The aim of this study was to test the hypothesis that a previous joint-preserving procedure for osteonecrosis of the femoral head (ONFH) would compromise the outcome of a subsequent total hip arthroplasty. The clinical and radiographic results of total hip arthroplasty using the S-ROM stem (DePuy/Johnson & Johnson, Leeds, UK) in 36 hips with failed joint-preserving procedures for ONFH were compared with those in a matched control group of 39 osteonecrotic hips without a previous joint-preserving procedure. After a mean follow-up of 4.6 years, with the exception of 1 reoperation for polyethylene wear and osteolysis, no revisions due to mechanical failure of the prostheses had been performed in the study cohort of 36 hips. However, the study group had a longer operative time, more perioperative blood loss, a higher rate of intraoperative complications, and poorer postoperative ranges of hip motion than those in the control group. These results confirm the hypothesis that a previous joint-preserving procedure for ONFH poses technical challenges for a subsequent total hip reconstruction and might have a detrimental effect on the short-term clinical outcome.