Introduction:. One method of femoral head preservation following avascular necrosis (AVN) is core decompression and Tantalum Rod insertion. There is, however, a published failure rate of up to 32% at 4 years. The purpose of the present study was to document the clinical and radiological outcome following Total Hip Arthroplasty (THA) subsequent to failed Tantalum Rod insertion. Methods:. Twenty-five failed Tantalum Rod insertions subsequently requiring THA were identified from a prospectively updated database. Seventeen patients met minimum 2 year clinical and radiographic follow-up criteria. St. Michael's Hip (SMH) scores were compared to a matched cohort of patients with THA for AVN without prior Tantalum Rod insertion. Postoperative radiographs were reviewed assessing component alignment, linear wear (Dorr & Wan) and presence of tantalum residue within the joint space. Results:. Nine females and eight males underwent removal of a Tantalum Rod with subsequent THA between May 2005 and March 2010. The mean time between Tantalum Rod insertion and conversion to THA was 23 months (range 6–48) with a mean follow-up of 3.5 years (range 2–5). At each follow-up interval the mean SMH scores were comparable between the two groups (p = 0.445). Femoral stem alignment (p = 0.428) and acetabular cup inclination (p = 0.723) were comparable between groups. Articular tantalum residue was identified in 12 of 17 articulations (7 mild, 3 moderate, 2 severe). Linear wear rates were comparable between the tantalum group (0.07 mm/yr, range 0.01–0.40) and controls (0.07 mm/yr, range 0.02–0.21, p = 0.951). There was no evidence of catastrophic wear. Conclusion:. Tantalum rod conversion to THA in the young adult patient with AVN reveals no early catastrophic sequelae. In the short term, Tantalum Rod insertion does not demonstrate a deleterious effect on subsequent total joint replacement surgery. There is, however, a high rate of retained tantalum debris within the effective joint space with the procedure and thus there is an unknown risk of accelerated articular wear necessitating longer term study