This article presents results for total hip arthroplasty after failed transtrochanteric rotational osteotomy according to Sugioka and after failed bone impaction grafting, both initially performed for osteonecrosis of the femoral head. After a minimal follow-up of 2 years, 33 hips were studied. In total hip arthroplasty after failed osteotomy, when compared with total hip arthroplasty after failed bone impaction grafting, clinical and radiologic outcome was less favorable, more complications were observed, and there was a higher revision rate for a technically more demanding procedure.