Background: Hip joint replacement surgery or total hip arthroplasty (THA) is an effective procedure for elderly patients. It can improve their quality of life and functionality while reducing the direct costs associated with arthritis. With increased THA procedures being performed on patients of different ages, it is essential to identify factors that may affect mortality for better patient care.

Objective: This study aimed to identify the early mortality rate and potential risk factors among patients undergoing primary total hip replacement (THR) at a tertiary hospital in Tanzania.

Methodology: This was a retrospective cohort study conducted from January 2020 to December 2021, which involved patients who had undergone THR.

Result: The study involved 183 participants, 53.6% of which were male with a mean age of 55.9 ± 18.4 years. Early mortality (death before 3 months) was found to be 7%. Having hypertension and being seropositive for HIV were independent prognostic factors for survival. Hypertension was associated with an increased chance of death by 4.8 times. The likelihood of death was eleven times higher among participants who were HIV+.

Conclusion: Hypertensive patients had an increased chance of death of five times more compared to those with no hypertension. HIV+ patients had an increased chance of death, up to eleven times higher with difference in disease profiles and HIV endemicity in our settings this calls for a different approach to THR.