This study investigated the perceived risks and complications associated with total hip arthroplasty for Paget's disease. A total of 98 Charnley low-friction arthroplasties were performed on 76 patients, 27 men (37 hips) and 49 women (61 hips), whose average age was 67.4 years (range, 51-79 years). Intraoperative blood loss averaged 388 mL (range, 110-1,730 mL), and minor heterotopic ossification occurred in 24 hips (25%), with significant changes in 4 hips (4%). After average follow-up of 10.4 years (range, 5.5-20 years), 10 acetabular (10%) and 8 femoral (8%) implants had loosened aseptically, but there was no evidence of progressive protrusio acetabuli or femoral deformity after operation. Survivorship to revision was 98% at 10 years (95% confidence interval [CI], 95%-100%) and 91% at 15 years (95% CI, 80%-100%) for the acetabular component and 93% (95% CI, 87%-99%) and 89% (95% CI, 80%-99%) for the femur. The only increased risk identified was nonunion of the trochanteric osteotomy (13%).