We reviewed the long-term results of 126 consecutive total hip arthroplasties performed with cement in eighteen men and 108 women who had an acute fracture of the femoral neck. The patients had a mean age of seventy-five years (range, thirty-nine to eighty-nine years) at the time of the operation and were followed for a minimum of 10.1 years (or until the patient died or had a revision operation) and a maximum of 20.4 years. The median duration of follow-up was 8.8 years for all patients and 15.7 years for the twenty-two patients who were alive at the end of the study period.Six hips (5 per cent) were revised because of aseptic loosening. Survivorship analysis revealed that the probability of survival of the prosthesis without revision (with 95 per cent confidence intervals) was 95 per cent (91 to 99 per cent) at five years, 94 per cent (88 to 98 per cent) at ten years, 89 per cent (79 to 97 per cent) at fifteen years, and 84 per cent (66 to 97 per cent) at twenty years. Of the 118 patients who were alive at the one-year postoperative examination, 117 (99 per cent) had no pain or mild pain and eighty-one (69 per cent) had regained or had an improvement in the preoperative level of function. At the latest follow-up examination, eighty-seven (86 per cent) of the 102 patients who were available still had no pain or only mild pain. Twenty-six patients (21 per cent) had had perioperative medical complications, and twenty-one patients (17 per cent) had had operative complications, including thirteen patients (10 per cent) who had had a dislocation of the hip.Total hip arthroplasty performed in elderly patients for the treatment of an acute fracture of the femoral neck was associated with a higher rate of complications than usually is reported for hemiarthroplasty in such patients. However, the total hip arthroplasty provided good clinical results and was associated with long-term survival of the prosthesis.