Total hip replacement is one of the most successful procedures in orthopedic surgery. However, hip joint replacement is still indicated rarely for young, active people. The aim of this study was to demonstrate the clinical and radiological results of hip arthroplasty in patients under 40 years of age. After an average of 8.5 years, a follow-up examination was carried out in the orthopedic clinic of the University Hospital Halle (Saale). The study population consisted of 72 cases, 35.6 years old on average. The preoperative Harris Hip Score was 59 and improved to 82 at the time of follow-up. The study demonstrated that high patient activity had a positive clinical outcome. In the present study, five cup components were revised and a complete hip prosthesis change was necessary in three cases. Radiologically aseptic loosening was identified as the main cause of revision. The 10-year survival rate was 85.2 %, and the 15-year survival rate was 71.3 %. Overall, this study showed a good result of hip replacement in young, active patients.