treating center.

Strategies for the durability of the prosthesis

Even if modern hip and knee TEPs can now achieve a lifespan of 15 to 25 years , younger patients are almost always at a higher risk of early loosening, abrasion or wear

Tips for long-term prosthesis function:

1. Avoidance of overweight:
   Every kilogram of body weight exerts 3–5 times the force on the joint.
   Goal: maintain a BMI below 30.
2. Correct gait pattern:
   Avoid incorrect loading due to protective posture, use insoles or orthoses if necessary.
3. No high-performance sports:
   Avoid shock loads (e.g., jumps, rapid changes of direction).
4. Physiotherapy for proprioception and stability:
   Especially for knee TEP or sled prosthesis to stabilize the ligament apparatus.
5. No need for long-term pain medication – but if new pain occurs, it should be clarified promptly!

What about occupational stress?

Many young patients are in the middle of their working lives. For physically demanding activities (e.g. nursing, construction, gastronomy), a return to work after 2–4 months may be possible – sometimes with adjustments or retraining needs.

After a joint replacement, the success of the surgery is only half the battle. Especially in young patients, postoperative care plays a crucial role in determining long-term success. Those who adhere to the recommendations, remain active – but do not overexert themselves – can lead a long, fulfilling, and pain-free life with an artificial joint. Personalized follow-up care is the key to maximum durability and quality of life.

What distinguishes ENDOPROTHETICUM?

✅ Specialization in modern endoprosthetics for young people

Unlike many other institutions, ENDOPROTHETICUM is not a general hospital, but a highly specialized center for joint replacement. The focus is on complex cases, revision surgeries and also on the care of young patients, where other clinics hesitate or rush to total joint replacement.

✅ Individual implant selection instead of “one-size-fits-all”

Thanks to the extensive experience of Prof. Kutzner and his team, modern, joint-preserving procedures such as the unicompartmental knee arthroplasty, patellofemoral prosthesis or short-stem implants are routinely offered. It is never operated "blindly" - but based on:

• Body structure and anatomy
• Occupational and athletic stress
• Bone quality
• Type and extent of osteoarthritis
• Long-term perspective

✅ Use of the latest technologies

• Digital surgical planning with 3D imaging
• Tissue-sparing minimally invasive techniques
• Special anesthesia techniques for maximum compatibility and rapid mobilization

✅ Personal care by Prof. Dr. Kutzner himself

Many patients appreciate that the diagnosis, consultation, surgery and follow-up care are not carried out by changing assistant doctors, but are personally supervised by Prof. Kutzner. This ensures trust, safety and high quality