Introduction The aim of the study was to review the results of total hip arthroplasty (THA) in relatively fit and mobile patients with Garden 3 and 4 fractures of the neck of femur.

Materials and methods 42 patients with displaced hip fractures who underwent THA ≥ 3years ago were reviewed. One was lost to follow-up.

Results Average age was 67.17 years (SD-9.4, range 37–80 years) with Male:Female ratio 6:35. Average follow-up was 5.8 years (3–9.6 years). Average Modified Barthel index before the fracture was 18.63 (SD-2.08, range 13–20). Majority were ASA grade II (22 patients). 33 hips were cemented, 1 uncemented and 7 hybrids. Canulated CF-30 femoral stem was most commonly used (33 patients) and acetabular component was Weber cup in most cases (34 patients). 35 hips had metal-on-metal bearing surface and the rest had metal-on-polyethylene. Average hospital stay was 12.5 days (SD-7.84, range 6–43); majority (36) of the patients were discharged home and the rest needed additional rehabilitation. Average post-operative drop in Hb was 2.78 (SD-1.34) and 15 (36.5%) patients needed blood transfusion. Average transfusion was 0.85 units per patient. Complications included: minor wound dehiscence (1), DVT (3), pulmonary embolism (1), dislocation (1), per-operative femur fracture (1), peri-prosthetic fracture (2) and stem loosening (1). 3 hips (7.3%) were revised (loosening 1, peri-prosthetic fractures 2). Average harris hip score at follow-up was 91 (66–100). At final follow-up 24 patients were independently mobile without support, 12 used 1 stick, one used 2 sticks, 3 used a frame and 1 patient was wheelchair bound due to stroke.

Conclusion In relatively fit and mobile patients, we recommend total hip replacement as the primary treatment since it promises better function and pain relief and avoid the drawbacks of internal fixation and hemiarthroplasty.