The effectiveness of autologous blood donation in reducing the need for homologous transfusion was evaluated in a review of 529 consecutive total hip replacements (THR) from 1988 to 1992. The review was retrospective from 1988 to 1990 and prospective from 1991 to 1992. Since 1988 there have been 188 primary THR performed using autologous blood donation. In 1988–89, this represented 18% of all primary THR, in 1990 37% and in 1991–92 73%. This increase reflects a growing enthusiasm for the programme and a loosening of age restrictions. In 1991–92, 4% of autologous donors undergoing primary THR required homologous transfusions compared to 84% of non‐autologous donors. Over the same period after revision THR, 36% of autologous donors required homologous transfusions compared to 100% of non‐autologous donors. The participation rate of patients undergoing revision THR was 33%. The prospective part of the study in 1991–92 compared autologous and matched non‐autologous patients. Blood loss, transfusion volumes and operating time were identical. The pre‐ and postoperative haemoglobin concentrations in the autologous group were lower by 15 and 10g/L, respectively, after primary THR and by 10 g/L in both instances after revision THR. This was not reflected in a l