Cemented low-friction arthroplasty, pioneered by Sir John Charnley, is the basis for modern total hip arthroplasty (THA). The Charnley THA is still considered as the gold standard against which new devices are compared. However, aseptic loosening was a relatively common cause for the failure of cemented THAs. Therefore, new fixation methods and bearing surfaces were developed, e.g., uncemented THAs, resurfacing arthroplasty (HRA), and metal-on-metal THAs. 

National arthroplasty registers were established to assess new THA devices and to detect outlier products as early as possible. The Swedish Hip Arthroplasty Register was established in 1979, the Finnish Arthroplasty Register (FAR) in 1980, the Norwegian Arthroplasty Register in 1987, and the Danish Hip Arthroplasty Register in 1995. A combined Nordic arthroplasty register (Nordic Arthroplasty Register Association, NARA) was established in 2007 with the overall aim of improving the quality of joint replacement surgery by registry-based research collaboration. 

The aim of this thesis was to assess risk factors and prevalence of adverse reaction to metal debris (ARMD) associated with two metal-on-metal hip devices – the Birmingham Hip Resurfacing (BHR) HRA and the Biomet ReCap Magnum THA – based on data of the joint replacement register of the Turku University Hospital. Another aim was to compare the differences in survivorship of three HRA designs with their analogous uncemented, large-diameter head metal-on-metal THAs based on FAR data. Further, survival of the most common cemented THA brands was assessed by data of the NARA. 

We found that hip resurfacing arthroplasty with the BHR HRA may be more dangerous than previously thought. Systematic follow-up of these patients is advised. There was a high prevalence of ARMD among ReCap-M2a-Magnum THA patients. The shortterm revision risk of large diameter head MoM hip replacements was not increased compared to similar HRAs (FAR data), but implant-related factors may contribute to this success. Several brands of cemented THAs performed well in the long term, but there are significant differences in implant survival between the best and the worst performers.