Background: The objective of this study was to investigate the preoperative risk factors for dissatisfaction after total hip arthroplasty for osteonecrosis of the femoral head.Methods: A total of 71 patients (91 hips) with osteonecrosis of the femoral head who underwent total hip arthroplasty surgery in our hospital were included. The degree of satisfaction was evaluated using a visual analogue scale one year after the total hip arthroplasty. The patients were divided into two groups: the satisfied group (S group; visual analogue scale score > 20 mm) and the dissatisfied group (D group; visual analogue scale score < 20 mm). The results of the preoperative quality-of-life self-assessments, including the Short Form-36 and Japanese Orthopaedic Association Hip Disease Evaluation Questionnaire, were compared between the satisfied and dissatisfied groups. Multivariate analysis was performed to examine the independent preoperative risk factors.Results: There were 49 patients (64 hips) and 22 patients (27 hips) in the S and D groups, respectively. Patient age was significantly higher in the D group, and the movement and mental scores obtained with the Japanese Orthopaedic Association Hip Disease Evaluation Questionnaire and the Mental Component Summary scores of the Short Form-36 were significantly lower. However, there were no between-group differences in the pain score obtained with the Japanese Orthopaedic Association Hip Disease Evaluation Questionnaire and the Physical Component Summary and Role/Social Component Summary scores of the Short Form-36. Multivariate analysis showed that age and mental score obtained with the Japanese Orthopaedic Association Hip Disease Evaluation Questionnaire were independent risk factors.Conclusions: Preoperative age and mental score obtained with the Japanese Orthopaedic Association Hip Disease Evaluation Questionnaire strongly affected satisfaction levels observed one year after total hip arthroplasty in patients with osteonecrosis of the femoral head.