Introduction: We studied the survival of primary total hip arthroplasty (THA) in patients undergoing surgery because of rheumatoid arthritis (RA) and compared our results to the survival of primary THA in patients undergoing surgery because of osteoarthritis (OA). Furthermore, we evaluated the effect of primary THA-survival in RA-patients concerning multiple confounders such as age, gender, comorbidity, and cemented/uncemented prosthesis.

Material and Methods: Using the Danish Hip Arthroplasty Register we gathered info concerning 1.302 primary THA’s in 1.106 RA-patients and 41.848 primary THA’s in 35.729 OA-patients. These patients underwent surgery from 1995 to 2004. Using the Cox regression model we estimated the relative risk (RR) for revision due to aseptic loosening, other reasons, and all reasons and adjusted for above mentioned confounders.

Results: The adjusted RR’s for cup-revision of primary THA’s in patients with RA (compared to OA) were 1.22 (aseptic loosening − 95% Confidence Interval (CI) 0.75–1.99), 0.90 (other causes for revision − 95% CI 0.61–1.32), and 1.00 (all revisions − 95% CI 0.74–1.35). For the stem the RR’s were 0.50 (aseptic loosening − 95% CI 0.25–0.99), 0.58 (other causes for revision − 95% CI 0.35–0.95), and 0.54 (all revisions − 95% CI 0.36–0.80). RR for all revisions (both cup and stem) was 0.83 (95% CI 0.64–1.09). The RAsubanalysis showed an increased RR (all revisions) for men compared to women (RR 2.60; 95% CI 1.19–5.66). No significant result concerning all revisions for age, comorbidity, and cemented/ uncemented prosthesis was found. The mean follow-up was 5,4 years for RA and 4,8 years for OA.

Conclusion: The survival of primary THA’s in RA could not be associated with any clearly overall increased risk of revision when compared to OA. However, male gender seems to be a risk factor for undergoing revision-THA in the RA-subgroup.