Twenty-seven cementless total hip arthroplasties were performed in 17 steroid-dependent renal transplant patients. The average age at operation was 39 years, and the average daily dose of prednisone was 10.9 mg. At a mean of 48 months post-surgery, all patients had good to excellent hip ratings on clinical examination and the results compared favorably with 235 non-steroid-dependent age-matched patients using the identical prosthetic hip system. The results of this study suggest that long-term immunosuppression does not prevent bone ingrowth. Noncemented total hip arthroplasty appears to be a reasonable therapeutic option for end-stage osteonecrosis in steroid-dependent renal transplant patients.