© 2020 Journal of Rheumatology. All rights reserved. Objective. To assess whether outcomes after primary total hip arthroplasty (THA) differ in systemic sclerosis (SSc). Methods. We used the 1998-2014 US National Inpatient Sample. THA and SSc were identified using procedure and diagnostic codes, respectively. Multivariable-adjusted logistic regression analyses assessed the association of SSc with in-hospital complications (implant infection, revision, transfusion, mortality) post-THA and associated healthcare use (hospital charges, hospital stay, discharge to non-home setting), adjusting for age, sex, race, Deyo-Charlson comorbidity index, primary diagnosis for THA, household income, and insurance payer. Results. Of the 4,116,485 primary THA performed in the United States in 1998-2014, SSc patients made up 0.06% (n = 2672). In multivariable-adjusted analyses, compared to people without SSc, people with SSc had higher adjusted OR (95% CI) of the following post-primary THA: (1) non-home discharge, 1.25 (95% CI 1.03-1.50); (2) hospital stay > 3 days, 1.61 (95% CI 1.35-1.92); (3) transfusion, 1.54 (95% CI 1.28-1.84); and (4) in-hospital revision, 9.53 (95% CI 6.75-13.46). Differences in in-hospital mortality had a nonsignificant trend [2.19 (95% CI 0.99-4.86)]. There were no differences in total hospital charges or implant infection rates. Conclusion. SSc was associated with a higher rate of in-hospital complications and healthcare use after primary THA. Future studies should examine whether pre- or postoperative interventions can reduce the risk of post-THA complications in people with SSc. (First Release April 1 2020;.