A 60-year-old man with beta-thalassemia intermedia and degenerative joint disease was successfully treated by total hip arthroplasty. The operation was complicated by severe bleeding associated with marked bone marrow hyperplasia. Despite autologous cell salvage, massive homologous transfusion was required. Special orthopaedic and perioperative complications stem from beta-thalassemia syndromes. Management may be complicated by anemia, medullary hyperplasia, organ dysfunction associated with iron overload, and susceptibility to infection. The orthopaedic manifestations of beta-thalassemia may be mitigated by chronic transfusions.