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German hip registry confirms: ceramic + 36mm heads set the standard in primary THA

The Endoprothesenregister Deutschland (EPRD) continues to broaden and deepen its findings to provide comprehensive, up-to-date statistics on German trends in total joint arthroplasty and German surgeon preferences in bearings, fixation and component types.

Cover and title page of the EPRD Annual Report 2024 from the Endoprosthesis Registry Germany, highlighting key authors and the theme “With Safety More Quality”.
Infographic from EPRD Annual Report 2024 illustrating trends in insert materials for primary hip arthroplasty, highlighting increased adoption of highly cross-linked polyethylene. Includes hip implant diagram and a data table with material usage percentages.
Infographic from EPRD Annual Report 2024 showing trends in femoral head sizes for primary hip arthroplasty, with a notable rise in 36-mm heads. Includes a diagram of hip implant and a data table comparing head size usage.
Infographic from EPRD Annual Report 2024 showing statistics on hip arthroplasty revision procedures and most frequent reasons for hip revisions.

Here are the hip highlights from the 2024 report: 

Primary hip replacements in 2023: 187,640

  • 88.8% total hip, 11.2% hemi-hip

Revision hip operations in 2023: 18,933

Fixation trends 

  • Most popular fixation type is (still) uncemented, accounting for 77.2% of procedures
  • Hybrid fixation is up from 17.9% in 2022 to 18.6% in 2023
  • Cemented fixation dropped from 3.7% in 2022 to 3.2% in 2023
  • Reverse hybrid fixation accounted for 0.9% of procedures

Head size stats

  • Ceramic is used in 90% of primary THAs in Germany – a stable trend
  • 3% rise in use of 36mm femoral heads (50.1%)
  • 2.4% decline in use of 32mm femoral heads (45.3%)
  • 28mm heads remain stable: 5% of procedures since 2018

Getting the bearings

  • CoP up: 67% in 2014 to  83% in 2023
  • CoC down: 15.4% in 2014 to 7.5% in 2022 to 7.1% in 2023
  • Same for MoP: 15.8% in 2014 to 5.3% in 2022 to 5% in 2023
  • Dual mobility couples used in 2.2% of primary THAs (up from 1.9% in 2022) and 41.3% of acetabular revisions (up from 38.5% in 2022)
  • CoC bearings perform best
  • Revision rate of bearings with metal heads was significantly higher than with ceramic heads (both cemented and uncemented stem fixation groups)
  • Short stems hit a new peak: 15.1% of stems

Revision reasons

  • Loosening: 22.1%
  • Infection: 18%
  • Periprosthetic fracture: 15.8%
  • Dislocation: 14.1%
  • Component failure: 2%

Revision rates due to infection have increased by 8 percentage points (from 10% in 2014 to 18% in 2024). Revision rates saw an increase as head size decreased.

CAUTION: 2023 saw 57 cases of hip replacement with mismatched size of head and insert.  Heads that are too large may result in malalignment, and heads that are too small in impingement and insert damage. The EPRD software now issues an automatic warning against prohibited implant combinations.

Please check for regulatory approval in your country.

References: 
Endoprothesenregister Deutschland (EPRD). Jahresbericht 2024 Mit Sicherheit mehr Qualität. 
https://www.eprd.de/fileadmin/user_upload/Dateien/Publikationen/Berichte/Short-presentation-AnnualReport2024_2025-03-27_F.pdf. Published October 24, 2024.

Slides used with permission of EPRD.
 

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