The study examined social inequalities in outcomes after primary total hip replacement (THR) for osteoarthritis in patients aged 50 years and over in England based on National Joint Register (NJR) data from 2007 to 2017 with follow-up to 2023. 448,184 patients with a mean age of 70 years (SD 9 years) were analysed, of which 61% were women, according to quintiles of the index of multiple deprivation at the area level. Patients from the most deprived areas had a higher risk of 90-day mortality (adjusted rate ratio RR: 1.25; 95% CI [1.07, 1.46]; risk difference RD: 9 per 10,000), medical complications (RR: 1.26; 95% CI [1.21, 1.32]; RD: 2.79%), 1-year rehospitalization (RD: 0.92–1.36%) and reoperations (RR: 1.23; 95% CI [1.13, 1.33]; RD: 0.31%). They also reported worse patient-reported Oxford Hip Score (adjusted score: −2.97; 95% CI [−3.10, −2.84]). There was no significant difference in the 5-year revision rate (RR: 1.02; 95% CI [0.94, 1.10]; RD: 0.02%). Major limitations include the lack of complete data on patient-reported outcomes and the exclusion of patients with THR in independent or private facilities.