Limited data exist on the safety of primary total hip arthroplasty (THA) and total knee arthroplasty (TKA) in cirrhotic patients. We retrospectively reviewed outcomes of these procedures in cirrhotic patients and matched controls. Significant adverse outcomes occurred in 20.7% (6 of 29) of cirrhotic patients compared with 3.23% (3 of 93) of controls. No significant differences were seen between the groups for elective TKA or THA. However, 80% (4 of 5) of the cirrhotic patients undergoing emergent THA secondary to fracture had major complications, with a 60% (3 of 5) mortality rate. There was a trend toward worse overall outcome in cirrhotic patients with more advanced liver disease. In conclusion, primary THA or TKA can be safely performed electively in Child's A and B cirrhotic patients. However, emergent THA to repair fractures in cirrhotic patients is associated with significantly increased morbidity and mortality.