Recent reports indicate that patients' expectations should be assessed as part of routine practice before total hip arthroplasty (THA). A total of 1,103 THA patients preoperatively completed the Hospital for Special Surgery Total Hip Replacement Expectations Survey, an 18-item scale tested for validity and reliability. Patients also completed measures of hip-specific function (American Academy of Orthopaedic Surgeons Hip/Knee Module), and overall physical function (SF-36). Patients with worse preoperative function had higher expectations of THA and were more likely to rate their expectations as very important compared with patients with better function. In multivariate analysis, older patients, men, and those with worse functional status (both hip-specific and overall physical function) had more expectations of THA. Identifying and addressing expectations, particularly possibly unrealistic expectations, are important elements in discussions with patients before THA.