Open Access Research article

A retrospective comparative study of mortality and causes of death among patients with metal-on-metal and metal-on-polyethylene total hip prostheses in primary osteoarthritis after a long-term follow-up

Tuomo Visuri1*, Håkan Borg2, Pekka Pulkkinen3, Pekka Paavolainen4 and Eero Pukkala5

Author Affiliations

1 Research Institute of Military Medicine, Helsinki, Finland

2 Clinics for Orthopaedics and Traumatology, Central University Hospital, Helsinki, Finland

3 Department of Public Health, University of Helsinki, Helsinki, Finland

4 Orton Orthopaedic Hospital, Helsinki, Finland

5 Finnish Cancer Registry, Helsinki, Finland, and School of Public Health, University of Tampere, Tampere, Finland

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BMC Musculoskeletal Disorders 2010, 11:78  doi:10.1186/1471-2474-11-78

Published: 23 April 2010



All patients with total hip arthroplasty (THA), especially those with metal-on-metal (MM) THA, are exposed to metallic particles and ions, which may cause total or site-specific mortality. We analyzed the causes of total and site-specific mortality among a cohort of patients with MM and with metal-on-polyethylene (MP) THA after a long follow-up time.


Standardized mortality ratios (SMR) of total and site-specific causes of death were calculated for 579 patients with MM (McKee-Farrar) and 1585 patients with MP (Brunswik, Lubinus) THA for primary osteoarthritis.


Mean follow-up time was 17.9 years for patients with MM and 16.7 years for patients with MP. Overall SMR was 0.95 for the MM cohort and 0.90 for the MP cohort, as compared to the normal population. Both cohorts showed significantly decreased mortality for the first decade postoperatively, equal mortality over the next 10 years, and significantly increased mortality after 20 years. Patients with MM THA had higher cancer mortality (SMR 1.01) than those with MP THA (SMR 0.66) during the first 20 years postoperatively, but not thereafter.


Both MM and MP prostheses are safe based on total and site-specific mortality of recipients during the first 20 postoperative years in comparison with the general population.