Sickle cell disease manifests itself in various forms the worst of which is sickle cell crisis. Among tissues most affected is bone with avascular necrosis of the femoral head (ANFH) being the most chronic and debilitating. After various treatments failed, recourse was made to total hip replacement or arthroplasty (THA). Over a period of 10 years 1999 to 2009, 27 THAs in 25 patients were done, 13 male and 12 female. There was one resurfacing done elsewhere. There were 11 cemented and 16 uncemented. Age ranged between 16 and 38 years. All patients came late with Ficat grade 4. Peak age for operations was 16 – 20 years. Six patients died, no death surgery related. End result was improvement of Harris hip score to between 70 and 88 from 40 to 55. Very few complications were noted and the overall outcome rated as good. Further research is recommended to identify viable biological treatment modalities.