We report a case of idiopathic thrombocytopenic purpura (ITP) accompanied by steroid-induced avascular necrosis of the femoral head in a 68-year-old woman. Extremely low platelet counts of ITP patients prohibit any surgical interventions. Her platelet count was 25,000/μL. We performed a total hip arthroplasty with high-dose immunoglobulin therapy and transfusion of platelet concentrates. Her platelet count increased to 94,000/μL just before the operation. No hemostatic complications were encountered perioperatively, and the postoperative course was uneventful. She left the hospital 20 days after the operation with a T-cane. Her platelet count decreased to 34,000/μL on the day she left the hospital. Three years after the operation, she had no groin pain and could walk without ambulatory assistive devices. We did not observe implant loosening.