Ninety patients who were Jehovah's Witnesses underwent 107 total hip replacements without transfusion; all procedures were performed under spinal anesthesia. Of these 90, 87 had not previously undergone hip replacement surgery. They sustained an average intraoperative blood loss of 300 mL, which was a significant reduction compared with that in controlled groups of patients reported by other authors. Factors other than spinal anesthesia that aided in reducing blood loss were posterior surgical exposure of the hip without capsulectomy or removal of the greater trochanter, hemostasis without electrocauterization, and rapidly performed surgery. There were three operative complications and one death, none of which were related to spinal anesthesia.