Background: Fracture neck of femur in patients above 60 years represents an important health care issue and the optimal line of treatment and prosthetic replacement remains controversial. The option of primary total hip replacement in patients with fracture neck of femur gives satisfactory functional results in this age group, which arouse the idea of this research to study the short term functional and radiological outcome of THR in cases with fracture neck of femur in patients above 60 years.Materials and methods: 30 cases of elderly active patients above 60 years admitted in the casuality department of Cairo university hospitals were included in our series, patients with pathological fractures and chronic terminal diseases were excluded from our study. Patients were operated after a mean of 4 weeks post fracture due to delayed referral, patient refusal of hospitalization, preoperative preparation from associated co morbidities and implant preparation. All patients were operated upon by THR either cemented cementless or hybrid; all operations were done by regional anesthesia either spinal or epidural anesthesia, all cases were performed by modified Hardinge approach in lateral position; all patients received IV antibiotics in preinduction of anesthesia. Postoperative all patients were allowed to bear weight as tolerated by using a walker the second day post operative, all patients were trained to exercise both hip abductors and flexors to avoid post operative limping. All patients were followed up at 6 weeks, 3months, 6 months and every 6 months after words, patients were examined for HHS and xrays were done in the form of pelvis AP view and the affected hip AP and lateral views to assure the position of the prosthesis any signs of loosening and compared to previous xrays.Results: The results were good in all patients at 3 months, excellent in 23 patients at 6 months and all were excellent in 1 year follow up. Patients were able to ambulate and walk for long distances with no hip pain. The improvement of HHS and function over time was due to improvement in pain, walking distance, support and use of stairs and public transportations, with mean HHS 91.7 at 1 year.Discussion: The results of this research were comparable to internationally published papers and researches, in which THR is preferred than Hemiarthroplasty and fixation to fracture neck of femur in this age group, due to the better functional outcome and lower rates of revision. The rate of complications was comparable favorably with the other published studies and both were better than the published rates for hemiarthroplasty and internal fixation.