Aim: The purpose of this retrospective study was to evaluate the migration and survival of the femoral component following cementless total hip replacement in patients with osteonecrosis of the femoral head in comparison to patients with osteoarthritis of the hip. Methods: The study included 31 patients who underwent 35 cementless total hip replacements for advanced osteo-necrosis of the femoral head and 49 patients with 58 total hip arthroplasties for osteoarthritis. The migration analysis of the femoral component was performed with the Einzel-Roentgen-Bild-Analyse (EBRA). Results: The follow-up for the patients with osteonecrosis and osteoarthritis of the hip was 6.1 and 5.9 years. Five stems (15.2%) from the osteonecrosis and two stems (3.6%) from the osteoarthritis group were revised for aseptic loosening. The median stem subsidence in the patients with osteonecrosis and osteoarthritis was 1.7mm (95% CI, 1 to 3.5) and 0.65mm (95% CI, 0.5 to 0.8), respectively (p< 0.01). Survivorship analysis with stem revision as endpoint for failure showed in the osteonecrosis and osteoarthritis group of 74.5% (95% CI, 56.1% to 92.8%) and 96.4% (95% CI, 91.5% to 100%), respectively (p< 0.05). Conclusions: The signiþcant difference in the subsidence and survival of the femoral component in the patients with osteonecrosis and osteoarthritis of the hip indicates that the bone around the prostheses is obviously inßuenced by the osteonecrosis. Young patients diagnosed with osteonecrosis of the femoral head should be treated with the most conservative treatment to preserve the hip joint.