An enlarged iliopsoas bursa caused by hip joint disease, such as osteoarthritis, rheumatoid arthritis, synovial chondromatosis, pigmented villonodular synovitis and septic arthritis, but rarely due to osteonecrosis of the femoral head have been documented. We experienced a rare case of an enlarged iliopsoas bursa associated with osteonecrosis of the femoral head, and drained the iliopsoas bursa through an anterior capsule during total hip arthroplasty, using a posterior approach. We describe this rare case, with a review of the literature.