One hundred patients who were Jehovah's Witnesses underwent total hip replacement without transfusion, of which eighty-nine procedures were performed under hypotensive anesthesia. Of these eighty-nine patients, sixty-five had not had previous hip surgery and sustained an average intraoperative blood loss of 450 milliliters. This was a 43 per cent reduction in blood loss as compared with a control group of patients, who were not Jehovah's Witnesses and who had total hip replacement under normotensive anesthesia. Twenty-four of the eighty-nine patients who were Jehovah's Witnesses and had had previous hip surgery underwent total hip arthroplasty under hypotensive anesthesia and sustained an average intraoperative blood loss of 680 milliliters, which was 30 per cent less than that of similar matched controls who were operated on under normotensive anesthesia. The postoperative blood loss in the patients who had had hypotensive anesthesia was not increased compared with that in the controls. Eleven Jehovah's Witnesses who were not candidates for hypotensive anesthesia had a total hip replacement under normotensive techniques. Factors other than hypotensive anesthesia that aided in reducing blood loss were careful surgical technique, meticulous hemostasis, and well planned surgery. There were six complications, one of which was possibly related to hypotensive anesthesia, and no deaths.