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We determined retrospectively the postoperative mortality and fatal pulmonary embolism (PE) rates in 1275 consecutive primary total hip replacements (THR) in the six-week period after surgery at an orthopaedic hospital. Patients were traced by questionnaires, outpatient appointments and by telephone. Post-mortem records were used to verify cause of death. Follow-up was 100%.The death rate from PE was 0.16% (CI 0.04% - 0.57%) and the all-cause mortality rate was 0.47% (CI 0.22% - 1.02%). All deaths were within the first 10 days during the initial hospitalisation. The patient mortality was compared with the population mortality for England and Wales, using standardised mortality ratios (SMRs). The SMR for both sexes combined was 1.08 (CI 0.4 - 2.36). We observed a lower mortality in females (SMR=0.58; CI 0.07 - 2.09) but a higher mortality in males (SMR=1.91; CI 0.52 - 4.9) during the first 42 postoperative days compared to the general population.Fatal PE after THR without routine chemical thromboprophylaxis is uncommon. The death rate in patients undergoing THR appears to be similar to that in the general population.