The aim of the study was to review the results of total hip replacement (THR) in relatively fit and mobile patients with Garden 3 and 4 fractures of the neck of femur. Forty-one patients who underwent THR for displaced intracapsular hip fractures from 1993 to 2001 were reviewed. Only those patients with three years or more follow-up were reviewed. Average follow-up was 5.8 years (3-9.6 years). Complications encountered were: minor wound dehiscence (1), DVT (3), pulmonary embolism (1), dislocation (1), per-operative femur fracture (1), periprosthetic fracture following repeat fall (2), stem loosening (1). Average Harris Hip score at follow-up was 91 (66-100). We recommend total hip replacement as the primary treatment in relatively fit and mobile patients with displaced intracapsular fractures of the hip. (Hip International 2005; 15: 33-7).