Tehran University of Medical Sciences Journal of Orthopedic and Spine Trauma 2538-2330 12 2 2026 05 18 72 6 Madhuchandra Puttamaregowda Professor, Department of Orthopedics, BGS Global Institute of Medical Sciences, Bengaluru, India Pawankumar Keelara Mahadevappa Professor, Department of Orthopedics, Dr. Chandramma Dayananda Sagar Institute of Medical Education and Research, Dayananda Sagar University, Bengaluru, India Nandeesh Shashidhar Associate Professor, Department of Orthopedics, BGS Global Institute of Medical Sciences, Bengaluru, India Raju Koluru Puttaswamygowda Professor, Department of Orthopedics, BGS Global Institute of Medical Sciences, Bengaluru, India 2025 09 25 2026 05 17 Background: The management of femoral neck fracture in elderly patients above 60 years of age remains controversial. Although internal fixation is one of the surgical options, it is associated with high failure rates due to complications such as non-union andvarus collapse. Hemiarthroplasty also has inherent complications, including acetabular erosion, secondary arthritis, and protrusio acetabuli. Primary total hip arthroplasty (THA) offers a stable hip joint with excellent functional outcomes. Methods: This study was conducted at a tertiary care institute between January 2020 and June 2024. A total of 48 THAs were performed in 47 patients as a primary procedure for femoral neck fracture. All procedures were cemented total hip replacements and were performed by a single surgeon. Preoperative evaluation was carried out using the Harris Hip Score (HHS). Radiological assessment was performed using standard radiological parameters. Results: At the end of the follow-up period, the mean HHS was 86.3 (range: 77-97). Of the 48 hips, 16 demonstrated excellent outcomes (HHS > 90), 27 showed good outcomes (HHS: 80-89), and 5 had fair outcomes (HHS: 70-79). Complications included three cases of superficial infection and four cases of deep vein thrombosis (DVT). Conclusion: Primary THA is an excellent alternative to internal fixation and hemiarthroplasty in the management of femoral neck fracture in elderly patients. The study also suggests that the modified lateral approach is a safer surgical approach in reducing the risk of dislocation.  https://jost.tums.ac.ir/index.php/jost/article/view/718 https://jost.tums.ac.ir/index.php/jost/article/download/718/466