Ochronosis and joint destruction are caused by accumulation of homogentisic acid in connective tissues1. Few cases have been reported of patients with severe ochronotic arthroplasty and need of surgical reconstruction with arthroplasty2,3,4. An 80-year-old white woman of Austrian descent presented at our outpatient clinic complaining of year-long pain and reduced range of motion in the right hip joint. Clinical and radiological examination showed severe osteoarthritis of the hip joint. Surgical reconstruction with primary total hip arthroplasty (THA) was indicated. Capsulotomy revealed dark brownish pigmentation of the cartilage of the hip joint. Histology of intracapsular tissue performed intraoperatively showed no signs…