Primary cementless Porous Coated Anatomic total hip arthroplasty was carried out in 36 hips in 29 patients with osteonecrosis (ON) patients and in 36 hips in 33 patients without ON. The ON was alcohol related in 11. steroid induced in 5, post-traumatic in 4, and idiopathic in 16 patients. The average follow-up period was 6 years. Clinical evaluation demonstrated 77.8% excellent or good results in the patients with ON, with the average Harris hip scores improved from 36.8 to 83.5. No revision of a prosthesis has yet been performed in the patients with ON. The patients with alcohol-related and steroid-induced ON had inferior clinical results when compared with the patients without ON. There were no statistically significant differences in the clinical results between the patients with post-traumatic or idiopathic ON and the patients without ON.