Gunshot injuries to the hip can be devastating, leading to posttraumatic arthritis and presenting a surgical challenge at the time of total hip arthroplasty (THA) due to the presence of metallic fragments and damaged soft tissues. However, there are few reports of gunshot-related posttraumatic arthritis. The purpose of this study was to describe the features and report the early outcomes of THA in 4 patients who developed posttraumatic arthritis from gunshot injuries to their hips 2, 10, 18, and 26 years after their initial injury, respectively. All 4 patients underwent successful THA without complications. None of the patients had undergone a revision procedure at a mean 26-month (range, 12-48 months) follow-up. The authors believe that primary THA is a safe and effective procedure to reduce pain and improve function for gunshot-related posttraumatic arthritis in patients in whom nonoperative management failed.