Sixty total hip arthroplasties (THA) were performed in 39 renal transplant recipients as the treatment for painful osteonecrosis of the femoral head. The average age was 32 years (range, 16-54 years). The average preoperative Harris hip score was 38, while the average postoperative score was 95 after an average follow-up period of 44 months. Ten hip dislocations occurred. The etiology appeared to be multifactorial. One femoral component loosened, and one patient died from a deep wound infection. Although renal transplant patients have a reduced life expectancy and chronic corticosteroid immunosuppression leads to osteoporosis of bone, THA is well tolerated and is recommended as the procedure of choice in patients with painful osteonecrosis.