The complications and results of 16 primary and revision total hip arthroplasties in patients with sickle-cell hemoglobinopathies were evaluated. One patient died from renal failure at 1 year, leaving 15 hips in 10 patients for review at a mean follow-up period of 6 years (range, 2-12 years). There were 7 cementless primary total hip arthroplasties and 8 revision arthroplasties, 6 of which were uncemented. Patients were evaluated clinically using a standard hip rating system and radiographically using accepted criteria. There were no early or late deep infections; however, 7 of 8 primary arthroplasties and 5 of 8 revisions had one or more early complications. No cementless component demonstrated loosening; however, there was asymptomatic polyethylene wear in 2 primary arthroplasties, treated with grafting and liner exchange, and femoral osteolysis was present in 4 of 13 cementless arthroplasties, one of which was revised to permit extensive grafting. Of the original 15 arthroplasties performed by the senior author, 5 required some type of reoperation during the study. At most recent follow-up evaluation, no component in the study was radiographically loose. In the hips that did not require reoperation, the overall results were excellent in 6 hips, good in 3, and poor in 1 hip. Of the 5 hips requiring reoperation, the results were excellent in 3 hips, good in 1, and fair in 1 hip at most recent follow-up evaluation. Cementless components should be considered for all primary and revision arthroplasties in patients with sickle-cell hemoglobinopathies, but early complications are frequent and a high incidence of polyethylene wear and osteolysis requiring reoperation may be expected.